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Special Considerations During Sedation of the Child with Autism Spectrum Disorder

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Pediatric Sedation Outside of the Operating Room

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Abstract

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and restricted and repetitive patterns of behaviors. The special needs of this population bring unique challenges to their medical care. Children with ASD often have sensory sensitivities, anxieties, irritability, and aggressive behaviors that require consideration of varying levels of sedation to safely undergo outpatient procedures. As the prevalence rises with increase in recognition, sedation providers need to be increasingly familiar with this population to minimize peri-procedural problems. Planning for procedures and sedation should include active pre-procedure planning by sedation unit staff aimed at understanding baseline behaviors and triggers, strategies such as using social stories and active parental engagement to familiarize the child and the parents with the procedure, arranging for early morning procedures and having the child recover in a familiar environment. Medication responses are similar to those described in children without ASD but providers should be prepared to utilize greater degrees of pre-procedure premedication to minimize worsening of anxiety, mitigate aggressive behavior, and sedate more deeply for procedures often not requiring sedation in other populations. With appropriate planning and collaboration between the treatment team with caregivers, patients with ASD can be safely and successfully sedated for both invasive and noninvasive procedures in multiple environments including the sedation unit, dental suites, and emergency departments.

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Authors and Affiliations

  1. Pediatrics/Pediatric Critical Care, University of Louisville, Norton Children’s Hospital, Louisville, KY, USA

    John W. Berkenbosch

  2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

    Thuc-Quyen Nguyen

  3. Department of Pediatric Dentistry, National and Kapodistrian University of Athens, Athens, Greece

    Dimitris Emmanouil

  4. Division of Child and Adolescent Psychiatry, Autism and Developmental Disorders Clinic, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

    Antonio Y. Hardan

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  1. John W. Berkenbosch
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  2. Thuc-Quyen Nguyen
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  3. Dimitris Emmanouil
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  4. Antonio Y. Hardan
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Correspondence to John W. Berkenbosch .

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  1. Department of Anesthesiology, Harvard Medical School, Boston, MA, USA

    Keira P. Mason, MD

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Berkenbosch, J.W., Nguyen, TQ., Emmanouil, D., Hardan, A.Y. (2021). Special Considerations During Sedation of the Child with Autism Spectrum Disorder. In: Mason, MD, K.P. (eds) Pediatric Sedation Outside of the Operating Room. Springer, Cham. https://doi.org/10.1007/978-3-030-58406-1_26

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  • DOI: https://doi.org/10.1007/978-3-030-58406-1_26

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