1. Currently medical science has
not elucidated the cause of autism. There is some very promising work
being done. Certainly this is a metabolic- physiologic problem not
caused by a psychiatric trauma.
2. No two autistic children are alike. This is
really a diagnosis of symptoms and signs. You cannot treat them the
same because they are not the same. When medical science gets this
figured out there will be multiple etiologies for this syndrome.
3. The unifying symptom that these
children have is difficulty with communication. They may not
understand what you are saying and may not be able to express what
they are thinking. My very strong bias is that most of an autistic
child's behavior problems stein from a frustration with not
understanding and not being understood.
4. With number three in mind, I
believe that our job as anesthesiologists is to not only safely
anesthetize them, but to try to return them to their baseline as
quickly as possible. A person with an altered perception of reality
will not improve if we further alter their reality. For example, a
drug such as ketamine, which alters sensory perception, would not be
the first choice for a person in whom auditory, visual and tactile
senses are already altered.
5. Please listen to the parents and caretakers
of your autistic patient. They really do know this child the best.
Know that many of these parents have been beaten up by our medical
system. Our medical colleagues have too often not listened, attributed
all physiologic symptoms to the "autism" (autism causes
diarrhea ... I kid you not....) Our colleague often base treatments
and prognosis on data 20 years out of date. Forgive them if they are a
little irritable. They have had to be advocates for their child's
education, insurance coverage and they are likely just trying to
ensure that the perioperative period goes as smoothly as possible.
They want the same thing for their child that you do for yours!