Postoperative Care of the Cerebral Palsy Patient

  • Hussam Alharash
  • Maxine Ames
  • Smitha Mathew
  • David Rappaport
  • Nicholas SlamonEmail author
Living reference work entry

Later version available View entry history


Many patients with cerebral palsy (CP) will undergo surgery at some point, often orthopedic procedures. Patients with more severe involvement (GMFCS IV and V) are most likely to need surgery and are also the group most likely to have other medical conditions that can complicate their surgery and post-op recovery. This chapter addresses the most common of these complications, including how to assess and treat them.


Cerebral Palsy Postoperative Respiratory complications Thromboembolism Fever 


  1. Abousamra O, Nishnianidze T, Rogers KJ, Er MS, Sees JP, Dabney KW et al (2016) Risk factors for pancreatitis after posterior spinal fusion in children with cerebral palsy. J Pediatr Orthop Part B 27(2):163–167Google Scholar
  2. Arvedson J, Rogers B, Buck G, Smart P, Msall M (1994) Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol 28(2–3):173–181CrossRefPubMedGoogle Scholar
  3. Badawy SM, Rychlik K, Sharathkumar AA (2016) Current practice of pharmacological thromboprophylaxis for prevention of venous thromboembolism in hospitalized children: a survey of pediatric hemostasis and thrombosis experts in North America. J Pediatr Hematol Oncol 38(4):301–307CrossRefPubMedGoogle Scholar
  4. Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110(5):1139–1157CrossRefPubMedGoogle Scholar
  5. Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CHC et al (2009) Timing and impact of infections in acute pancreatitis. Br J Surg 96(3):267–273CrossRefPubMedGoogle Scholar
  6. Blackmer AB, Feinstein JA (2016) Management of sleep disorders in children with neurodevelopmental disorders: a review. Pharmacotherapy 36(1):84–98CrossRefPubMedGoogle Scholar
  7. Bonadio WA (1993) Defining fever and other aspects of body temperature in infants and children. Pediatr Ann 22(8):467–473CrossRefPubMedGoogle Scholar
  8. Brenn BR, Theroux MC, Dabney KW, Miller F (2004) Clotting parameters and thromboelastography in children with neuromuscular and idiopathic scoliosis undergoing posterior spinal fusion. Spine 29(15):E310–E314CrossRefPubMedGoogle Scholar
  9. Cameron S et al (2015) Early mobilization in the critical care unit: a review of adult and pediatric literature. J Crit Care 30(4):664–672. Scholar
  10. Casas M, Kenny D, McPherson K (1994) Swallowing/ventilation interactions during oral swallow in normal children and children with cerebral palsy. Dysphagia 9(1):40–46CrossRefPubMedGoogle Scholar
  11. Caselli TB, Lomazi EA, Montenegro MAS, Bellomo-Brandão MA (2017) Assessment of nutritional status of children and adolescents with spastic quadriplegic cerebral palsy. Arq Gastroenterol 54(3):201–205CrossRefPubMedGoogle Scholar
  12. Cashman JN, Dolin SJ (2004) Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth 93(2):212–223CrossRefPubMedGoogle Scholar
  13. Colver A (2010) Why are children with cerebral palsy more likely to have emotional and behavioural difficulties? Dev Med Child Neurol 52(11):986CrossRefPubMedGoogle Scholar
  14. Cuesta M, Thompson C (2015) The relevance of hyponatraemia to perioperative care of surgical patients. Surgeon 13(3):163–169CrossRefPubMedGoogle Scholar
  15. de Jonge JC, Melis GI, Gebbink TA, de Kort GAP, Leijten FSS (2014) Safety of a dedicated brain MRI protocol in patients with a vagus nerve stimulator. Epilepsia 55(11):e112–e115CrossRefPubMedGoogle Scholar
  16. Dellinger RP et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Critical Care Medicine 41:580–637. Scholar
  17. Edler A, Murray DJ, Forbes RB (2003) Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease: is there an increased risk? Pediatric Anesthesia 13:818–822. Scholar
  18. Epstein NE (2014) A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures. Surg Neurol Int 5(Suppl 3):S66–S73. Scholar
  19. Foster T, Rai AIK, Weller RA, Dixon TA, Weller EB (2010) Psychiatric complications in cerebral palsy. Curr Psychiatry Rep 12(2):116–121CrossRefPubMedGoogle Scholar
  20. Garibaldi RA, Brodine S, Matsumiya S, Coleman M (1985) Evidence for the non-infectious etiology of early postoperative fever. Infect Control 6(07):273–277CrossRefPubMedGoogle Scholar
  21. Gloor B, Müller CA, Worni M, Martignoni ME, Uhl W, Büchler MW (2001) Late mortality in patients with severe acute pancreatitis. Br J Surg 88(7):975–979CrossRefPubMedGoogle Scholar
  22. Gregersen M, Damsgaard EM, Borris LC (2015) Blood transfusion and risk of infection in frail elderly after hip fracture surgery: the TRIFE randomized controlled trial. Eur J Orthop Surg Traumatol Orthop Traumatol 25(6):1031–1038CrossRefGoogle Scholar
  23. Himmelmann K, Sundh V (2015) Survival with cerebral palsy over five decades in western Sweden. Dev Med Child Neurol 57(8):762–767. Scholar
  24. Hollway JA, Aman MG (2011) Pharmacological treatment of sleep disturbance in developmental disabilities: a review of the literature. Res Dev Disabil 32(3):939–962CrossRefPubMedGoogle Scholar
  25. Humes DJ, Nordenskjöld A, Walker AJ, West J, Ludvigsson JF (2015) Risk of venous thromboembolism in children after general surgery. J Pediatr Surg 50(11):1870–1873CrossRefPubMedGoogle Scholar
  26. Kim S-J, Sabharwal S (2014) Risk factors for venous thromboembolism in hospitalized children and adolescents: a systemic review and pooled analysis. J Pediatr Orthop Part B 23(4):389–393CrossRefGoogle Scholar
  27. Koff SA (1983) Estimating bladder capacity in children. Urology 21(3):248CrossRefPubMedGoogle Scholar
  28. Kubicka ZJ, Limauro J, Darnall RA (2008) Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure? Pediatrics 121(1):82–88CrossRefPubMedGoogle Scholar
  29. Laupland KB, Zygun DA, Davies HD, Church DL, Louie TJ, Doig CJ (2002) Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J Crit Care 17(1):50–57CrossRefPubMedGoogle Scholar
  30. Lélis ALPA, Cardoso MVLM, Hall WA (2016) Sleep disorders in children with cerebral palsy: an integrative review. Sleep Med Rev 30:63–71CrossRefPubMedGoogle Scholar
  31. Mandelli M, Tognoni G, Garattini S (1978) Clinical pharmacokinetics of diazepam. Clin Pharmacokinet 3(1):72–91CrossRefPubMedGoogle Scholar
  32. McKenzie SG (1983) Introduction to the pharmacokinetics and pharmacodynamics of benzodiazepines. Prog Neuro-Psychopharmacol Biol Psychiatry 7(4–6):623–627CrossRefGoogle Scholar
  33. Mikalsen IB, Davis P, Øymar K (2016) High flow nasal cannula in children: a literature review. Scand J Trauma Resusc Emerg Med 24(1):93CrossRefPubMedGoogle Scholar
  34. Misurac J et al (2013) Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. J Pediatr 162(6):1153–1159. Scholar
  35. Monagle P, Chan AKC, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U et al (2012) Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: american College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e737S–e801SCrossRefPubMedGoogle Scholar
  36. Moriichi A, Kawaguchi A, Kobayashi Y, Yoneoka D, Ota E (2016) The effectiveness and safety of various methods of post-pyloric feeding tube placement and verification in infants and children. Kawaguchi A ed. Cochrane Database Syst RevGoogle Scholar
  37. Munin MC, Rudy TE, Glynn NW, Crossett LS, Rubash HE (1998) Early inpatient rehabilitation after elective hip and knee arthroplasty. JAMA 279(11):847–852. Scholar
  38. Munro H et al (2002) Low-dose ketorolac improves analgesia and reduces morphine requirements following posterior spinal fusion in adolescents. Can J Anesth 49(5):461–466CrossRefPubMedGoogle Scholar
  39. Mustard RA (1987) C-reactive protein levels predict postoperative septic complications. Arch Surg 122(1):69CrossRefPubMedGoogle Scholar
  40. Newman CJ, O’Regan M, Hensey O (2006) Sleep disorders in children with cerebral palsy. Dev Med Child Neurol 48(7):564–568CrossRefPubMedGoogle Scholar
  41. Nguyen M, Tharani S, Rahmani M, Shapiro M (2014) A review of the use of clonidine as a sleep aid in the child and adolescent population. Clin Pediatr (Phila) 53(3):211–216CrossRefGoogle Scholar
  42. Noble-Jamieson CM, Heckmatt JZ, Dubowitz V, Silverman M (1986) Effects of posture and spinal bracing on respiratory function in neuromuscular disease. Arch Dis Child 61(2):178–181CrossRefPubMedGoogle Scholar
  43. Panella JJ (2016) Preoperative Care of Children: strategies from a child life perspective. AORN J 104(1):11–22CrossRefPubMedGoogle Scholar
  44. Patel MI, Watts W, Grant A (2001) The optimal form of urinary drainage after acute retention of urine. BJU Int 88(1):26–29CrossRefPubMedGoogle Scholar
  45. Peltola V, Mertsola J, Ruuskanen O (2006) Comparison of total white blood cell count and serum C-reactive protein levels in confirmed bacterial and viral infections. J Pediatr 149(5):721–724CrossRefPubMedGoogle Scholar
  46. Pugin J, Auckenthaler R, Mili N, Janssens J-P, Lew PD, Suter PM (1991) Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. American Review of Respiratory Disease 143(5_pt_1):1121–1129CrossRefPubMedGoogle Scholar
  47. Raffini L, Huang Y-S, Witmer C, Feudtner C (2009) Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics 124(4):1001–1008CrossRefPubMedGoogle Scholar
  48. Reddihough D, Baikie G, Walstab J (2001) Cerebral palsy in Victoria, Australia: mortality and causes of death. J Paediatr Child Health 37(2):183–186. Scholar
  49. Robinson AA, Malow BA (2013) Gabapentin shows promise in treating refractory insomnia in children. J Child Neurol 28(12):1618–1621CrossRefPubMedGoogle Scholar
  50. Schlefman A, Rappaport DI, Adams-Gerdts W, Stubblefield SC (2016) Brief report: healing touch consults at a tertiary care Children’s hospital. Hosp Pediatr 6(2):114–118CrossRefPubMedGoogle Scholar
  51. Schulman D, Palmert MR, Kemp SF (2007) Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 119(2):484–494 Retrieved 10 Oct 2017CrossRefGoogle Scholar
  52. Seddon PC, Khan Y (2003) Respiratory problems in children with neurological impairment. Arch Dis Child 88(1):75–78. Scholar
  53. Singhi P, Jagirdar S, Khandelwal N, Malhi P (2003) Epilepsy in children with cerebral palsy. J Child Neurol 18(3):174–179CrossRefPubMedGoogle Scholar
  54. Soylu OB, Unalp A, Uran N, Dizdarer G, Ozgonul FO, Conku A et al (2008) Effect of nutritional support in children with spastic quadriplegia. Pediatr Neurol 39(5):330–334CrossRefPubMedGoogle Scholar
  55. Strunden MS, Heckel K, Goetz AE, Reuter DA (2011) Perioperative fluid and volume management: physiological basis, tools and strategies. Ann Intensive Care 1:2CrossRefPubMedGoogle Scholar
  56. Sun Z, Sessler DI, Dalton JE, Devereaux PJ, Shahinyan A, Naylor AJ et al (2015) Postoperative hypoxemia is common and persistent: a prospective blinded observational study. Anesth Analg 121(3):709–715CrossRefPubMedGoogle Scholar
  57. Tenner S, Baillie J, De Witt J, Vege SS, American College of Gastroenterology (2013) American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 108(9):1400–1415, 1416CrossRefPubMedGoogle Scholar
  58. Tsao GJ, Messner AH, Seybold J, Sayyid ZN, Cheng AG, Golianu B (2015) Intraoperative acupuncture for posttonsillectomy pain: a randomized, double-blind, placebo-controlled trial. Laryngoscope 125(8):1972–1978CrossRefPubMedGoogle Scholar
  59. Veugelers R, Benninga MA, Calis EAC, Willemsen SP, Evenhuis H, Tibboel D et al (2010) Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Dev Med Child Neurol 52(9):e216–e221CrossRefPubMedGoogle Scholar
  60. Wilkinson DJ, Baikie G, Berkowitz RG, Reddihough DS (2006) Awake upper airway obstruction in children with spastic quadriplegic cerebral palsy. J Paediatr Child Health 42(1–2):44–48. Scholar
  61. Woods BI, Rosario BL, Chen A, Waters JH, Donaldson W, Kang J et al (2013) The association between perioperative allogeneic transfusion volume and postoperative infection in patients following lumbar spine surgery. J Bone Joint Surg Am 95(23):2105–2110CrossRefPubMedGoogle Scholar
  62. Working Group IAP/APA Acute Pancreatitis Guidelines (2013) IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatol Off J Int Assoc Pancreatol IAP Al 13(4 Suppl 2):e1–e15Google Scholar
  63. Wu BU, Banks PA (2013) Clinical management of patients with acute pancreatitis. Gastroenterology 144(6):1272–1281CrossRefPubMedGoogle Scholar
  64. Yeung RSW, Buck JR, Filler RM (1982) The significance of fever following operations in children. J Pediatr Surg 17(4):347–349CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Hussam Alharash
    • 1
  • Maxine Ames
    • 1
  • Smitha Mathew
    • 1
  • David Rappaport
    • 1
  • Nicholas Slamon
    • 1
    Email author
  1. 1.Critical Care Division, Department of PediatricsNemours, AI DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  • Steven J. Bachrach
    • 2
    • 3
  1. 1.Nemours Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Department of Pediatrics (Emeritus)Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  3. 3.Sidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaUSA

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