Special Needs Patients & Anesthesia

The author conducts the study of anesthesia of uncooperative children with ASD. The author focuses on the premedication of child patients with ASD. The premedication is very important for the effective anesthesia. On analyzing the premedication treatment, the author recommends the combination of ketamine and midazolam may be preferred as they improve compliance with minimal side effects. In such a way, anesthesiology becomes not invasive. The use of physical restraints is not recommended by the author. In this regard, the author suggests the alternative approach to restraint methods, which are used very seldom today because such methods become out-of-date and alternative methods, like those suggested by the author are introduced instead. Non-invasive and non-restraining methods are effective as the study conducted by Bozkurt proves. Special Needs Patients & Anesthesia Paper

Jeffery, K. (2002). Therapeutic restraint of children: it must always be justified. Paediatr Nurs. 14: 20-22.
The author studies the use of physical restraints with regard to patients with ASD. According to the author, an anesthesiologist can introduce various interventions such as: basic explanations teaching, a visit to the operating room, play therapy, mock anesthesia induction, rewards, and premedication. Various forms of distractions can also be used including music, television, video games, DVDs, toys, lucky dip baskets, and hypnotherapy. In extreme cases autistic patients may become violent or self destructive, refusing all premedication or surgery itself. Physical restraints have been described in literature and although a topic of debate, may be justified in severe cases. When used by trained staff in a decisive, quick and effective manner, they will help to minimize harm to the child and staff. The author also points out that, in case of children patient, anesthesiologists can use toys and play to persuade to take the premedication and undergo the anesthesia procedure.

Filatov SM, Baer GA, Rorarius MG, Oikkonen M. (2000). Efficacy and safety of premedication with oral ketamine for day-case adenoidectomy compared with rectal diazepam/diclofenac and EMLA. Acta Anaesthesiol Scand. 44: 118-124.
The authors argue that there must be appropriate pre-anesthetic consultation and careful planning. The premedication should be used carefully. Ketamine can be used for its sedative and analgesic properties. Oral ketamine in the dose of 8 mg/kg has shown to be more effective in improving compliance during induction of anesthesia. When compared with oral midazolam, benefits of ketamine include less respiratory depression. Ketamine does cause nystagmus, increased salivation, hallucinations and emergence delirium. The authors stress the different dosage of medicaments for children and adults. Their recommendation is to define the dosage of the medicament individually for each patient. Special Needs Patients & Anesthesia Paper