Autistic children and anesthesia: is their perioperative experience different?
BACKGROUND
Children with autism spectrum disorders (ASD) are an increasingly common patient population in the perioperative setting. Children with ASD present with abnormal development in social interaction, communication, and stereotyped patterns of behavior and may be more prone to elevated perioperative anxiety. The perioperative experience for these patients is complex and presents a unique challenge for clinicians.


OBJECTIVE
The aim of the current study was to provide a further understanding of the premedication patterns and perioperative experiences of children with ASD in comparison to children without ASD.


METHODS
Using a retrospective cohort study design, medical records were evaluated for patients with and without ASD undergoing general anesthesia for dental rehabilitation from 2006-2011. The following objectives were measured and compared: (i) premedication patterns and (ii) complications, pain, anesthetic type, PACU time, and time to discharge. To compare categorical variables, the chi-square test was used. Bivariate and multivariable analyses were performed to control for potential confounding as a result of baseline differences between the two groups.


RESULTS
A total of 121 ASD patients and 881 non-ASD patients were identified. When controlling for age, weight, and gender, children in the ASD group were more likely to have nonstandard premedication types (P < 0.0001), while children without ASD were more likely to have standard premedication types (P < 0.0001). No significant group differences were identified in regards to the other outcome measures.


CONCLUSIONS
Other than a significant difference in the premedication type and route, we found that children with ASD seemed to have similar perioperative experiences as non-ASD subjects. It was especially interesting to find that their postoperative period did not pose any special challenges. There is much to be learned about this unique patient population, and a more in-depth prospective evaluation is warranted to help better delineate the best approach to caring for these patients.
Northern Colorado Anesthesia Professionals, Ft. Collins, CO, USA.
Brook
B
Arnold
Department of Anesthesiology and Perioperative Medicine, Oregon Health Sciences University, Portland, OR, USA.
Anila
A
Elliott
Department of Anesthesiology and Perioperative Medicine, Oregon Health Sciences University, Portland, OR, USA.
Dean
D
Laohamroonvorapongse
Department of Pediatric Dentistry, School of Dentistry, Oregon Health Sciences University, Portland, OR, USA.
John
J
Hanna
Spectrum Research Inc., Tacoma, WA, USA.
Daniel
D
Norvell
Department of Anesthesiology and Perioperative Medicine, Oregon Health Sciences University, Portland, OR, USA.
Jeffrey
J
Koh
D000762:Anesthesia Recovery Period; D001007:Anxiety / Q000523:psychology*; D001321:Autistic Disorder / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D019990:Perioperative Care / Q000379:methods* / Q000523:psychology*; D059035:Perioperative Period / Q000523:psychology; D011229:Preanesthetic Medication; D012189:Retrospective Studies
autism; autism spectrum disorders; dental restoration; pain; perioperative complication; premedication