Letter to my fellow anesthesiologists
Author Unknown


Dear Colleagues,

I know what a challenge anesthetizing an autistic child can be. As a board certified anesthesiologist and a parent of two autistic boys I have been on both sides of this problem. I would not presume to dictate your anesthetic practice. As you know most autistic children are physiologically healthy and tolerate general anesthesia very well. There are a few items I would like to remind you of, if you do not routinely work with this population.

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 Our colleague often base treatments and prognosis on data 20 years out of date.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!