Induction of anesthesia in a combative child; management and issues.
A developmentally delayed, 13-year old autistic boy required management of multifocal cerebral and pulmonary tumors, involving several anesthetics over a 4-month period. At each anesthetic he refused premedication, displayed increasing anxiety and became more combative. With parental guidance and involvement, a variety of anesthetists tried a range of techniques to achieve induction, each ultimately resorting to the use of physical restraint. Principles essential to the care of such a child include early recognition, parental support, multi-disciplinary planning of procedures requiring general anesthesia, continuity of anesthesia care, and clear guidelines about the perioperative management of uncooperative children, including the ethical use of restraint.
Christiansen
Elaine
E
Department of Anaesthesia, Princess Margaret Hospital For Children, Perth, WA, Australia.
Chambers
Neil
N
D000293:Adolescent; D000768:Anesthesia, General; D001007:Anxiety / Q000523:psychology; D001321:Autistic Disorder / Q000150:complications* / Q000523:psychology*; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery; D002408:Catheters, Indwelling; D002653:Child Behavior Disorders / Q000523:psychology*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery; D008297:Male; D010290:Parents; D010347:Patient Care Planning; D011229:Preanesthetic Medication; D012149:Restraint, Physical / Q000941:ethics