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Cerebral Palsy Anaesthetic Concerns — FRCA Final MCQ

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ModeratePaediatric AnaesthesiaCerebral Palsy Anaesthetic ConcernsFRCA Final

A 7-year-old boy weighing 25 kg has severe spastic cerebral palsy and kyphoscoliosis. He requires dental extractions under general anaesthesia. He is gastrostomy-fed but has frequent regurgitation, a wet cough after feeds and two previous admissions with right lower-lobe pneumonia. His epilepsy is well controlled on sodium valproate, and there is no history of latex sensitivity. Peripheral venous access is difficult. His blood tests show haemoglobin 105 g/L, platelets 180 × 10^9/L, INR 1.0 and vitamin D below 10 nmol/L. Which coexisting problem presents the greatest risk of a serious respiratory complication during induction of anaesthesia?

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Correct answer: D — Gastro-oesophageal reflux with impaired airway protection

The correct answer is D. Frequent regurgitation, a wet cough after feeding and recurrent dependent-lobe pneumonia indicate reflux, bulbar dysfunction and impaired airway protection. These create a substantial risk of regurgitation and pulmonary aspiration during induction. Kyphoscoliosis and an ineffective cough may further reduce respiratory reserve and clearance of aspirated material, so the airway and induction strategy must be individualised accordingly. Difficult venous access requires advance planning but is not the principal respiratory hazard. Breakthrough seizure is less likely when epilepsy is stable and anticonvulsant treatment is continued. Latex precautions are not specifically indicated without a relevant history or recognised high-risk exposure. Severe vitamin D deficiency requires treatment because of impaired bone health but is not the dominant immediate risk during dental anaesthesia.

Reference: National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease in children and young people: diagnosis and management, NG1, Introduction, updated 2019. https://www.nice.org.uk/guidance/ng1/chapter/introduction