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Enhanced perioperative management of children with autism: a pilot study

Amanda Whippey1, Leora M Bernstein2, Debra O'Rourke3

  • 1Department of Anesthesia, McMaster University, 1200 Main St West, Hamilton, ON, L8S 4K1, Canada. amanda.cull@medportal.ca.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|June 2, 2019
PubMed

Insights

A new perioperative care pathway for children with autism spectrum disorder (ASD) proved feasible. This enhanced approach, including individualized plans and support, was highly accepted by patients, parents, and staff.

Area of Science:

  • Pediatric Anesthesiology
  • Autism Spectrum Disorder Research
  • Healthcare Pathway Development

Background:

  • Children with autism spectrum disorder (ASD) face heightened challenges in hospital settings due to communication, socialization, and behavioral difficulties.
  • Existing perioperative care often does not adequately address the unique needs of children with ASD.
  • Developing specialized care pathways is crucial for improving patient outcomes and experiences.

Purpose of the Study:

  • To establish the feasibility of an enhanced perioperative care pathway for children with autism spectrum disorder (ASD).
  • To assess the acceptance and effectiveness of a multidisciplinary approach tailored to the needs of children with ASD undergoing surgery.
  • To identify key components for successful implementation of specialized perioperative care.

Main Methods:

  • A nine-month development period involving parental and provider feedback to create a protocol.
  • Protocol components included environmental modifications, anxiolysis plans, specialized order sets, and child life specialist (CLS) support.
  • Individualized care plans were created using autism severity scores (ASS), communication styles, triggers, and prior experiences. Emotion and sedation scores were recorded throughout the perioperative period.

Main Results:

  • Eighteen children with severe ASD (15 nonverbal) were enrolled; all feasibility criteria were met.
  • Protocol adherence was 97%, and patient follow-up was 94%.
  • Anesthetic inductions were rated as excellent in 83% of cases. Parents and staff reported high satisfaction and acceptance (100%), citing personalized plans and CLS support as key benefits.

Conclusions:

  • A multidisciplinary perioperative care plan for children with severe ASD is feasible and highly accepted.
  • Individualized anxiolysis plans were identified as a significant strength of the protocol.
  • This enhanced pathway demonstrates potential for improving perioperative care for children with ASD.
Abstract

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