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O'Brien EM, Stricker PA, Harris KA, Liu H, Griffis H, Muhly WT. Perioperative Management and Outcomes in Patients With Autism Spectrum Disorder: A Retrospective Cohort Study. Anesth Analg 2024; 138:438-446. [PMID: 37010953 DOI: 10.1213/ane.0000000000006426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurocognitive disorder characterized by impairments in communication and socialization. There are little data comparing the differences in perioperative outcomes in children with and without ASD. We hypothesized that children with ASD would have higher postoperative pain scores than those without ASD. METHODS Pediatric patients undergoing ambulatory tonsillectomy/adenoidectomy, ophthalmological surgery, general surgery, and urologic procedures between 2016 and 2021 were included in this retrospective cohort study. ASD patients, defined by International Classification of Diseases-9/10 codes, were compared to controls utilizing inverse probability of treatment weighting based on surgical category/duration, age, sex, race and ethnicity, anesthetizing location, American Society of Anesthesiology physical status, intraoperative opioid dose, and intraoperative dexmedetomidine dose. The primary outcome was the maximum postanesthesia care unit (PACU) pain score, and secondary outcomes included premedication administration, behavior at induction, PACU opioid administration, postoperative vomiting, emergence delirium, and PACU length of stay. RESULTS Three hundred thirty-five children with ASD and 11,551 non-ASD controls were included. Maximum PACU pain scores in the ASD group were not significantly higher than controls (median, 5; interquartile range [IQR], 0-8; ASD versus median, 5; IQR, 0-8 controls; median difference [95% confidence interval {CI}] of 0 [-1.1 to 1.1]; P = .66). There was no significant difference in the use of premedication (96% ASD versus 95% controls; odds ratio [OR], 1.5; [95% CI, 0.9-2.7]; P = .12), but the ASD cohort had significantly higher odds of receiving an intranasal premedication (4.2% ASD versus 1.2% controls; OR, 3.5 [95% CI, 1.8-6.8]; P < .001) and received ketamine significantly more frequently (0.3% ASD versus <0.1% controls; P < .001). Children with ASD were more likely to have parental (4.9% ASD versus 1.0% controls; OR, 5 [95% CI, 2.1-12]; P < .001) and child life specialist (1.3% ASD versus 0.1% controls; OR, 9.9 [95% CI, 2.3-43]; P < .001) presence at induction, but were more likely to have a difficult induction (11% ASD versus 3.4% controls; OR, 3.42 [95% CI, 1.7-6.7]; P < .001). There were no significant differences in postoperative opioid administration, emergence delirium, vomiting, or PACU length of stay between cohorts. CONCLUSIONS We found no difference in maximum PACU pain scores in children with ASD compared to a similarly weighted cohort without ASD. Children with ASD had higher odds of a difficult induction despite similar rates of premedication administration, and significantly higher parental and child life specialist presence at induction. These findings highlight the need for future research to develop evidence-based interventions to optimize the perioperative care of this population.
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Affiliation(s)
- Elizabeth M O'Brien
- From the Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul A Stricker
- From the Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen A Harris
- From the Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hongyan Liu
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather Griffis
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wallis T Muhly
- From the Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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IMOVE-An Intuitive Concept Mobility Systems for Perioperative Transfer and Induction of Anaesthesia for Special Needs Children. SENSORS 2020; 20:s20174901. [PMID: 32872602 PMCID: PMC7506866 DOI: 10.3390/s20174901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022]
Abstract
Children with autistic spectrum disorder (ASD) often exhibit uncontrollable disruptive behaviour during transfer to the operating room and operating table and at the induction of anaesthesia (sleep). This process often involves the physical restraining of children. These children are then lifted onto the operating table by healthcare staff after being anaesthetized. This predisposes children to fall risk and hospital staff to musculoskeletal injuries. We developed two concept mobility devices, IMOVE-I and -II, based on robotics systems comprising of restraint modules and multi-positional modality (sitting, supine, Trendelenburg). The aim was to intuitively secure children to facilitate the safe induction of sleep and ease of transfer onto operating tables upon sleep. IMOVE-I loads the child in standing position using a dual arm restraint module that is activated by trained healthcare staff. IMOVE-II loads the child in the sitting position by motivating the self-application of restraints. Opinions were obtained from 21 operating theatre healthcare staff with experience in the care of ASD children and parents with ASD children. The mean satisfaction rating of IMOVE-I was 5.62 (95% CI 5.00, 6.27) versus 8.10 (95% CI 7.64, 8.55) in IMOVE-II, p < 0.001. IMOVE-II is favoured over IMOVE-I in system operation and safety, ease of use and module functionality.
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Selvey P, Stypulkowski K, Waisbren S. Surgical management of the patient living with autism. Surg Open Sci 2020; 1:90-96. [PMID: 32754699 PMCID: PMC7391914 DOI: 10.1016/j.sopen.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022] Open
Abstract
Background Although 1 in 59 children currently born are diagnosed with autism spectrum disorder (ASD), little is known on how to best manage those patients who require surgical intervention. The purpose of this study is to (1) investigate the best care strategies for surgical patients living with autism spectrum disorder (2) provide recommendations on how to apply those strategies to clinical practice. Methods A literature review was conducted to investigate the best clinical practices for optimizing surgical care for individuals living with autism spectrum disorder. Relevant articles were selected and examined, and individual references from those articles were manually searched using Ovid Medline and Google Scholar. Results The wide spectrum of symptoms associated with autism spectrum disorder pose unique challenges for surgical management. Early coordination with the patient and family optimizes the development of an effective care plan. Strategies include identifying triggers for anxiety as well as soothing mechanisms, performing surgery in the morning, completing preoperative paperwork prior to surgery, choosing appropriate analgesia and anxiolytics, and fast resumption of normal routines. Based on these findings a surgical checklist was created to aid in treating the patient with autism spectrum disorder. The checklist provides insight into navigating the surgical experience and emphasizes planning surgical interventions to most effectively fit individual patient needs. Conclusion The surgical treatment of those living with autism spectrum disorder poses unique challenges for the health care team. The widespread adoption of such individualized approaches encompassing pre/intra/post-operative will become more important as these children grow into adults with increased needs for surgical services. Early coordination optimizes development of an effective care plan. Identifying triggers for anxiety as well as soothing mechanisms can be helpful. Performing surgery first in the morning decreases deviation from normal routines. Completing preoperative paperwork prior to surgery reduces surgical day work. Choosing appropriate analgesia and anxiolytics assists in surgical interventions.
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Affiliation(s)
- Paige Selvey
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States
| | - Katie Stypulkowski
- University of Colorado Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States
| | - Steven Waisbren
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.,Minneapolis VA Health Care System, 1 Veterans Drive Ste 2J, Minneapolis, MN 55417, United States
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Taghizadeh N, Heard G, Davidson A, Williams K, Story D. The experiences of children with autism spectrum disorder, their caregivers and health care providers during day procedure: A mixed methods study. Paediatr Anaesth 2019; 29:927-937. [PMID: 31448870 DOI: 10.1111/pan.13689] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 04/25/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autism Spectrum Disorder is now diagnosed in more than 1% of children in Australia and USA. Children with autism spectrum disorder may have additional health care needs, require more specialized services for their health care, or experience more difficulties during hospital attendance. Customized care for these children may assist in decreasing potentially challenging behaviours during hospitalization. The purpose of this study was to explore the experiences of children with autism spectrum disorder and their caregivers during attendance for day procedures in two hospitals in Melbourne, Australia. Further, the perceptions of their health care providers were explored. METHODS Twenty-nine participants, including 14 health care providers and 15 caregivers of children with autism spectrum disorder, were interviewed within 72 hours of their day procedure attendance at the Royal Children's Hospital and the Royal Dental Hospital in Melbourne, Australia. Interviews were recorded digitally, then transcribed and coded. Mixed quantitative and qualitative methods (content analysis) were used. RESULTS Hospital attendance was often stressful. Participants identified a number of facilitating factors including good communication, clear explanations, and friendly attitudes of staff. Flexibility and individualized care of patients (such as avoiding unnecessary blood pressure measurements, and not changing into hospital gowns) were valued. Supportive aids (such as computers or special interest objects), use of social stories, and giving premedication were all considered helpful. Perceived barriers to care included prolonged waiting times for operation date as well as waiting on the day of operation, lack of private space, lack of noninvasive equipment such as cutaneous infrared thermometers, poor communication, and inadequate training of staff about autism spectrum disorder. CONCLUSION Providing optimal care for children with autism spectrum disorder requires a multifaceted approach that may require changes to hospital work flow, staff training, better use of aids (such as tablet computers and social stories), and premedication. Good communication and flexibility are key areas of importance.
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Affiliation(s)
- Neda Taghizadeh
- Anesthesia Trial Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Anesthesia, Royal Dental Hospital, Carlton, Victoria, Australia
| | - Gaylene Heard
- Department of Anesthesia, Royal Dental Hospital, Carlton, Victoria, Australia.,Department of Anesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Parkville, Victoria, Australia.,Department of Anesthesia and Acute Pain Medicine, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Andrew Davidson
- Anesthesia Trial Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Anesthesia and Pain Management, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katrina Williams
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Neurodevelopment and Disability Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Developmental Disability and Rehabilitation Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David Story
- Department of Anesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Parkville, Victoria, Australia
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Abulebda K, Louer R, Lutfi R, Ahmed SS. A Comparison of Safety and Efficacy of Dexmedetomidine and Propofol in Children with Autism and Autism Spectrum Disorders Undergoing Magnetic Resonance Imaging. J Autism Dev Disord 2019; 48:3127-3132. [PMID: 29680960 DOI: 10.1007/s10803-018-3582-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Children with autism and autism spectrum disorders have a high incidence of neurologic comorbidities. Consequently, evaluation with magnetic resonance imaging (MRI) is deemed necessary. Sedating these patients poses several challenges. This retrospective study compared the efficacy and safety of dexmedetomidine to propofol in sedating autistic patients undergoing MRI. There were 56 patients in the dexmedetomidine group and 49 in the propofol group. All of the patients successfully completed the procedure. Recovery and discharge times were significantly lower in the propofol group, while the dexmedetomidine group maintained more stable hemodynamics. Both propofol and dexmedetomidine proved to be adequate and safe medications in the sedation of autistic children undergoing MRI.
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Affiliation(s)
- Kamal Abulebda
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Phase 2, Room 4900, Indianapolis, IN, 46202, USA.
| | - Ryan Louer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Riad Lutfi
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Phase 2, Room 4900, Indianapolis, IN, 46202, USA
| | - Sheikh Sohail Ahmed
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Phase 2, Room 4900, Indianapolis, IN, 46202, USA
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Whippey A, Bernstein LM, O’Rourke D, Reddy D. Enhanced perioperative management of children with autism: a pilot study. Can J Anaesth 2019; 66:1184-1193. [DOI: 10.1007/s12630-019-01410-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/22/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022] Open
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Brendt P, Mathews A, Greenberg R, Arnold M. Autistic Man Falling Through the Cracks: Advanced Patient Transport and the "Pop-up" Recovery Ward. PREHOSP EMERG CARE 2018; 23:578-579. [PMID: 30501448 DOI: 10.1080/10903127.2018.1555296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Royal Flying Doctor Service was tasked to relocate a 19 year-old autistic patient with severe social anxiety, agoraphobia, and morbid obesity from one residential location to another. The retrieval team was confronted with two main challenges: 1) Continuous risk elevation in an elective patient transportation as distinct from other urgent prehospital transfers of mental health patients; and 2) prehospital ketamine/propofol sedation of an aggressive/combative patient with recovery from sedation in a private property. The transfer accomplished the successful relocation of the patient.
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Brown JJ, Gray JM, Roback MG, Sethuraman U, Farooqi A, Kannikeswaran N. Procedural sedation in children with autism spectrum disorders in the emergency department. Am J Emerg Med 2018; 37:1404-1408. [PMID: 30528052 DOI: 10.1016/j.ajem.2018.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED. METHODS We performed a retrospective chart review of children with ASD who underwent sedation at two tertiary care EDs between January 2009-December 2016. Data were collected on children 1-18 years of age with ASD who were sedated in the ED. RESULTS There were 6020 ED visits by children with ASD, 126 (2.1%) of whom received sedation. The most frequent indications for sedation were laceration repair (24.6%), incision and drainage (17.5%), diagnostic imaging (14.3%), and physical examination (11.9%). The most common sedatives used were ketamine (50.8%) and midazolam (50.8%). Ketamine was most commonly given intravenously (71.9%), while midazolam was usually given intranasally (71.9%). Procedures could not be completed in 4 (3.2%) patients, and adverse events were noted in 23 (18.3%) patients. Only four (3.2%) patients required supplemental oxygenation, and one received positive pressure ventilation. CONCLUSIONS Children with autism in the ED commonly received sedation; one in four of which were for non-painful diagnostic procedures or physical examination. Over one-third received sedation via a non-parenteral route for intended minimal sedation. Sedative medication dosing and observed adverse events were similar to those reported previously in children without ASD. Emergency providers must be prepared to meet the unique sedation needs of children with ASD.
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Affiliation(s)
- James J Brown
- Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America.
| | - James M Gray
- University of Minnesota Medical School, Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, 2450 Riverside Avenue, Minneapolis, MN 55454, United States of America
| | - Mark G Roback
- University of Minnesota Medical School, Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, 2450 Riverside Avenue, Minneapolis, MN 55454, United States of America
| | - Usha Sethuraman
- Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
| | - Ahmad Farooqi
- Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
| | - Nirupama Kannikeswaran
- Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
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Elmorsy SA, Soliman GF, Rashed LA, Elgendy H. Dexmedetomidine and propofol sedation requirements in an autistic rat model. Korean J Anesthesiol 2018; 72:169-177. [PMID: 29843508 PMCID: PMC6458507 DOI: 10.4097/kja.d.18.00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/28/2018] [Indexed: 12/27/2022] Open
Abstract
Background Autism is a challenging neurodevelopmental disorder. Previous clinical observations have suggested altered sedation requirements for children with autism. Our study aimed to test this observation experimentally in an animal model and to explore its possible mechanisms. Methods Eight adult pregnant female Sprague-Dawley rats were randomly divided into two groups. Four were injected with intraperitoneal sodium valproate on gestational day 12 and four were injected with normal saline. On postnatal day 28, the newborn male rats were subjected to the open-field test to confirm autistic features. Each rat was injected intraperitoneally with a single dose of propofol (50 mg/kg) or dexmedetomidine (0.2 mg/kg). The times to loss of righting reflex (LORR) and to return of righting reflex (RORR) were recorded. On the following day, all rats were re-sedated and underwent electroencephalography (EEG). Thereafter, the rats were euthanized and their hippocampal gamma-aminobutyric acid type A (GABAA) and glutamate N-methyl-D-aspartate (NMDA) receptor gene expressions were assessed. Results Autistic rats showed significantly longer LORR times and shorter RORR times than did the controls (median LORR times: 12.0 versus 5.0 min for dexmedetomidine and 22.0 versus 8.0 min for propofol; P < 0.05). EEG showed a low-frequency, high-amplitude wave pattern 2 min after LORR in the control rats. Autistic rats showed a high-frequency, low-amplitude awake pattern. Hippocampal GABAA receptor gene expression was significantly lower and NMDA gene expression was greater in autistic rats. Conclusions This study supports the clinical observations of increased anesthetic sedative requirements in children with autism and our biochemical analyses using GABAA and glutamate receptor gene expression highlight possible underlying mechanisms.
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Affiliation(s)
- Soha A Elmorsy
- Department of Medical Pharmacology, Cairo University Faculty of Medicine, Qatar
| | - Ghada F Soliman
- Department of Medical Pharmacology, Cairo University Faculty of Medicine, Qatar
| | - Laila A Rashed
- Department of Medical Biochemistry, Cairo University Faculty of Medicine, Qatar
| | - Hamed Elgendy
- Department of Anesthesia, Assiut University Hospital, Egypt & Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar
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Elliott AB, Holley AL, Ross AC, Soleta AO, Koh JL. A prospective study comparing perioperative anxiety and posthospital behavior in children with autism spectrum disorder vs typically developing children undergoing outpatient surgery. Paediatr Anaesth 2018; 28:142-148. [PMID: 29226493 DOI: 10.1111/pan.13298] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research describing the experience of youth with autism spectrum disorders in the perioperative setting is limited. This study compared youth with autism spectrum disorder to typically developing children in the perioperative setting and examined group differences in: child anxiety, parent anxiety, premedication patterns, induction compliance, and changes in behavior postprocedure. METHODS Participants were 60 youth (32 with autism spectrum disorder, 28 typically developing) of ages 2-19 years undergoing outpatient surgery and their parents. Parents and research assistants rated children's anxiety at 3 time points (waiting room, preoperative holding, separation), and parents rated their own anxiety in the waiting room and at separation. The anesthesiologist rated induction compliance. Postprocedure behavior change was assessed via phone survey 1 and 7 days postprocedure. Analyses examined group differences in anxiety, medication patterns, and behavior. RESULTS Children with autism spectrum disorder had higher research assistant reported anxiety than typically developing youth in the holding room only. There were no group differences in parent report of their own anxiety or their child's anxiety across time points. Compared to typically developing youth, children with autism spectrum disorder were more likely to receive a premedication (including nonstandard premedication), and had poorer induction compliance. Groups did not differ on posthospital behavior change 1 or 7 days postsurgery. CONCLUSION Findings revealed ratings of anxiety in youth with and without autism spectrum disorder facing surgery varied by reporter and setting, highlighting the importance of using multiple reporters in research of youth with autism spectrum disorder in the perioperative period. Furthermore, while results showed group differences in premedication patterns and induction compliance, groups did not differ in level of negative behavior change after surgery. Future research can examine how individual differences in youth with autism impact anxiety in the perioperative setting and degree of behavior change postprocedure.
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Affiliation(s)
- Anila B Elliott
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Amy Lewandowski Holley
- Department of Pediatrics, Institute on Development and Disability, Oregon Health and Science University, Portland, OR, USA
| | - Alexandra C Ross
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy O Soleta
- Department of Anesthesiology, & Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jeffrey L Koh
- Department of Anesthesiology, & Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA
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Swartz JS, Amos KE, Brindas M, Girling LG, Ruth Graham M. Benefits of an individualized perioperative plan for children with autism spectrum disorder. Paediatr Anaesth 2017; 27:856-862. [PMID: 28618130 DOI: 10.1111/pan.13189] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perioperative care for children with autism spectrum disorder may be challenging. Previous investigators recommend development of an individualized perioperative management plan with caregiver involvement. AIM The primary goal was to determine the usefulness of an individualized plan based on the decision to provide preoperative sedation stratified by autism spectrum severity level. Secondary goals were to assess the effectiveness of the plan based on subjective assessment of patient behavior at induction of anesthesia and caregiver satisfaction. METHODS We developed an individualized plan for each child with autism spectrum disorder scheduled for anesthesia. Children were categorized by autism spectrum disorder severity level. With institutional ethics approval, we conducted a retrospective chart review to document need for preoperative sedation, sedation stratified by autism spectrum disorder severity level, behavior at induction, and caregiver satisfaction. RESULTS Between 2012 and 2014, we successfully prepared a plan for 246 (98%) of 251 surgical or diagnostic procedures in 224 patients. Severity level was distributed as 45% Severity Level 1 and Asperger's, 25% Severity Level 2, and 30% Severity Level 3. The majority (90%) of cases were scheduled as day surgery. Preoperative sedation increased with increasing severity level: Severity Level 1 (21%) or Asperger's (31%), Severity Level 2 (44%), and Severity Level 3 (56%). The odds ratio for sedation use was 5.5 [CI: 2.6-11.5, P<.001] with Severity Level 3 vs Severity Level 1 patients. Cooperation at induction of anesthesia was 90% overall with preoperative sedation administered to 94 (38%) of the entire cohort. Cooperation was greatest in Severity Level 1 (98%) and Asperger's patients (93%) and somewhat less (85%) in patients in Severity Levels 2 and 3. The plan was helpful to guide sedation choices as cooperation did not differ between sedated and unsedated children at any severity level (overall χ2 =2.87 P=.09). Satisfaction among caregivers contacted was 98%. CONCLUSION The results suggest that an individualized plan is helpful in the perioperative management of children with autism spectrum disorder and that knowledge of autism spectrum disorder severity level may be helpful in determining the need for preoperative sedation.
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Affiliation(s)
- Jo S Swartz
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen E Amos
- Department of Nursing, Child Health, Children's Hospital, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Mirna Brindas
- Child Life Department, Children's Hospital, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Linda G Girling
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M Ruth Graham
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Prakash S, Pai VK, Dhar M, Kumar AA. Premedication in an autistic, combative child: Challenges and nuances. Saudi J Anaesth 2016; 10:339-41. [PMID: 27375393 PMCID: PMC4916822 DOI: 10.4103/1658-354x.174917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Children with autistic spectrum disorders are often encountered in anesthesia practice mainly for outdoor procedural sedation or anesthesia in endoscopy and magnetic resonance imaging suites. We describe a case of a 7-year-old autistic boy who required management of dental caries. He had a phobia to intravenous cannulation, displayed increasing anxiety and became combative on the day of surgery. With parental involvement and distraction, we succeeded in giving oral midazolam by concealing it, with the intent of avoiding intramuscular injection or unnecessary restraint. Lack of knowledge about the medical condition of such a patient can lead to inadequate preoperative preparation and use of restraint on the patient, which might cause anxiety or panic attacks in the operative room. To effectively manage children with special needs one needs to have clear guidelines on the management of uncooperative children, involve parents perioperatively, plan ahead with an emphasis on perioperative analgesia and sometimes incorporate the ethical use of restraint.
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Affiliation(s)
- S Prakash
- Department of Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - V K Pai
- Department of Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - M Dhar
- Department of Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - A A Kumar
- Department of Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Arnold B, Elliott A, Laohamroonvorapongse D, Hanna J, Norvell D, Koh J. Autistic children and anesthesia: is their perioperative experience different? Paediatr Anaesth 2015; 25:1103-10. [PMID: 26338278 DOI: 10.1111/pan.12739] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with autism spectrum disorders (ASD) are an increasingly common patient population in the perioperative setting. Children with ASD present with abnormal development in social interaction, communication, and stereotyped patterns of behavior and may be more prone to elevated perioperative anxiety. The perioperative experience for these patients is complex and presents a unique challenge for clinicians. AIM The aim of the current study was to provide a further understanding of the premedication patterns and perioperative experiences of children with ASD in comparison to children without ASD. METHODS Using a retrospective cohort study design, medical records were evaluated for patients with and without ASD undergoing general anesthesia for dental rehabilitation from 2006-2011. The following objectives were measured and compared: (i) premedication patterns and (ii) complications, pain, anesthetic type, PACU time, and time to discharge. To compare categorical variables, the chi-square test was used. Bivariate and multivariable analyses were performed to control for potential confounding as a result of baseline differences between the two groups. RESULTS A total of 121 ASD patients and 881 non-ASD patients were identified. When controlling for age, weight, and gender, children in the ASD group were more likely to have nonstandard premedication types (P < 0.0001), while children without ASD were more likely to have standard premedication types (P < 0.0001). No significant group differences were identified in regards to the other outcome measures. CONCLUSIONS Other than a significant difference in the premedication type and route, we found that children with ASD seemed to have similar perioperative experiences as non-ASD subjects. It was especially interesting to find that their postoperative period did not pose any special challenges. There is much to be learned about this unique patient population, and a more in-depth prospective evaluation is warranted to help better delineate the best approach to caring for these patients.
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Affiliation(s)
- Brook Arnold
- Northern Colorado Anesthesia Professionals, Ft. Collins, CO, USA
| | - Anila Elliott
- Department of Anesthesiology and Perioperative Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Dean Laohamroonvorapongse
- Department of Anesthesiology and Perioperative Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - John Hanna
- Department of Pediatric Dentistry, School of Dentistry, Oregon Health Sciences University, Portland, OR, USA
| | | | - Jeffrey Koh
- Department of Anesthesiology and Perioperative Medicine, Oregon Health Sciences University, Portland, OR, USA
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15
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Taghizadeh N, Davidson A, Williams K, Story D. Autism spectrum disorder (ASD) and its perioperative management. Paediatr Anaesth 2015; 25:1076-84. [PMID: 26248302 DOI: 10.1111/pan.12732] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 11/29/2022]
Abstract
Autism spectrum disorder (ASD) is now diagnosed in more than 1 in 100 children, so it is not surprising that anesthetists are increasingly providing care for children with this diagnosis. The diagnostic classification for ASD has recently changed and our understanding of the causes and management of ASD are also changing rapidly. This review provides a timely update to increase understanding and awareness of the problems that children with ASD experience, and to minimize perioperative problems. Current literature on premedication and the increasing use of alpha-2 agonists such as clonidine and dexmedetomidine as well as the use of old favorites midazolam and ketamine is reviewed. Some simple strategies that will improve care and decrease anxiety, like social stories, the use of tablet computers, other comfort items or games for distraction, and using favorite drinks to disguise the bitter taste of medications, are described. Remember, the parents are their child's expert and will know what agitates and settles them. Talking to them prior to the day of the procedure is ideal. The importance of staff training and having a clinical practice guideline available at every institution cannot be overstated.
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Affiliation(s)
- Neda Taghizadeh
- Anaesthetic Research Group, Murdoch Children Research Institute, Parkville, VIC, Australia.,Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Davidson
- Anaesthetic Research Group, Murdoch Children Research Institute, Parkville, VIC, Australia.,Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Katrina Williams
- Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Royal Children's Hospital, Parkville, VIC, Australia
| | - David Story
- Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Parkville, VIC, Australia
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16
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Chandley MJ, Crawford JD, Szebeni A, Szebeni K, Ordway GA. NTRK2 expression levels are reduced in laser captured pyramidal neurons from the anterior cingulate cortex in males with autism spectrum disorder. Mol Autism 2015; 6:28. [PMID: 26000162 PMCID: PMC4440594 DOI: 10.1186/s13229-015-0023-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/24/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The anterior cingulate cortex (ACC) is a brain area involved in modulating behavior associated with social interaction, disruption of which is a core feature of autism spectrum disorder (ASD). Functional brain imaging studies demonstrate abnormalities of the ACC in ASD as compared to typically developing control patients. However, little is known regarding the cellular basis of these functional deficits in ASD. Pyramidal neurons in the ACC are excitatory glutamatergic neurons and key cellular mediators of the neural output of the ACC. This study was designed to investigate the potential role of ACC pyramidal neurons in ASD brain pathology. METHODS Postmortem ACC tissue from carefully matched ASD and typically developing control donors was obtained from two national brain collections. Pyramidal neurons and surrounding astrocytes were separately collected from layer III of the ACC by laser capture microdissection. Isolated RNA was subjected to reverse transcription and endpoint PCR to determine gene expression levels for 16 synaptic genes relevant to glutamatergic neurotransmission. Cells were also collected from the prefrontal cortex (Brodmann area 10) to examine those genes demonstrating differences in expression in the ACC comparing typically developing and ASD donors. RESULTS The level of NTRK2 expression was robustly and significantly lower in pyramidal neurons from ASD donors as compared to typically developing donors. Levels of expression of GRIN1, GRM8, SLC1A1, and GRIP1 were modestly lower in pyramidal neurons from ASD donors, but statistical significance for these latter genes did not survive correction for multiple comparisons. No significant expression differences of any genes were found in astrocytes laser captured from the same neocortical area. In addition, expression levels of NTRK2 and other synaptic genes were normal in pyramidal neurons laser captured from the prefrontal cortex. CONCLUSIONS These studies demonstrate a unique pathology of neocortical pyramidal neurons of the ACC in ASD. NTRK2 encodes the tropomyosin receptor kinase B (TrkB), transmission through which neurotrophic factors modify differentiation, plasticity, and synaptic transmission. Reduced pyramidal neuron NTRK2 expression in the ACC could thereby contribute to abnormal neuronal activity and disrupt social behavior mediated by this brain region.
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Affiliation(s)
- Michelle J Chandley
- />Department of Health Sciences, College of Public Health, East Tennessee State University, P.O. Box 70673, Johnson City, TN 37614 USA
| | - Jessica D Crawford
- />Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, P.O. Box 70582, Johnson City, TN 37614 USA
| | - Attila Szebeni
- />Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, P.O. Box 70582, Johnson City, TN 37614 USA
| | - Katalin Szebeni
- />Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, P.O. Box 70582, Johnson City, TN 37614 USA
| | - Gregory A Ordway
- />Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, P.O. Box 70582, Johnson City, TN 37614 USA
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17
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Seo KH, Jung HS, Kang EG, Kim CJ, Rhee HY, Jeon YS. Sedation using 5% lidocaine patches, midazolam and propofol in a combative, obese adolescent with severe autistic disorder undergoing brain magnetic resonance imaging: a case report. Korean J Anesthesiol 2015; 67:421-4. [PMID: 25558344 PMCID: PMC4280481 DOI: 10.4097/kjae.2014.67.6.421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/05/2014] [Accepted: 08/18/2014] [Indexed: 11/17/2022] Open
Abstract
We present a 17-year-old man who underwent brain magnetic resonance imaging and laboratory exams for uncontrolled seizure. Patients with an autistic disorder require deep sedation or, occasionally, general anesthesia even for radiologic exams or simple procedures. The anesthetic management of an obese, violent patient with a severe autistic disorder and mental retardation can be challenging to anesthesiologists and requires a more careful approach in selecting adequate anesthetics and doses. This case emphasizes the importance of having a detailed plan to ensure the smooth process of premedication, anesthetic induction, maintenance, emergence and safe discharge of incorporated patients in the event of unexpected situations. A 5% lidocaine patch to relieve the pain from the intramuscular injection and intravenous cannulation, intramuscular midazolam as premedication, and propofol for the maintenance of sedation can be a good sedation protocol in incorporated patients.
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Affiliation(s)
- Kwon Hui Seo
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Hong Soo Jung
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Eu Gene Kang
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Change Jae Kim
- Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ho Young Rhee
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Yeon Soo Jeon
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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18
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Short JA, Calder A. Anaesthesia for children with special needs, including autistic spectrum disorder. ACTA ACUST UNITED AC 2013. [DOI: 10.1093/bjaceaccp/mks065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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BIS-Guided Total Intravenous Anesthesia for Orchiopexy and Circumcision in a Child with Severe Autism: A Case Report. Case Rep Anesthesiol 2012; 2012:718594. [PMID: 23227368 PMCID: PMC3512242 DOI: 10.1155/2012/718594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/30/2012] [Indexed: 12/01/2022] Open
Abstract
Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety.
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20
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Abstract
There appears to be little literature in paediatric anaesthetic practice relevant to children suffering with autism (Rainey & Van der Walt 1998). Recent findings suggest a need for rigorous study of the potential problems that autistic children may have when undergoing an anaesthetic (Kirz 2007). Some healthcare professionals do not have the knowledge or professional guidance to be able to identify these children (DH 2001, Disability Rights Commission 2006, DH 2008a, b, 2009, Rankin 2009).
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21
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Shah S, Shah S, Apuya J, Gopalakrishnan S, Martin T. Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient. J Anesth 2009; 23:126-8. [PMID: 19234837 DOI: 10.1007/s00540-008-0685-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 08/12/2008] [Indexed: 12/19/2022]
Abstract
Patients with impaired ability to understand and communicate can be difficult to manage perioperatively. They frequently require lateral thinking on the part of the anesthesiologists to make the induction process as smooth as possible. We present a case of a severely autistic and violent patient scheduled for dental rehabilitation under general anesthesia. A combination of oral ketamine and midazolam was mixed in the beverage Dr Pepper to mask the taste and the appearance of the drugs. The unique flavor of Dr Pepper is well suited to increase the palatibility and the acceptability of medications in children and patients with developmental delay.
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Affiliation(s)
- Shailesh Shah
- Department of Pediatric Anesthesiology and Pain Medicine, Arkansas Children's Hospital, Little Rock, AR, 72202, USA
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22
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Ross AK, Hazlett HC, Garrett NT, Wilkerson C, Piven J. Moderate sedation for MRI in young children with autism. Pediatr Radiol 2005; 35:867-71. [PMID: 15902433 DOI: 10.1007/s00247-005-1499-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 04/02/2005] [Accepted: 04/19/2005] [Indexed: 11/29/2022]
Abstract
UNLABELLED Autism is a pervasive neurodevelopmental disorder. Because of the deficits associated with the condition, sedation of children with autism has been considered more challenging than sedation of other children. OBJECTIVE To test this hypothesis, we compared children with autism against clinical controls to determine differences in requirements for moderate sedation for MRI. MATERIALS AND METHODS Children ages 18-36 months with autism (group 1, n = 41) and children with no autistic behavior (group 2, n = 42) were sedated with a combination of pentobarbital and fentanyl per sedation service protocol. The sedation nurse was consistent for all patients, and all were sedated to achieve a Modified Ramsay Score of 4. Demographics and doses of sedatives were recorded and compared. RESULTS There were no sedation failures in either group. Children in group 1 (autism) were significantly older than group 2 (32.02+/-3.6 months vs 28.16+/-6.7 months) and weighed significantly more (14.87+/-2.1 kg vs 13.42+/-2.2 kg). When compared on a per-kilogram basis, however, group 1 had a significantly lower fentanyl requirement than group 2 (1.25+/-0.55 mcg/kg vs 1.57+/-0.81 mcg/kg), but no significant difference was found in pentobarbital dosing between groups 1 and 2, respectively (4.92+/-0.92 mg/kg vs 5.21+/-1.6 mg/kg). CONCLUSION Autistic children in this age range are not more difficult to sedate and do not require higher doses of sedative agents for noninvasive imaging studies.
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Affiliation(s)
- Allison Kinder Ross
- Division of Pediatric Anesthesia, Duke University Medical Center, 3094, Durham, NC 27710, USA.
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23
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Abstract
A developmentally delayed, 13-year old autistic boy required management of multifocal cerebral and pulmonary tumors, involving several anesthetics over a 4-month period. At each anesthetic he refused premedication, displayed increasing anxiety and became more combative. With parental guidance and involvement, a variety of anesthetists tried a range of techniques to achieve induction, each ultimately resorting to the use of physical restraint. Principles essential to the care of such a child include early recognition, parental support, multi-disciplinary planning of procedures requiring general anesthesia, continuity of anesthesia care, and clear guidelines about the perioperative management of uncooperative children, including the ethical use of restraint.
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Affiliation(s)
- Elaine Christiansen
- Department of Anaesthesia, Princess Margaret Hospital For Children, Perth, WA, Australia
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24
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Abstract
An intellectually impaired adult with a history of escalating violence towards hospital personnel was given an anaesthetic in his home prior to transfer to hospital for surgery. We review the implications and problems encountered, and suggest means by which such a retrieval can occur smoothly.
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Affiliation(s)
- W P Chan
- Department of Anaesthesia, Launceston General Hospital, PO Box 1963, Launceston, Tas. 7250
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25
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Abstract
BACKGROUND Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. METHODS We have developed a unique management program for autistic children admitted for medical and surgical procedures requiring a general anaesthetic. Details of each patient managed according to this program have been prospectively entered into an Autistic Register. RESULTS An audit of this database shows that we have administered anaesthesia on 87 occasions for 59 autistic children over 4 years. CONCLUSIONS There is great variation in the severity of autism and hospital needs of these children. The focus is on early communication with the patient's families, flexibility to individualize the admission process and anaesthetic plan with admission and early discharge on the day of surgery whenever possible. Oral midazolam is an effective premedication for the milder cases and oral ketamine is the most reliable for moderate and severe cases. Comparison of oral midazolam and ketamine shows no significant different postoperative recovery and hospital discharge times. Routine intravenous fluids and antiemesis prophylaxis with removal of the i.v. cannula before return to the ward are also seen as important steps to decrease stress and smooth the postoperative phase. This program has also successfully been extended to the management of problem children due to other causes.
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Affiliation(s)
- J H van der Walt
- Department of Paediatric Anaesthesia, Paediatric Day Surgery Unit, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia 5006, Australia
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26
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van der Walt JH, Sainsbury DA, Pettifer R. Anaesthesia alert: an integrated, networked, register of paediatric anaesthetic problems. Anaesth Intensive Care 2001; 29:113-6. [PMID: 11314829 DOI: 10.1177/0310057x0102900204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Paediatric Register of Anaesthetic Problems (PaedRAP) is a network-based anaesthesia hazard alert system. It is integrated with pre-anaesthesia consultations and patient questionnaires. All files, both electronic and on paper, are available 24 hours a day close to the operating theatres. This ensures that pertinent information is readily available when and where it is most needed. The PaedRAP is also linked to the automated theatre booking system to print warnings on the theatre lists. This minimizes the chance that important information goes unnoticed. Documentation of the progression of the various categories of patient problems and evolving management strategies has been useful both for individuals and groups.
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Affiliation(s)
- J H van der Walt
- Department of Paediatric Anaesthesia, Women's and Children 's Hospital, Adelaide, South Australia
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