difficult to sedate; oral medications may not be effective or may be
difficult to administer. Excessive pre-sedation can extend discharge
times, which affects nursing ratios. Also, there is evidence that chil-
dren with ASD may metabolize medications differently. Sedation and
anesthesia can affect some children significantly in the post-op peri-
od. Some patients exhibit effects for days after the procedure.
2. Individualized plans
We ask patients and family members to visit us for a pre-op meeting.
A pre-op nurse with a standardized autism checklist can do an excel-
lent job of pre-op screening. (Download a checklist you can use to
assess and manage children with autism at
outpatientsurgery.net/forms.)
Parents appreciate being asked about how we can best support their
child and being involved in creating a coping plan. They typically are
eager to share how autism affects their child's daily function and behav-
ioral triggers. These may include loud noises, bright lights, groups of
people, strong smells, transitions and previous experiences at health-
care facilities. Based on the information gathered, your team can cus-
tomize the child's experience to make the visit as stress-free as possi-
ble. Some patients only need slight environmental modification, or a
few changes in the way the perioperative staff communicates. Others
may need more extensive coping plans. Document and communicate
these coping plans to everyone involved in the patient's care.
One important question is whether sedation will be required and, if
so, how much? If the child is verbal, I typically ask the child to stand
up so that I can listen to the heart and lungs and do an airway exam.
This gives needed information on how the child tolerates strangers,
healthcare professionals in their space and physical touch (all neces-
sary during anesthetic induction). If the child is cooperative, I proceed
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