Higher anesthetic dose requirement for sedation in children with autism spectrum disorder compared to neuro-atypical controls- a prospective observational study

Abstract

IntroductionChildren with Autism Spectrum Disorders (ASD) are known to require general anesthesia or sedation for undergoing procedures like Magnetic Resonance Imaging (MRI). The dose required for sedation may vary depending on multiple factors. The aim of this study was to compare the sedative requirements of children with ASD with those who do not have ASD for undergoing MRI. MethodsThirty-four children with ASD and 31 neuro-atypical controls (children with other neurological disorders undergoing MRI) were recruited into the study. Children were premedicated with injection midazolam 0.1 mg/kg. This was followed by dexmedetomidine 2 mcg/kg over 2 min, followed by 2 mcg/kg/hour infusion inside the MRI gantry. If the above anesthetic was insufficient to make the child immobile, a bolus dose of thiopentone 3 mg/kg was supplemented and this was compared between the two groups. The children were monitored with ECG, and oxygen saturation. Since, these children were on sedative medications, each patient was given a sedation score depending on the number of sedative medications, the child was receiving. ResultsTwenty one of 34 children in the ASD group required thiopentone for sedation while 5 of 31 in the control group required thiopentone supplementation (p < 0.001). The thiopentone requirement continued to be significantly different between the two groups at each level of sedation score (0, 1, 2 +) (p < 0.004). ConclusionChildren with ASD required higher anesthetic dose for sedation compared to neuro-atypical controls for MRI. This study has shown that dexmedetomidine can be safely used for children with autism and additional sedatives are often required for imaging.