Special Needs Patients & Anesthesia Paper
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suggests the alternative approach to restraint methods, which are used very seldom today because such methods become out-of-date and alternative methods, like those suggested by the author are introduced instead.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
Kanegaye JT, Favela JL, Acosta M, Bank DE. (2003). High-dose rectal midazolam for pediatric procedures: a randomized trial of sedative efficacy and agitation. Pediatr Emerg Care. 19: 329-336.
The authors discuss the use of midazolam in anesthesia of children with ASD. Oral midazolam is the preferred drug in the US and Europe due to its rapid onset, short duration of onset, and lack of major side effects with a routine dose of about 0.5 mg/kg. Midazolam can be associated with adverse psychotropic effects including disinhibition and at higher doses can cause dysphoria. The researchers also argue that the dosage for children is different from the dosage for adults. The use of the proper dosage is crucial for the effective and safe anaesthesiology.Kemper TL. (2005). Neuroanatomic observations of the brain in autism: a review and future directions. Int J Dev Neurosci. 23: 183-187.
The author reveals the problem of the development of autism and treatment of patients with this health problem. The author explores the problem of the development of effective approaches to the treatment of autism and conducts the brief study of the treatment of health issues patents with ASD may have. In this regard, the author argues that the anesthesia of patients with ASD is different from other patients. This is why the author recommends having the discussion with parents of the anesthetic plan and options. Also the patient recommends placing autistic patients first on the operating list, to minimize the effects of waiting and starvation. Special Needs Patients & Anesthesia Paper
Posey DJ, Stigler KA, Erickson CA, McDougle CJ. (2008). Antipsychotics in the treatment of autism. J Clin Invest. 118: 6-14.
Autistic patients are considered difficult patients due to increased anxiety of patient and family members, uncooperative or combative behavior, or in extreme cases very violent behavior of patients. The authors argue that the treatment of patients with ASD needs special attention, if anesthesia is needed. The treatment of patients with ASD needs the preliminary communication and interaction between anesthesiologists and their autistic patients. The authors argue that the treatment may need more time to come prepared to anesthesiology.
Rossignol DA . (2007). Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism. Med Hypotheses. 68: 1208-1227.
The author focuses on the treatment of autism and the treatment of various health problems that patients with ASD may have. The author argues that the treatment of patients with ASD requires considerable efforts and the use of the proper medication, if anesthesia is needed. Special Needs Patients & Anesthesia Paper The author points out that anesthesiologists should take into consideration the regular medication with ASD have to avoid possible side effects of the medicaments used in anesthesiology. Although various non-pharmacologic measures are available to make pre-induction period smooth, they are often not sufficient and premedication becomes a vital part of the pre-induction period. Premedication can modify behavior by providing amnesia, anxiolysis and sedation improving overall compliance. When administered, premedication should be safe and effective and oral route is preferred.Schreiber S1, Backer MM, Weizman R, Pick CG. (1997). Augmentation of opioid induced antinociception by the atypical antipsychotic drug risperidone in mice. Neurosci Lett. 228: 25-28.
The authors explore testing of medicaments that may be used in medication of patients with ASD in the course of anesthesiology. The study reveals the fact that dexmedetomidine is a particularly attractive premedication because it is both a reliable sedative, and it possesses an excellent safety profile with minimal respiratory depression and hemodynamic changes that are rarely clinically significant.Special Needs Patients & Anesthesia Paper