Preoperative Sedation via Cecostomy Tube in an Autistic Adolescent: A Case Report

Preoperative sedation of autistic children is frequently complicated by challenges in communication, sensory processing, and participation in medical care. We report a 40-kg, 13-year-old autistic boy with a preexisting cecostomy tube for chronic constipation, in whom previous oral and intramuscular sedation had failed due to agitation and physical aggression. Midazolam 10 mg (0.25 mg/kg) and ketamine 200 mg (5 mg/kg) were administered via cecostomy tube, producing sedation within 20 minutes. Dental rehabilitation under general anesthesia proceeded uneventfully. Cecal administration of sedatives may be a feasible option when conventional routes are poorly tolerated, although absorption, dosing, and reproducibility remain uncertain.