Abstract
Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety.
Highlights
Autism is an heterogeneous developmental disorder mainly characterized by three domains of impairments: communication-language, social interaction, and behavioral oddities [1]
Patients with autism present many potential problems in terms of management of anesthesia. This case aimed at reporting a case of Bispectral Index System-guided TIVA in autistic patient
Anesthesia was maintained with oxygen (1 L/min), medical air (1.5 L/min), and continuous infusion of 100–150 μg/kg/min of propofol and 0.2–0.4 μg/kg/min of remifentanil using an infusion pump
Summary
Autism is an heterogeneous developmental disorder mainly characterized by three domains of impairments: communication-language, social interaction, and behavioral oddities [1]. There is a great variation in the severity of autism and hospital needs of these children. Patients with autism present many potential problems in terms of management of anesthesia.
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