From Sean P Antosh, MD, Chief Medical Wellness and Engagement Officer, Pediatric Anesthesiologist, Dayton Children's Hospital
I truly appreciated your review of Perioperative Management and Outcomes in Patients With Autism Spectrum Disorder (February 15,2024) and I agree it is a very vulnerable patient population in which we as a specialty need to address to help provide equitable and safe care. Through the Society for Pediatric Anesthesia, Dr Katie Harris and I have started a Special Interest Group for the “Perioperative Care of Children with Special Developmental and/or Behavioral Health Needs | Society for Pediatric Anesthesia (pedsanesthesia.org)” and encourage those interested in helping become part of the solution. Our goals include: developing best practice guidelines for the perioperative care of children with special developmental and /or behavioral health needs, improving the education of pediatric anesthesiologists for these patients by developing curriculum resources, and collaborate with centers nationally and internationally to identify knowledge gaps in the care of these children to identify future research initiatives. While we are early in our endeavors, we have a strong group of pediatric anesthesiologists from around the country to bring attention to this patient population.
(from Myron: All SPA committees and SIGs are open to all membership. If you are interested in joining this or any of SPA’s committees or SIGS simply sign up and join!)
I agree with your assessment that there needs to me more research into the preoperative process, to decrease pharmacologic interventions for a successful induction. Organizational culture can go a long way to improving care. Here at Dayton Children’s Hospital, we have developed adaptive sensory environments that allow the child to wait prior to surgery. The room is adapted based on the patient’s individual coping plans to decrease environmental sensitivities such as fluorescent lights or loud sounds. We have seen a large decrease in premedication use, we are now routinely only giving less than 20% of patients with autism a premedication – with no changes in our induction scores. We are hoping our upcoming manuscript on this will help provide more context for non-pharmacologic techniques. More information regarding our adaptive sensory rooms can be found here: our sensory program sets the gold standard for patient care | Dayton Children's Hospital (childrensdayton.org).
I really enjoyed your thought provoking questions, those have been living in my mind for a long time now. So many questions and so few answers. The other one that I always consider is, “what about the adults with autism”? I have many adult colleagues who are uncomfortable taking care of a severely autistic individual in their 40-50s for routine cases. We need to find a way to provide education and best practices to help provide equitable and safe care no matter the age.