Performing procedures, imaging studies and sedation for children with developmental delays can be particularly challenging. Increased anxiety, aggressive behaviors, inability to communicate and parental stress are some factors in particular that are of concern. This may lead to delays for the sedation team and the need for increased resources.
In this article, Kamat, et al, looks specifically at patients with autism spectrum disorder diagnoses who are sedated for magnetic resonance imaging. This was a single center, case control study. The hypothesis was that children with autism spectrum disorder (ASD) would require more staff/personnel prior to sedation start and would have more sedation related adverse events and interventions performed. Additionally, of interest were delays in sedation, strain on workflow and longer sedation times that may be created by children with ASD due to increased resource requirements and utilization.
The primary outcome assessed by the research team was the number of personnel required to accomplish sedation. The secondary outcomes included duration of stay, time of registration to start of sedation, duration of sedation, serious adverse events, and interventions required in response to serious adverse events. Children with ASD were directly compared to children without ASD diagnoses.
Statistically significant differences between the ASD group and the control/non-ASD were race/ethnicity and reason for requesting MRI of the brain. Children in the ASD group were most likely to have requested an MRI for seizures (39% vs 17% for controls), whereas children in the non-ASD control were most likely to have requested an MRI for tumor follow-up (52% vs 13% in ASD group). Sedation providers include the sedation physician (emergency medicine, critical care, pediatric anesthesia), sedation bedside nurse, or child life specialist. Most children, regardless of ASD diagnosis, required 2-3 sedation providers. However, children with ASD required ~4-5 sedation providers on ~9% of sedation encounters while there were no children without ASD requiring this number of providers. After induction was achieved, there were no differences in adverse events or interventions performed in the ASD group vs the non-ASD group. Procedures were completed in 99% of sedation encounters, regardless of diagnosis.
There is certainly a paucity of literature discussing effective and efficient sedation of children with developmental delays. Children with autism, in particular, are often referred to general anesthesia because there is a perception that they are difficult to sedate. Kilbaugh et al describes a similar experience with sedations and autistic children. Kilbaugh et al describe a similar experience in that children with autism and developmental delays often have complex neurologic medical histories placing them at higher risk for sedation related adverse events, especially upper airway obstruction.
Carmen D. Sulton, MD
Assistant Professor of Pediatrics and Emergency Medicine
Emory University School of Medicine
Patricia Scherrer, MD
Sedation Services, Children’s Healthcare of Atlanta at Egleston
The article abstract can be found via the link on our blog.
- Kamat PP, Karaga MK, Wisiewski BL, et al. Outpatient Procedural Sedation of Patient with Autism Spectrum Disorders for Magnetic Resonance Imaging of the Brain Using Propofol. Journal of Child Neurology, vol. 33, no. 5, 2018, pp. 313–319.
- Kilbaugh TJ, Friess SH, Raghupahthi R, et al. Sedation and Analgesia in Children with Developmental Disabilities and Neurologic Disorders. International Journal of Pediatrics, vol 2010, Article ID 189142.