Anesthetic Consideration in a Cerebral Palsy Patient Undergoing Bilateral Breast Excision Biopsy: A Case Report

Abstract

Cerebral palsy (CP) is a neurodevelopmental disorder associated with a spectrum of motor and systemic impairments that pose unique anesthetic challenges. We describe the perioperative management of a 20-year-old woman with spastic quadriplegic CP undergoing bilateral breast excision biopsy under general anesthesia. Her medical history included severe thoracic scoliosis with prior posterior spinal instrumentation and moderate restrictive lung disease. She also had a previous history of postoperative nausea and vomiting (PONV). Preoperative assessment identified high aspiration risk, and she received appropriate aspiration and antiemetic prophylaxis. Intravenous access was technically difficult due to severe limb contractures, requiring multiple attempts. Anesthesia was induced with the modified rapid sequence technique using fentanyl, propofol, and rocuronium. Sevoflurane was maintained at a low minimum alveolar concentration (0.7–0.8) to mitigate emetogenic risk, and multimodal analgesia included intravenous ketamine, paracetamol, and local infiltration. Intraoperative hemodynamics remained stable. Copious oropharyngeal secretions were noted during emergence and were adequately suctioned to minimize aspiration risk. One self-limiting episode of vomiting occurred postoperatively. The patient exhibited emotional lability but was otherwise stable, with no signs of respiratory distress or aspiration. She was discharged without complications. This case underscores the importance of meticulous perioperative planning in patients with CP, including strategies for aspiration prophylaxis, vascular access, PONV prevention, secretion management, and tailored multimodal analgesia. Clinicians must anticipate atypical responses and behavioral variability during recovery. A structured, individualized approach involving preoperative preparation, intraoperative vigilance, and extended postoperative monitoring can help optimize safety and outcomes in this high-risk population.