Related Experiment Videos
An audit of perioperative management of autistic children
1Department of Paediatric Anaesthesia, Paediatric Day Surgery Unit, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia 5006, Australia.
Insights
A specialized hospital management program effectively supports autistic children undergoing anesthesia, utilizing tailored plans and specific oral medications like ketamine for smoother procedures and recovery. This approach enhances care for autistic individuals in medical settings.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Disorders
Background:
- Autistic children exhibit significant challenges in hospital settings due to their sensitivity to routine changes.
- Managing autistic children requires specialized approaches to mitigate distress during medical procedures.
Purpose of the Study:
- To introduce and evaluate a unique management program for autistic children undergoing medical and surgical procedures requiring general anesthesia.
- To prospectively collect data on the management of autistic children within a dedicated register.
Main Methods:
- Development of a specialized management program for autistic children requiring anesthesia.
- Prospective data collection in an Autistic Register for patients managed under the program.
- Audit of the database to analyze anesthetic administrations over a four-year period.
Main Results:
- Anesthesia was administered on 87 occasions for 59 autistic children over a 4-year period.
- The program demonstrated flexibility in individualizing admission and anesthetic plans.
- Oral midazolam and ketamine were found effective for premedication, with no significant difference in postoperative recovery.
Conclusions:
- Individualized care, early family communication, and flexible anesthetic plans are crucial for managing autistic children in hospitals.
- Oral ketamine is effective for moderate to severe cases, while oral midazolam suits milder cases.
- Minimizing stress through strategies like early discharge and specific postoperative care improves outcomes for autistic children.
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.