Author Details

Background and Aims: Sciatic nerve block with femoral nerve block besides its advantages has been used to achieve complete anaesthesia for knee and below knee surgery. The anterior approach has been the most seldom used due to absence of reliable landmarks and technical difficulty. We evaluated the clinical application of the anterior approach to Sciatic nerve block under ultrasound guidance. Methods: This pilot study was conducted in 30 patients aged 18-59 yrs of ASA I-II who underwent knee and below knee surgery. With patient supine and knee externally rotated, sciatic nerve was approached under ultrasound guidance and 15 ml 0.5% bupivacaine along with 10 ml2% lignocaine with adrenaline was injected. Then 10 ml 0.5% bupivacaine&5 ml 2% lignocaine with adrenaline was injected at femoral nerve. Number of attempts, block execution time, onset of complete sensory and motor block, patient satisfaction was measured. Results: Surgical anaesthesia was achieved in 22 patients. 8 patients needed SAB wereas this was a pilot study no comparisons could be made and hence there was no p valueconsidered as failure of procedure. We observed themean number of attempts required to place the needle at site 3.50 ± 1.106; mean block execution time 9.66 ± 3.63 min; mean onset time of sensory block&motor block was 17.83 ± 7.552 min&24.97 ± 3.479 min respectively. 12 (40%) patients were satisfied with the technique used and reported it as excellent. Conclusion: Results of this study show promising outcome in terms of the number of attempts, block execution time, onset of sensory&motor block and patient satisfaction and indicate the need to conduct this study on a larger scale. We conclude that anterior approach is an excellent alternative approach to other approaches for sciatic nerve block especially in patients with multiple injuries.

Keywords

Anterior Approach, Pilot Study, Sciatic Nerve Anatomy, Various Approaches for Block.

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References

Labat G. Its technique and clinical applications, Regional Anaesthesia, 2nd edition. Philadelphia, Saunders Publishers 1924; 45–55

Seymor DG, Prigle R. Post-operative complications in the elderly surgical population. Gerontology 1983; 29:262–70.

Tantry TP, Kadam D, Shetty P, Bhandary S. Combined femoral and sciatic nerve blocks for lower limb anaesthesia in anticoagulated patients with severe cardiac valvular lesions. Indian Journal of Anaesthesia. 2010; 54(3):235–38.

Beck GP. Anterior approach to sciatic nerve block. Anesthesiology 1963; 24: 222–4.

Fuzier R, Fuzier V, Albert N, Barbero C, Villaceque E, Samii K et al. The sciatic nerve block in emergency settings: A comparison between a new anterior and the classic lateral approaches. Med SciMonit 2004; 10(10):563–7.

Dalens B, Tanguy A, Vanneuville G. Sciatic Nerve Blocks in Children: Comparison of the Posterior, Anterior, and Lateral Approaches in 180 Pediatric Patients. Anesthesia Analgesia 1990; 70:131–7.

Ericksen ML, Swenson JD, Pace NL. The anatomic relationship of the sciatic nerve to the lesser trochanter: Implications for anterior sciatic nerve block. Anesthesia Analgesia 2002; 95:1071–4.

Chan V, Nova H, Abbas S, McCartney CJ, Perlas A, Xu DQ. Ultrasound Examination and Localization of the Sciatic Nerve: A Volunteer Study. Anesthesiology 2006; 104:309–14.

Bromage PR. (1978): Description of the Bromage score. Quoted from Owen, M.D. (1998). 0.25% Ropivacaine is similar to 0.25% bupivacaine for labor analgesia using patient control epidural infusion. Anesthesia Analgesia; 1998.

Amin Wafik A, Abou SMO, Saeed Mervat F, Mohammad Sohair F, AbdelHaleem TM, Shabaan EA. Continuous Sciatic Nerve Block: Comparative Study between the Parasacral, Lateral and Anterior Approaches for Lower Limb Surgery. Middle East Journal of Anesthesiology 2010; 20(5):695–702.

Ota J, Sakura S, Hara K, Saito Y. Ultrasound-Guided Anterior Approach to Sciatic Nerve Block: A Comparison with the Posterior Approach. Anesthesia Analgesia 2009; 108:660–5.

Alsatli RA. Comparison of ultrasound-guided anterior versus transgluteal sciatic nerve blockade for knee surgery. Anesthesia Essays and Research 2012 Jan-June; 6(1):29–33.

Dolan J. Ultrasound-guided anterior sciatic nerve block in the proximal thigh: an in-plane approach improving the needle view and respecting fascial planes. British Journal of Anaesthesia 2013 Feb; 110(2):319–20

Chelly JE, Delaunay L. A New Anterior Approach to the Sciatic Nerve Block. Anesthesiology 1999; 91:1655–60.

Van Elstraete AC, Poey C, Lebrun T, Pastureau F. New Landmarks for the Anterior Approach to the Sciatic Nerve Block: Imaging and Clinical Study. Anesthesia Analgesia 2002; 95:214–8.

The Effect of Low-Flow and High-Flow Sevoflurane Anaesthesia on Renal and Liver Function:A Comparative Study

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Authors

Pratibha Jain Shah ¹, Jaya Lalwani ¹, Kriti Pandey ², Kamal Kishore Sahare ², Sumitra Uraon ²

Affiliations
1 Department of Anaesthesia & Critical Care, Pt. JNM Medical College, Raipur, IN
2 Department of Anaesthesia & Critical Care Pt. JNM Medical College, Raipur, IN

Source

Central Journal of ISA, Vol 1, No 1 (2017), Pagination: 26-30

Abstract

Background and Aims: Sevoflurane degradation products can affect liver and renal functions. The study was undertaken to assess the safety of low- flow sevoflurane anaesthesia and high- flow sevoflurane anaesthesia by comparing their effects on renal and liver functions. Material and Methods: The study was conducted in 100 adult patients of American Society of Anaesthesiologists physical status I or II, who underwent elective surgery under general anaesthesia. Patients were selected randomly into two groups to receive either low-flow Sevoflurane (n=50) or high-flow Sevoflurane (n=50) anaesthesia. In all these patients, preoperative renal function tests (RFT)&liver function tests (LFT) were done. RFT included blood urea, serum creatinine, creatinine clearance, urinary protein&LFT included serum bilirubin, SGOT, SGPT, ALP. The patients were induced by intravenous thiopentone [4-7 mg/kg] and succinylcholine [1-2 mg/kg] was given to facilitate tracheal intubation. Trachea was intubated with appropriate size cuffed endotracheal tube. Anaesthesia was maintained with either highflow Sevoflurane with fresh gas flow of 4.5- 7 Liters/minute or low-flow Sevoflurane with fresh gas flow of 1- 3 L/min. Blood samples were collected before operation and at 0 hour, 06 hr, 24 hr, 48 hr&72 hr postoperatively to measure Blood urea, Serum creatinine, Creatinine Clearance (CL), serum bilirubin, Serum Glutamic Oxaloacetic Transaminases (SGOT), Serum Glutamic Pyruvic Transaminases (SGPT), Alkaline phosphatase (ALP). Urine samples were collected at 24 hrs preoperatively&every 24 hrs for up to 72 hrs postoperatively to measure urine protein. Results: This study shows alterations in renal&hepatic functions in low-flow sevoflurane anaesthesia as well as high-flow sevoflurane anaesthesia. However, the alterations in renal&hepatic functions were within upper normal limit in both groups as assessed using conventional measures of hepatic&renal functions. Conclusion: We conclude that there were no statistically significant differences in the hepato-renal function by the effect of low flow and high flow sevoflurane anaesthesia and both seem to be equally safe.

Keywords

High-Flow, Kidney Function, Low-Flow, Liver Function, Sevoflurane.

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References

Smith I, Nathanson M, White PF. Sevoflurane- A long- awaited volatile anesthetic. Br J Anaesth 1996; 76:435–45.

Evers AS, Crowdery CM, Basler JR. General Anaesthetic. In: Goodman LS, Brunton LL, Gilman A, Chabner B, Knollmann BC editors. Goodman & Gilman’s the pharmacological basis of therapeutics. New York, McGraw-Hill, 2011; 546.

Behne M, Wilke HJ, Harder S. Clinical Pharmacokinetics of sevoflurane. Adis 1999; 36:13–26.

Bito H, Ikeda K. Renal and hepatic function in surgical patients after low–flow Sevoflurane or Isoflurane Anaesthesia. Anaesth Analg 1996; 82:173–6.

Hamimy W, Ashour E, Afif M. Effects of Regional Epidural Ropivacaine Anaesthesia on α-Glutathione-S-Transferase: Comparison with Low Flow Sevoflurane and Total Intravenous Propofol Anaesthesia. Journal of Biological Sciences 2004; 4(3):398–404.

Morio M, Fuji K, Satoh N, Imai M, Kawakami U, Mizuno T et al. Reaction of sevoflurane and its degradation products with sodalime: Toxicity of the by products. Anesthesiology 1992; 77:1155.

Kharash ED , Frink EJ Jr, Zager R, Bowdle TA, Artru A, Nogami WM. Assessment of low-flow Sevoflurane & Isoflurane effects on renal function using sensitive markers of tubular toxicity. Anesthesiology 1997; 86:1238–53.

Eger El, Koblin DD, Bowland T, Ionescu P, Laster MJ, Fang Z et al. Nephrotoxicity of Sevoflurane versus Desflurane anesthesia in volunteers. Anaesth Analg 1997; 84:160–8.

Sahin SH, Cinar SO, Paksoy I, Sut N, Oba S. Comparison between low flow Sevoflurane anaesthesia & total intravenous anaesthesia during intermediate-duration surgery: Effects on renal & hepatic toxicity. Hippokratia 2011 Jan-Mar; 15(1):69–74.

Kim JW, Kim JD, Yu SB, Ryu SJ. Comparison of hepatic & renal function between Inhalation anaesthesia with Sevoflurane and Remifentanil and Total Intravenous anaesthesia with Propofol and Remifentanil for thyroidectomy. Korean J Anesthesiol 2013; 64(2):112–6.

Nishiyama T, Yokoyama T, Hanaoka K. Liver and renal function after repeated Sevoflurane or Isoflurane anaesthesia. Can J Anaesth 1998; 45:789–93.

Kharasch ED, Frink EJ, Artru A, Michalowski P, Rooke GA, Nogami W. Long duration low-flow Sevoflurane and Isoflurane effects on post-operative renal and hepatic function. Anaesth Analg 2001; 93:1511–20.

Obata R, Bito H, Ohmura M, Moriwaki G, Ikeuchi Y, Katoh T et al. The effects of prolonged low-flow Sevoflurane anaesthesia on renal and hepatic function. Anaesth Analg 2000; 91:1262–8.

Ebert TJ, Arain SR. Renal responses to low-flow Desflurane, Sevoflurane and Propofol in patients. Anesthesiology 2000; 93:1401–6.

Lin IH, Fan SZ, Chen HM, Lee JJ, Cheng SJ, Chang HH et al. Changes in biomarkers of hepatic & renal function after prolonged general anaesthesia for oral cancer surgery: A cohort comparison between desflurane & Sevoflurane. Journal of Dental Sciences 2013; 8:385–91.

Groudine SB, Fragen RJ, Kharasch ED, Eisenman TS, Frink EJ, McConnel S. Comparison of renal function following anaesthesia with lowflow Sevoflurane and Isoflurane. J Clin Anesth 1999; 11:201–7.

Hanaki C, Fujii K, Morio M, Tashima T. Decomposition of sevoflurane by sodalime. Hiroshima J Med Sci 1987; 36:61.

Frink EJ Jr, Malan TP, Morgan SE, Brown EA, Malcomson M, Gandolfi AJ et al. Quantification of the degradation products of sevoflurane in two CO₂ absorbents during low-flow anesthesia in surgical patients. Anesthesiology 1992; 77:1064.

Anaesthetic Management of Patient with Ellis Van Creveld Syndrome

Abstract Views :318 | PDF Views:90

Authors

Jaya Lalwani ¹, Mukesh Patel ¹, Pratibha Jain Shah ¹

Affiliations
1 Pt. JNM Medical College and DR. BRAM Hospital, Raipur (C.G.), IN

Source

Central Journal of ISA, Vol 1, No 2 (2017), Pagination: 78-80

Abstract

Ellis van Creveld syndrome (EVC syndrome) also known as chondroectodermal or mesoectodermal dysplasia was first described by Richard W.B. Ellisand Simon Van Creveld in 1940. The name chondroectodermal is used because it affects the skeleton (chondro) and skin (ectoderm). In general population the incidence is reported as 7 per 1,000,000 live births. Due to multisystem involvement anaesthesia care is challenging during intraoperative as well as post-operative period. Here we describe the perioperative care of a 14 year old female with EVC syndrome who underwent corrective osteotomy of tibia for genu valgum. Patient was given anaesthesia fitness under American Society of Anesthesiologists as grade 1. We planned to give subarachnoid block to the patient as she had no anomalies involving any other system of body except skeletal system, moreover our patient had normal lumbosacral spine study but thoracic spine scoliosis. Perioperative period was without any adverse events. Postoperative management constitutes adequate analgesia and prevention of adverse cardiorespiratory events.

Keywords

Ellis Van Creveld Syndrome, Genu Valgum.

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References

Ellis RW, Van Creveld S. A syndrome characterized ectodermal dysplasia, polydactyly, chondrodysplasia and congenital morbiuscordis: Report of three cases. Arch Dis Child. 1940; 15(82):65–84. https://doi.org/10.1136/adc.15.82.65.

Prakash M, Swain A, Mishra S, Badhe A. Bronchospasm in a case of Ellis Van Creveld syndrome in a patient posted for corrective osteotomy and elizarove surgery. The Internet Journal of Anesthesiology. 2008; 22(1).

McKusick VA. Ellis-van Creveld syndrome and the Amish. Nat Genet. 2000; 24(3):203–04. https://doi.org/10.1038/73389 PMid:10700162

Howard TD, Guttmacher AE, McKinnon W, Sharma M, McKusick VA, Jobs EN. Autosomal dominant postaxial polydactyly, nail dystrophy, and dental abnormalities map to chromosome 4p16, in the region containing the Ellis van Creveld syndrome locus. Am J Hum Genet. 1997; 61:1405–12. https://doi.org/10.1086/301643 PMid:9399901 PMCid:PMC1716089.

McKusick VA, Egeland JA, Eldridge R, Krusen DE. Dwarfism in the Amish I. The Ellis-van Creveld syndrome. Bull Johns Hopkins Hosp. 1964; 115:306–36. PMid:14217223.

Ruize-Perez VL, Ide SE, Strom TM, et al. Mutatios in a new gene in Ellisvan Creveld syndrome and Weyers acrodentaldysostosis. Nat Genet. 2000; 24(3):283–6. https://doi.org/10.1038/73508 PMid:10700184.

Ruize-Perez VL, Tompson SW, Blair HJ, et al. Mutation in two nonhomologous genes in a head-to-head configuration cause Ellis-van Creveld syndrome. Am J Hum Gen et. 2003; 72(3):728–32. https://doi.org/10.1086/368063.

Tompson SW, Ruize-Perez VL, Blair HJ, et al. Sequencing EVC and EVC2 identifies mutations in two-thirds of Ellis-van Creveld syndrome patients. Hum Genet. 2007; 120(5):663–70. https://doi.org/10.1007/ s00439-006-0237-7 PMid:17024374.

Shamim F, Minai F. Anaesthetic management of patient with Ellis-van Creveld syndrome. Journal of the Pakistan Medical Association. 2008; 58(8):460–2. PMid:18822649.

Bohm N, Fukuda M, Staudt R, Helwig H. Chondroectodermal dysplasia (Ellis-van Creveld Syndrome) with dysplasia of renal medulla and bile ducts. Histopathology. 1978; 2:267–81. https://doi.org/10.1111/j.1365-2559.1978.tb01719.x PMid:700603.

Katsouras C, Thomadakis C, Michalis LK. Cardiac Ellis-van Creveld Syndrome. Int J Card. 2003; 87:315–6. https://doi.org/10.1016/ S0167-5273(02)00289-9.

An Unforeseen Complication of Suctioning an Endotracheal Tube having Murphy's Eye

Abstract Views :282 | PDF Views:84

Authors

Pratibha Jain Shah ¹, Ankit Ray ¹, Samrat Verma ¹

Affiliations
1 Pt J N M Medical College, Raipur (C.G.), IN

Source

Central Journal of ISA, Vol 1, No 2 (2017), Pagination: 81-82

Abstract

Endotracheal Tube (ETT) suction is necessary to clear secretions, to maintain patency, to optimize oxygenation and ventilation in an intubated patient. The goal of ETT suctioning should be to maximize the amount of secretion removed with minimal adverse effects. We report an unusual case of suction catheter impaction while endotracheal suctioning.

Keywords

Endotracheal Tube, Suction.

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References

Jackson GNB, Bartlett R, Yentis SM. Forces required to remove bougies from tracheal tubes. Anaesthesia. 2009; 64:320–2. https://doi.org/10.1111/j.1365-2044.2008.05761.x PMid:19302648.

Sharma PK, Khan RM, Kaul N. An unnoticed broken sheathed metallic stylet in an Endotracheal Tube. SQU MED J. 2010; 10:126–8.

Kubo K, Nakao S, Kawabata Y, Nishimae H, Masuko S, Shingu K. An unusual case of airway obstruction at the tip of an endotrachealtube caused by insertion of a nasogastric tube. J Anesth. 2008; 22:52–4. https://doi.org/10.1007/s00540-007-0563-5 PMid:18306014.

Takrouri MS, Nafakh R, Abbas AA. Suction catheter impaction in preformed nasal endotracheal tube (PNETT) during pediatricdental anesthesiahazard notice. Internet J Anesth. 2008; 22:1.

Gupta A, Mohta A, Kamal G, Bathla S. Impaction of suction catheter – Complication of endotracheal suctioning. Indian J Crit Care Med. 2010; 14:222. https://doi.org/10.4103/0972-5229.76092 PMid:21572759 PMCid: PMC3085229.

Jagannathan N, Pak TY. An unusual complication of endotracheal tube suctioning. J Anesth. 2009; 23:170–1. https://doi.org/10.1007/s00540-008-0707-2 PMid:19234851.

Raut MS, Joshi S, Maheshwari A. Stuck suction catheter in endotracheal tube. Indian J Crit Care Med. 2015; 19:113–5. https://doi.org/10.4103/0972-5229.151020 PMid:25722554 PMCid:PMC4339896.

Dubey PK, Sanjeev OP. Impaction of suction catheter during paediatric anaesthesia. Anaesthesia. 2013; 68:102–18. https://doi.org/10.1111/anae.12104 PMid:23231612.

Peri-Operative Management of Cerebral Palsy: Our Experience

Abstract Views :479 | PDF Views:103

Authors

Pratibha Jain Shah ¹, Pratiksha Agrawal ¹

Affiliations
1 Department of Anesthesiology and Critical Care, Pt. JNM Medical College and BRAM Hospital, Raipur, IN

Source

Central Journal of ISA, Vol 2, No 2 (2018), Pagination: 37-43

Abstract

Cerebral Palsy (CP) is the most common movement disorder in children. Its prevalence ranges from 1-2.5 per 1000 live births. In our hospital, average number of children with CP presenting specially for MRI imaging ranges from 100-150 per year. The clinical picture varies considerably ranging from mild monoplegia with normal intellect to severe spastic quadriplegia with mental retardation. Children with cerebral palsy present with various spastic and dyskinetic movements along with mental retardation, cognitive impairment, sensory loss, seizures, communication and behavioral disturbances, as well as chronic systemic problems and their management requires a multidisciplinary approach. An anesthesiologist plays an active role at various levels ranging from sedation for diagnostic procedures to anesthesia and pain relief for various lifestyle enhancing surgical interventions. Hence, an understanding about the etiopathology, clinical presentation and pharmacological treatment will help the anesthesiologist for hassle-free management during the peri-operative period.

Keywords

Anesthesia, Cerebral Palsy, Pain Management, Peri-Operative Management, Regional Anesthesia.

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References

Wongprasartsuk P, Stevens J. Cerebral palsy and anaesthesia. Paediatr Anaesth. 2002; 12:296-303.

Aker J, Anderson DJ. Update for nurse anesthetists- Part 6- Perioperative care of patients with cerebral palsy. AANA J. 2007; 75:65-73

Flett PJ. Rehabilitation of spasticity and related problems in childhood cerebral palsy. J Paediatr Child Health. 2003; 39(1):6-14. DOI: 10.1046/j.14401754.2003.00082.x.

Shaikh SI, Hegade G. Role of anaesthesiologist in the management of a child with cerebral palsy. Anesth Essays Res. 2017; 11(3):544-549. DOI:10.4103/0259-1162.194569.

Stoelting RK. Antiepileptic drugs, em: Stoelting RK- Pharmacology and physiology in anesthetic practice. 3rd ed. Philadelphia: Lippincott Raven; 1999. p. 506-514.

Anderson KJ, Farmer JP, Brown K. Reversible coma in children after improper baclofen pump insertion. Paediatr Anaesth. 2002; 12:454-460.

Gomar C, Carrero EJ. Delayed arousal after general anesthesia associated with baclofen. Anesthesiology. 1994; 81:1306-7.

Sill JC, Schumacher K, Southorn A, Reuter J, Yaksh TL. Bradycardia and hypotension associated with baclofen used during general anesthesia. Anesthesiology. 1986; 64:255-8.

Fiacchino F, Grandi L, Soliveri P, Carella F, Bricchi M. Sensitivity to vecuronium after botulinum toxin administration. J Neurosurg Anesthesiol. 1997; 9:149-153.

Paranjpe JS, Purohit AP. Upper airway management in a patient with cerebral palsy. Med J DY Patil Univ. 2016; 9:558-9.

Singh Bajwa SJ, Haldar R. Anesthesia for cerebral palsy- Need for meticulous peri operative planning. Med J DY Patil Univ. 2017; 10:602-4.

Kilbaugh TJ, Friess SH, Raghupathi R, Huh JW. Sedation and analgesia in children with developmental disabilities and neurologic disorders. Int J Pediatr. 2010. DOI: 10.1155/2010/189142.

Leet AI, Mesfin A, Pichard C, Launay F, Brintzenhofeszoc K, Levey EB, et al. Fractures in children with cerebral palsy. Journal of paediatric orthopaedics. 2006; 26:624-7.

Choudhry DK, Brenn BR. Bispectral index monitoring: A comparison between normal children and children with quadriplegic cerebral palsy. Anesth Analg. 2002; 95:1582-5.

Akhlaghpoor S, Shabestari AA, Moghdam MS. Low dose of rectal thiopental sodium for pediatric sedation in spiral computed tomography study. Pediatr Int. 2007; 49(3):387-91.

Kim EJ, Jo YY, Kil HK. Optimal sedative dose of propofol to start MRI in children with cerebral palsy. Korean J Anesthesiol. 2011; 61:216-9.

Theroux MC, Brandom BW, Zagnoev M, Kettrick RG, Miller F, Ponce C: Dose response of succinylcholine at the adductor pollicis of children with cerebral palsy during propofol and nitrous oxide anesthesia. Anesth Analg. 1994; 79:761-5

Moorthy SS, Krishna G, Dierdorf SF. Resistance to vecuronium in patients with cerebral palsy. Anaesth Analg. 1991; 73:275-7.

Frei FJ, Haemmerle MH, Brunner R, Kern C. Minimum alveolar concentration for halothane in children with cerebral palsy and severe mental retardation. Anaesthesia. 1997; 52:1056-1060.

Yilbas AA, Ayhan B, Akinci SB, Saricaoglu F, Aypar U. The effect of different end tidal Desflurane concentrations on bispectral index values in normal children and children with cerebral palsy. Turk J Anaesth Reanim. 2013; 41(6):200-5.

Iijima T, Nakamura Z, Ilvao Y et al. The epileptogenic properties of the volatile anesthetics sevoflurane and isoflurane in patients with epilepsy. Anesth Analg. 2000; 91:989-995.

Ogasawara H, Shimodate Y, Isozaki K. Sevoflurane anesthesia for a patient with cerebral palsy. Masui.1990; 39:500-502.

Moore RP, Wester T, Sunder R, Schrock C, Park TS. Peri-operative pain management in children with cerebral palsy: comparative efficacy of epidural vs systemic analgesia protocols. Paediatr Anaesth. 2013 Aug; 23(8):720-725.

Darcey M. Hypothermia in cerebral palsy. Anaesthetic management of patients with cerebral palsy. ATOTW. 196; 2010:1-7.

Liu, Y, Kang, DL, Na, HY. Consequence of dexmedetomidine on emergence delirium following sevoflurane anesthesia in children with cerebral palsy. Int J Clin Exp Med. 2015; 8:16238-16244.

Wass CT, Warner ME, Worrell GA et al. Effect of general anaesthesia in patients with cerebral palsy at the turn of the new millennium: a population-based study evaluating perioperative outcome and brief overview of anaesthetic implications of this coexisting disease. J Child Neurol. 2012; 27:859-866

Malviya S, Terri VL, Burke C, Merkel S, Tail RA. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Pediatric Anesthesia. 2006; 16:258-265.

Boldingh EJ, Monique A, Bruggen JUD, Lankhorst GJ, Bouter LM. Assessing pain in patients with severe cerebral palsy: Development, reliability and validity of a pain assessment instrument for cerebral palsy. Arenphy Med Rehabil. 2004; 85:758-766.

Long LS, Ved S, Koh JL. Intraoperative opioid dosing in children with and without cerebral palsy. Paediatr Anaesth. 2009; 19:513-520.

Brenn BR, Brislin RP, Rose JB. Epidural analgesia in children with cerebral palsy. Can J Anaesth. 1998; 45(12):1156-61.

Piriya KS, Kumar KS, N, Iqbal M, Kumar SP, Sivashanmugham A. Postoperative muscle spasm in a child with cerebral palsy: A case report. J Evol Med Dent Sci. 2014; 3(57):13043-13046. DOI: 10.14260/jemds/2014/3732.

Pedersen LK, Nikolajsen L, Rahbek O, Duch BU, Møller-Madsen B. Epidural analgesia is superior to local infiltration analgesia in children with cerebral palsy undergoing unilateral hip reconstruction. Acta Orthop. 2015; 87(2):176-82.

Muthusamy K, Recktenwall SM, Friesen RM, Zuk J, Gralla J, Miller NH, Cralinkin JL, et al. Effectiveness of an anaesthetic continuous- infusion device in children with cerebral palsy undergoing orthopaedic surgery. J Pediatr Orthop. 2010; 30(8):840-5.

Onal O, Apiliogulları S, Gunduz E, Celik JB, Senaran H. Spinal anaesthesia for orthopaedic surgery in children with cerebral palsy: Analysis of 36 patients. Pak J Med Sci. 2015; 31(1):189-93.

Kim SH, Chun DH, Chang CH, Kim TW, Kim YM, Shin YS. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatric Anaesth. 2011; 21:394-398.

Inal M. Anaesthetic management of a patient with cerebral palsy during caesarean section. Int J Anesthesiol. 2006; 15.

Halemani KR, Basheer S, Ahmmed N. Anesthetic management of parturients with cerebral palsy and polymyositis coming for caesarean section: Two case reports. J Obstet Anaesthcrit Care. 2016; 6:107-8.

Aiudi C, Sharpe E, Arenalt K, Pasteurnak J, Suiggum H. Anaesthetic management of two parturients with cerebral palsy and prior selective dorsal rhizotomy. Int J Obstet Anesth. 2017. DOI: https: //doi.org/10.1016/j.ijoa.2017.12.003

Esa WAS, Toma J, Tetzlaff JE, Barsoum S. Epidural analgesia in labour for a woman with an intrathecal pump. Int J Obstet Anesth. 2009; 18(1):64-6.

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