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A Familiarization Protocol Facilitates the Participation of Children with ASD in Electrophysiological Research
Published on: July 31, 2017
Autism spectrum disorder (ASD) and its perioperative management
Neda Taghizadeh1,2, Andrew Davidson1,2, Katrina Williams2,3
1Anaesthetic Research Group, Murdoch Children Research Institute, Parkville, VIC, Australia.
Insights
Anesthetists increasingly care for children with autism spectrum disorder (ASD). This review updates perioperative management strategies, including premedication and non-pharmacological interventions, to improve care for these children.
Area of Science:
- Anesthesiology
- Pediatrics
- Developmental Neuroscience
Background:
- Autism spectrum disorder (ASD) prevalence is rising, necessitating specialized anesthetic care for affected children.
- Evolving understanding of ASD causes and management requires updated clinical approaches.
- Perioperative challenges in children with ASD demand targeted strategies.
Purpose of the Study:
- To provide a comprehensive review of current literature on anesthetic management for children with ASD.
- To enhance awareness and understanding of ASD-related perioperative issues.
- To offer practical strategies for minimizing anxiety and improving care.
Main Methods:
- Systematic review of current literature on pediatric anesthesia for ASD.
- Analysis of premedication options, including alpha-2 agonists (clonidine, dexmedetomidine), midazolam, and ketamine.
- Identification and description of non-pharmacological interventions for anxiety reduction.
Main Results:
- Review covers updated premedication protocols and pharmacologic agents.
- Non-pharmacological strategies such as social stories, distraction techniques (tablets, games), and palatable medication delivery are detailed.
- Emphasis on parent collaboration and staff training for optimal outcomes.
Conclusions:
- Effective perioperative management of children with ASD requires a multi-faceted approach.
- Individualized care, informed by parental expertise, is crucial.
- Implementing clinical practice guidelines and ensuring staff preparedness are essential for minimizing patient distress and optimizing anesthetic care.
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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