Autism and Anaesthesia

Question 1

Incidence of Autism

Answer 1

1-2%

Question 2

Definition of autism

Answer 2

A lifelong neurodevelopmental difference that influences the way a person interacts and
communicates with others and experiences the world around them.

Often manifesting with:
- Unconventional social communication
- Sensory sensitivities
- Focused interests
- Repetitive behaviours

Question 3

Genetic conditions associated with autism

Answer 3

• Fragile X
• Angelman Syndrome
• Phelan McDermid Syndrome
• Neurofibromatosis 1
• Tuberous sclerosis

Question 4

Conditions associated with autism

Answer 4

• Epilepsy
• Intellectual disability
• Obesity
• HTN
• Diabetes
• Depression and Anxiety
• Chronic pain
• Parkinson’s disease

Question 5

SPACE framework for autism

Answer 5

• Sensory: consider noise, touch, lighting
• Predictability: try to create a routine
• Acceptance: encourage routines that help nerves (fidget spinners)
• Communication: can range from normal to non-verbal, usually stress worsens this
• Empathy: may be more challenging for healthcare workers to display

Question 6

Pre-operative anaesthetic considerations for patients with autism

Answer 6

• Information leaflets, detailed explanation of what to expect on the day
• Disseminate autism passport to staff if one is available
• Aim to have first on the list
• Try to provide a private area
• Communication- consider collateral if non-verbal
• Pre-med- midazolam, clonidine, dexmed, ketamine

Question 7

Intra-operative anaesthetic considerations for patients with autism

Answer 7

• Consider induction in anaesthetic room with dimmed lights if safe
• Consider patient holding own mask, minimise touching
• Secure IV access before extubation
• Quiet emergence

Question 8

Post-operative anaesthetic considerations for patients with autism

Answer 8

• Dim quiet environment if possible