title: Autism spectrum disorder (ASD) and its perioperative management.
abstract: Autism spectrum disorder (ASD) is now diagnosed in more than 1 in 100 children, so it is not surprising that anesthetists are increasingly providing care for children with this diagnosis. The diagnostic classification for ASD has recently changed and our understanding of the causes and management of ASD are also changing rapidly. This review provides a timely update to increase understanding and awareness of the problems that children with ASD experience, and to minimize perioperative problems. Current literature on premedication and the increasing use of alpha-2 agonists such as clonidine and dexmedetomidine as well as the use of old favorites midazolam and ketamine is reviewed. Some simple strategies that will improve care and decrease anxiety, like social stories, the use of tablet computers, other comfort items or games for distraction, and using favorite drinks to disguise the bitter taste of medications, are described. Remember, the parents are their child's expert and will know what agitates and settles them. Talking to them prior to the day of the procedure is ideal. The importance of staff training and having a clinical practice guideline available at every institution cannot be overstated.
authors.affiliation: Anaesthetic Research Group, Murdoch Children Research Institute, Parkville, VIC, Australia.|Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Neda
authors.initials: N
authors.lastname: Taghizadeh
authors.affiliation: Anaesthetic Research Group, Murdoch Children Research Institute, Parkville, VIC, Australia.|Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davidson
authors.affiliation: Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.|Department of Paediatrics, Royal Children's Hospital, Parkville, VIC, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Williams
authors.affiliation: Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Parkville, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Story
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000067877:Autism Spectrum Disorder / Q000601:surgery*; D002648:Child; D006801:Humans; D019990:Perioperative Care / Q000379:methods*
keywords: anesthesia (major); anesthesia conduction; autistic disorder; child; child developmental disorder; pervasive (major); premedication; surgical procedures