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Enhanced perioperative management of children with autism: a pilot study

  • Amanda WhippeyEmail author
  • Leora M. Bernstein
  • Debra O’Rourke
  • Desigen Reddy
Reports of Original Investigations

Abstract

Purpose

When children with autism spectrum disorder (ASD) are in hospital, difficulties with socialization, communication, and behaviour can be exacerbated. The purpose of this study was to establish feasibility of an enhanced perioperative care pathway.

Methods

Utilizing parental and provider feedback, a protocol including environment modification, anxiolysis plans, specialized order sets, and child life specialist (CLS) support was developed over a nine-month period. Autism severity scores (ASS), communication styles, triggers, and previous experiences were used to create individualized care plans in the preoperative clinic. Emotion and sedation scores in the same day surgery unit, at anesthesia induction, and in the postanesthesia care unit were recorded. Acceptance was obtained from nurses, anesthesiologists, and parents. Feasibility criteria included the recruitment rate, adherence to protocol, data collection, and patient follow-up.

Results

Eighteen patients were enrolled in this pilot study. All feasibility criteria including recruitment, adherence to study protocol (97%), and follow-up (94%) were met. Fifteen (83%) patients were nonverbal and minimally interactive (ASS = 3). Common triggers were loud noises (78%), crowds (78%), and bright lights (56%). After implementation of the protocol, 15 (83%) of the anesthetic inductions were described as excellent. Ten different premedication plans were used. Parents described the personalized plan, anxiolysis medication, and CLS support as advantageous. All (100%) nurses, anesthesiologists, and parents felt the program should continue.

Conclusion

We showed that a multidisciplinary perioperative care plan for children with severe ASD was feasible and 100% accepted at our institution. The individual nature of anxiolysis plans was considered a strength of the protocol.

Optimisation de la prise en charge périopératoire des enfants atteints d’autisme : une étude pilote

Résumé

Objectif

Lorsque des enfants souffrant d’un trouble du spectre de l’autisme (TSA) sont à l’hôpital, leurs difficultés en matière de socialisation, de communication et de comportement peuvent être exacerbées. L’objectif de cette étude était d’établir la faisabilité d’un plan d’intervention périopératoire optimisé.

Méthode

En nous fondant sur les commentaires des parents et des professionnels des soins de santé, un protocole comprenant des modifications de l’environnement, des plans de gestion de l’anxiété, des ensembles d’ordonnances spécialisés et le soutien d’un spécialiste de l’enfance a été mis au point sur une période de neuf mois. Les scores de sévérité de l’autisme (SSA), les styles de communication, les déclencheurs et les expériences passées ont été utilisés afin de créer des plans d’intervention personnalisés en clinique préopératoire. Les scores d’émotion et de sédation ont été enregistrés à l’unité de chirurgie d’un jour, à l’induction de l’anesthésie et en salle de réveil. L’accord sur le plan d’intervention a été obtenu du personnel infirmier, des anesthésiologistes et des parents. Les critères de faisabilité comprenaient le taux de recrutement, l’observance du protocole, la collecte de données et le suivi des patients.

Résultats

Dix-huit patients ont été recrutés dans cette étude pilote. Tous les critères de faisabilité, y compris le recrutement, l’observance du protocole (97 %) et le suivi (94 %), ont été respectés. Quinze (83%) patients étaient non verbaux et minimalement interactifs (SSA = 3). Les déclencheurs fréquents étaient les bruits forts (78 %), les foules (78 %), et les lumières vives (56 %). Après la mise en œuvre du protocole, 15 (83 %) des inductions anesthésiques ont été décrites comme excellentes. Dix plans de prémédication différents ont été utilisés. Les parents ont estimé que le plan d’intervention personnalisé, la médication anxiolytique et le soutien du spécialiste de l’enfance étaient bénéfiques. Tous les intervenants (100 %, c’est-à-dire personnel infirmier, anesthésiologistes et parents) étaient d’avis que le programme devrait se poursuivre.

Conclusion

Nous avons démontré qu’un plan d’intervention périopératoire multidisciplinaire spécialement conçu pour les enfants souffrant de TSA sévère était faisable et accepté à 100 % dans notre institution. La nature personnalisée des plans de gestion de l’anxiété a été considérée comme l’une des forces du protocole.

Notes

Acknowledgements

The authors gratefully acknowledge the participation and support of the perioperative staff at McMaster Children’s Hospital, without whom this project would not have been possible. We thank Sara Miller M.Sc., Scientific Editor, Department of Anesthesia – Research Office, McMaster University for editing this manuscript.

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Amanda Whippey contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Leora Bernstein contributed to the study conception and design, analysis of the data, and drafting of the manuscript. Debra O’Rourke contributed to the study conception and design, and acquisition of data. Desigen Reddy contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article.

Funding

None declared.

Supplementary material

12630_2019_1410_MOESM1_ESM.pdf (883 kb)
Supplementary material 1 (PDF 883 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of AnesthesiaMcMaster UniversityHamiltonCanada
  2. 2.McMaster Children’s HospitalHamiltonCanada

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