Anaesthesia for children with special needs, including autistic spectrum disorder

Abstract

Approximately 2% of the population are thought to have a learning disability, with an estimated prevalence in England of 75 000 children and young people whose condition is moderate to severe. 1 For the purposes of this article, the term ‘special needs’ encompasses learning disability (IQ,70), language and communication disorder, or any disability that prevents a child from coping well with new experiences. Although children with learning disability may have robust physical health, developmental delay is often one manifestation of a syndrome or condition associated with other physical comorbidities (e.g. cerebral palsy, Down’s syndrome, metabolic disorders). Clinical aspects of the anaesthesia management of these conditions have been addressed previously in this journal and can be found in the archive. Many children with special needs may attend hospital for investigations, medical management, or surgery. They may exhibit high levels of anxiety when faced with hospital treatment, and may have difficulty conforming to the usual pattern of care. In extreme cases, children may become so uncooperative that their procedure is postponed or abandoned, or can only be undertaken with the use of heavy sedative premedication or restraint. It is therefore important to find ways to meet their individual needs, particularly in areas such as information, communication, and pain assessment in order to minimize anxiety and distress and create a calm and positive experience for the child and family. These psychological and social aspects of care will be the focus of this article.