Management of critical care emergencies in children with autism spectrum disorder

Table 9 Sedation and anesthesia protocols for children with autism spectrum disorder in the emergency setting¹

Protocol component	Guidelines
Pre-procedure assessment
Medical history	Obtain a detailed medical history, including any previous reactions to sedation or anesthesia
	Review comorbid conditions, current medications, and allergies
Behavioral assessment	Assess baseline behaviors and any known triggers for anxiety or behavioral issues
	Consult with caregivers for effective calming strategies and past experiences with sedation
Preparation for sedation/anesthesia
Communication	Explain the procedure to the child using simple language and visual aids
	Involve caregivers to help explain and reassure the child
Familiar items	Allow the child to have familiar comfort items during the preparation phase
Pre-medication	Consider using anxiolytics or mild sedatives as premedication to reduce anxiety and agitation
Sedation/anesthesia plan
Tailored dosage	Adjust dosages based on the child’s weight, age, and medical history
	Use the lowest effective dose to achieve the desired level of sedation or anesthesia
Medication choice	Select sedatives and anesthetics with a favorable safety profile and minimal side effects
	Avoid medications known to exacerbate behavioral issues or cause adverse reactions in children with ASD
Multidisciplinary Consultation	Involve a pediatric anesthesiologist and other specialists as needed to develop a comprehensive plan
During sedation/anesthesia
Monitoring	Continuously monitor vital signs, including heart rate, respiratory rate, blood pressure, and oxygen saturation
	Observe for any signs of distress, adverse reactions, or changes in behavior
Behavioral observation	Monitor behavioral responses to sedation, noting any unusual or unexpected reactions
Post-procedure care
Recovery monitoring	Monitor the child closely during the recovery phase for any delayed reactions or complications
	Ensure a calm and quiet environment to facilitate smooth recovery
Pain management	Provide appropriate pain relief post-procedure, considering the child’s pain threshold and sensitivities
	Use non-pharmacological methods in conjunction with medication for effective pain management
Caregiver involvement	Allow caregivers to be present during recovery to provide comfort and reassurance
	Educate caregivers on what to expect during the recovery period and signs of potential complications
Documentation and follow-up
Detailed documentation	Document all sedation/anesthesia process aspects, including medications used, dosages, and responses
	Record any adverse reactions or complications and the interventions used to address them
Follow-up care	Schedule follow-up appointments to monitor the child’s recovery and address any ongoing concerns
	Provide caregivers with contact information for post-procedure questions or emergencies

¹This table format organizes the guidelines for sedation and anesthesia protocols for children with autism spectrum disorder in an emergency setting.

ASD: Autism spectrum disorder.