Dental Anesthesia for the Autistic Child
I am a member of the anesthesiology faculty at Stanford University Hospital, writing in response to the question of autistic children requiring anesthesia for dental procedures.
There are no data that any anesthetic drug(s) cause or worsen autism, nor are there any published data on preferred drugs for anesthetizing autistic children.
Dental anesthesia is usually performed in the dentist’s office. The mandatory requirements are: (1) that an M.D. (or sometimes a D.D.S.) anesthesiologist experienced in dental and in pediatric anesthesia does the anesthesia care, and (2) that standard hospital operating room monitoring instruments (e.g., pulse oximetry, ECG, and blood pressure), and resuscitation equipment (including a defibrillator) are present in the dental suite.
If the child has serious medical problems (e.g., heart problems, breathing problems, seizures, or airway problems) it is sometimes unsafe to give anesthesia care in the dental office, and the dentist will need to do the procedure in a hospital room setting. This decision is made by the anesthesiologist.
Our standard of care is to make a preoperative phone call to the parent(s), both to obtain information on the child’s medical history, and also to describe the anesthetic planned for the child.
The preferred technique for dental office anesthesia is ‘deep sedation,’ where the child is asleep, without awareness of pain, is breathing spontaneously, and has stable vital signs. The anesthesiologist is in constant attendance.
The anesthetic begins by sedating the child so that an intravenous (IV) can be inserted. There are two common ways to do this:
- If the child is cooperative, oral midazolam (Versed), a Valium-like sedative, is given. The child will become relaxed, sleepy, and will separate from the parents with minimal distress. The IV is then started in the operating suite, using a small amount of local anesthetic injected into the skin.
- If the child is emotionally uncooperative, an injection is given into the muscle of the shoulder or thigh. We use a combination of midazolam, ketamine, and atropine. This combination reliably produces a sleeping child in 5 - 10 minutes. At this point, the child is separated from his parents, and the IV is started in the operating suite.
The monitors of vital signs are applied to the child, including the pulse oximeter, the electrocardiogram, the blood pressure cuff, and a stethoscope. Additional sedation is added via the IV as needed to maintain the deep sedation state safely. Typically we add narcotic pain relievers such as meperidine (Demerol), or the short acting sedative propofol. Local anesthetic is sometimes injected by the dentist.
When the dental procedure is finished, the child stays at the facility until safely aware. This usually requires a minimum of 30 minutes.
Post-anesthesia side effects are sleepiness, sometimes nausea, and in some children, aggressive behavior or agitation.
When dental sedation is done by an experienced anesthesiologist with modern monitoring equipment and medications, the rate of major complications should be low. The risk of driving in the car to the dental office should exceed the anesthetic risk.
Please refer to our anesthesia website at www.aamgpaloalto.com, particularly the sections on dental anesthesia and pediatric anesthesia. Email response is provided.
Richard John Novak, M.D.
Clinical Associate Professor
Stanford Department of Anesthesiology
© copyright 2005, 2006 Autism Research Institute
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