piperidines and Cerebral-Palsy

Salivary drooling is a common and debilitating problem in cerebral palsy (CP). We hypothesised that gastro-oesophageal reflux (GOR) may exacerbate drooling by stimulation of the oesophago-salivary reflex. The aim of our study was to assess the role of GOR in children with CP and severe drooling. Twenty-four children with CP and severe drooling underwent oesophageal pH monitoring (N = 23) or oesophagoscopy (N = 1). Nine had pathological GOR and were enrolled in a double blinded, placebo controlled cross-over trial of medical antireflux therapy (ranitidine plus cisapride) versus placebo. Drooling was measured by semi-quantitative observation (drooling quotient) and a questionnaire-based scoring system (rated by the child's caregivers). Mean drooling quotients and scores for drooling severity and frequency were not significantly different between active medication and placebo. In our study, treatment of pathological GOR did not improve salivary drooling in children with CP.

Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Cisapride; Esophagus; Female; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Hydrogen-Ion Concentration; Male; Parasympathomimetics; Piperidines; Ranitidine; Salivation; Severity of Illness Index; Sialorrhea

Here, we report successful anesthetic management of posterior cervical spinal fusion utilizing block of the frontal nerve, the greater occipital nerve, and the superficial cervical plexus in a patient with athetoid cerebral palsy. A 69-year-old woman (height 157 cm; weight 33 kg) with athetoid cerebral palsy was scheduled to undergo posterior cervical spinal fusion for cervical spondylotic myelopathy. After induction of general anesthesia, we performed tracheal intubation using the Pentax-AWS Airwayscope with a thin Intlock. After tracheal intubation, we used ropivacaine for the frontal nerve, greater occipital nerve, and superficial cervical plexus block. Anesthetic maintenance was performed with total intravenous anesthesia utilizing propofol and remifentanil. Continuous administration of dexmedetomidine was started during operation. Following surgery, smooth spontaneous ventilation was observed following uneventful extubation. No significant pain and no athetoid movement were observed under continuous administration of dexmedetomidine.

Topics: Aged; Amides; Cerebral Palsy; Cervical Plexus; Cervical Plexus Block; Cervical Vertebrae; Cranial Nerves; Facial Nerve; Female; Humans; Nerve Block; Piperidines; Propofol; Remifentanil; Ropivacaine; Spinal Fusion

Cisapride was used to treat gastro-oesophageal reflux in seven children with neurodevelopmental disorders and in 15 children who were neurologically normal. 24-hour lower-oesophageal pH monitoring was carried out before and after treatment. The neurologically normal group had a statistically significant decrease after treatment in percentage time pH less than 4, but children with neurological abnormalities did not have a comparable improvement in reflux scores.

Topics: Acetylcholine; Brain Damage, Chronic; Cerebral Palsy; Child; Child, Preschool; Cisapride; Down Syndrome; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Infant; Myenteric Plexus; Piperidines; Serotonin Antagonists

Topics: Cerebral Palsy; Child; Child, Preschool; Chlorpromazine; Epilepsy; Epilepsy, Absence; Glutamates; Humans; Infant; Infant, Newborn; Intellectual Disability; Muscles; Piperidines; Pyridoxine; Reserpine; RNA; Spasms, Infantile

Topics: Cerebral Palsy; Child; Child, Preschool; Chlorpromazine; Humans; Infant; Infant, Newborn; Mephenesin; Movement Disorders; Muscles; Piperidines; Reserpine; Vitamin B Complex

Topics: Acetylcholine; Atropine; Cerebral Palsy; Child; Child, Preschool; Chlorpromazine; Hearing Disorders; Humans; Infant; Infant, Newborn; Mephenesin; Muscles; Parasympatholytics; Piperidines; Procaine; Pyridoxine; Speech Disorders; Thiamine; Vision, Ocular; Vitamin B 12