21 January 2015

Sheridan Pioneers Anesthesia Care for Pediatric Patients with Autism

Guest post by Dr. Sandra Kaufmann, Chief of Pediatric Anesthesia, Chief of Pediatric Pain, Joe DiMaggio Children's Hospital

According to the CDC, around 1 in 68 American children are affected by autism spectrum disorder — representing a ten-fold increase in prevalence over the last 40 years. It is not surprising that these children, on occasion, will require anesthesia for various procedures and examinations. At Joe DiMaggio Children’s Hospital we have gained extensive experience over the years caring for autistic children, and have developed methodologies that address both the behavioral and metabolic issues that are associated with this disorder. The perioperative needs of a child with autism differ in almost every way from the traditional processes, and our hospital is committed to pioneering procedures and practices that best serve this growing subset of patients.

Preoperative Strategies

At the very onset, we understand that children with autism are challenged by new surroundings and a change in their routines and life patterns. We try to minimize their fears as much as possible by mirroring their routines where possible and trying to make their hospital visit as brief as it reasonably can be. Our autistic patients are usually the first case on the operating room’s schedule to reduce any waiting time. All rooms in the pre-operative area are private and quiet, where the family can stay with the patient. We also have a team of child life specialists, as well as in-house therapy dogs, who are available to provide comfort and entertainment.

Autism Friendly Medical Regime

Choices of medications for autistic patients are determined by their clinical presentations, any concomitant medical issues and the degree of sedation required. We have devised our own Autism Friendly Regime to minimize any ill effects while optimizing the operative experience. This regime begins with an oral medication to reduce stress, calm the patient and provide a degree of amnesia. If necessary, with the assistance of the caretaker, we camouflage this medication in whatever drink the patient is familiar with to make the first step as easy as possible. If the patient refuses the oral medication, we work closely with the family to devise an alternative plan.

Customized Anesthesia Plan

Family apprehensions about the anesthesia plan usually revolve around two issues. The first concerns the intraoperative medications. We make every attempt to avoid polypharmacy, which has been found to be problematic in these children. Specific medications thought to be detrimental to children with associated mitochondrial disorders are clearly avoided. The second concern is always the IV. This is placed once the child is asleep, and it is extremely well secured. It is also removed earlier than usual in the recovery room to minimize undue anxiety.

In essence, the anesthesia team at Joe DiMaggio is very conscious of the fact that our autistic patients require special care. Every child is different, and our flexibility and creativity are the cornerstones of ensuring that all of our patients receive the best treatment possible.