title: Sedation using 5% lidocaine patches, midazolam and propofol in a combative, obese adolescent with severe autistic disorder undergoing brain magnetic resonance imaging: a case report.
abstract: We present a 17-year-old man who underwent brain magnetic resonance imaging and laboratory exams for uncontrolled seizure. Patients with an autistic disorder require deep sedation or, occasionally, general anesthesia even for radiologic exams or simple procedures. The anesthetic management of an obese, violent patient with a severe autistic disorder and mental retardation can be challenging to anesthesiologists and requires a more careful approach in selecting adequate anesthetics and doses. This case emphasizes the importance of having a detailed plan to ensure the smooth process of premedication, anesthetic induction, maintenance, emergence and safe discharge of incorporated patients in the event of unexpected situations. A 5% lidocaine patch to relieve the pain from the intramuscular injection and intravenous cannulation, intramuscular midazolam as premedication, and propofol for the maintenance of sedation can be a good sedation protocol in incorporated patients.
authors.affiliation: Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
authors.forename: Kwon Hui
authors.initials: KH
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
authors.forename: Hong Soo
authors.initials: HS
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
authors.forename: Eu Gene
authors.initials: EG
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Change Jae
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Rhee
authors.affiliation: Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Jeon
keywords: Autistic disorder; Deep sedation; Magnetic resonance imaging; Midazolam; Obesity