Behavioural training and mirroring techniques to prepare elective anaesthesia in severe autistic spectrum disorder patients: an illustrative case and review

Summary

Children with autistic spectrum disorder are more likely to become distressed during induction of anaesthesia. Inhalational induction is almost always the preferred route with acceptance of the face mask often presenting a considerable challenge. Tempering measures to facilitate gas induction such as forced premedication and physical restraint are no longer viable options except in extenuating circumstances. Recent research interest has focused on the need for advanced planning in collaboration with the caregiver to tailor an individualised perioperative plan. This plan may include both pharmacological and non pharmacological interventions. Applied behaviour analysis strategies have a well documented efficacy in this unique population to systematically change an individual's usual behaviour. These can be used, as a non pharmacological strategy, to ensure a smooth perioperative course. We present a successful case of preoperative desensitisation of a child with severe autistic spectrum disorder using a mirror demonstration technique associated with positive reinforcement to prepare him for general anaesthesia. We discuss the potential application of applied behaviour analysis strategies for anaesthesia in this unique population. From a practical point of view, early communication with carers is required to establish who may benefit from this behavioural training. Planned individual preparation for general anaesthesia must be provided by trained multidisciplinary staff.

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