Pediatric neurodegenerative disorders and anesthesia considerations

Pediatric neurodegenerative disorders encompass a wide range of conditions that result from progressive damage to cells and nervous system connections that are essential for mobility, coordination, strength, sensation, and cognition. Neurodegenerative diseases affect millions of people worldwide. Neurological disorders are disorders that involve the brain, spinal cord or nerve and muscle. Children with neurological disorders may have disorders such as epilepsy, developmental delay, cerebral palsy, meningitis, genetic/metabolic diseases or diseases of muscle or nerve such as muscular dystrophy or peripheral neuropathy. These illnesses are frequently severe and potentially have long lasting consequences for the affected children. The pathologies most frequently responsible for psycho-physical disorders can be summarized into three groups: collaboration difficulties (autism spectrum disorders, intellectual impairment, phobia); motor dysfunction (cerebral palsy, epilepsy, other brain pathologies, neuromuscular disorders), and craniofacial anomalies (Down syndrome, other genetic syndromes). Due to their clinical history, and the lack of collaboration, in pediatric non-cooperative patients with Special Needs (SN), the anesthesiological risk may result difficult to assess, despite the fact that they meet the criteria of the outpatient management applied for the patient without disabilities. The perioperative management of pediatric patients with psycho-physical disorders with related relational and cognitive problems must be carefully planned, in order to make the entire hospitalization process as comfortable and as less traumatic as possible. General anesthesia is the most suitable type of anesthesia in pediatric patients with Special Needs (SN), although anesthetic complications are more frequent in these patients, mainly due to comorbidities, taken drugs and anatomical peculiarities. Some studies observed no correlation between multiple anesthesia exposures and neurodevelopmental deficits, while others reported that even a single exposure could increase the risk of deficits. An increased risk of developmental or behavioral disorders as the consequence of surgeries requiring general anesthesia was observed. Based on current studies, it is necessary to endeavor to limit the duration and numbers of anesthesia and the dose of anesthetic agents. The evaluation must include history and physical examination pertaining to the conditions requiring special anaesthetic considerations. Early diagnosis and intervention are crucial in managing these neurological disorders in pediatric patients to improve overall quality of life and long-term outcomes.