Benefits of an individualized perioperative plan for children with autism spectrum disorder

• Published in: Pediatric anesthesia 2017-08, Vol.27 (8), p.856-862
• Main Authors: Swartz, Jo S., Amos, Karen E., Brindas, Mirna, Girling, Linda G., Ruth Graham, M., Bosenberg, Adrian
• Format: Article
• Language: English
• Subjects: Adolescent; Ambulatory Surgical Procedures; Anesthesia; Anesthesia - methods; Asperger Syndrome - psychology; Asperger's; Autism; autism spectrum disorder; Autism Spectrum Disorder - psychology; Autistic children; Caregivers; Child; Conscious Sedation - methods; Cooperation; Female; general anesthesia; Humans; Male; Patient Care Planning; Patient Satisfaction; perioperative; Perioperative Care - methods; Precision Medicine - methods; Retrospective Studies; sedation
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.13189

Summary Background Perioperative care for children with autism spectrum disorder may be challenging. Previous investigators recommend development of an individualized perioperative management plan with caregiver involvement. Aim The primary goal was to determine the usefulness of an individualized plan based on the decision to provide preoperative sedation stratified by autism spectrum severity level. Secondary goals were to assess the effectiveness of the plan based on subjective assessment of patient behavior at induction of anesthesia and caregiver satisfaction. Methods We developed an individualized plan for each child with autism spectrum disorder scheduled for anesthesia. Children were categorized by autism spectrum disorder severity level. With institutional ethics approval, we conducted a retrospective chart review to document need for preoperative sedation, sedation stratified by autism spectrum disorder severity level, behavior at induction, and caregiver satisfaction. Results Between 2012 and 2014, we successfully prepared a plan for 246 (98%) of 251 surgical or diagnostic procedures in 224 patients. Severity level was distributed as 45% Severity Level 1 and Asperger's, 25% Severity Level 2, and 30% Severity Level 3. The majority (90%) of cases were scheduled as day surgery. Preoperative sedation increased with increasing severity level: Severity Level 1 (21%) or Asperger's (31%), Severity Level 2 (44%), and Severity Level 3 (56%). The odds ratio for sedation use was 5.5 [CI: 2.6‐11.5, P