Child With Autism has Scoliosis of Thoracic Spine

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
A 12 years old child with Autism, has scoliosis of thoracic spine of 15 degrees, with carotinemia, lipid disorders and muscle weakness. She was presented for orchidopexy in a day care unit under general anesthesia. What are the precautions to be taken and is it wise to be done in the main theatre with or without admission post operative. Thanks
Answer
Here are a few pointers which the anesthesiologist should bear in mind in such a case: Autism: Autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder, that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Autism tends to occur more frequently than expected among individuals who have certain medical conditions, including Fragile X syndrome, tuberous sclerosis, congenital rubella syndrome, and untreated phenylketonuria. (PKU) Carotenemia: This condition most commonly occurs in children with liver disease, hypothyroidism, or diabetes mellitus. Carotenemia may be particularly evident when the stratum corneum is thickened or when the subcutaneous fat is strongly represented. This child also has an lipid disorder with muscle weakness , so she couldmay have lipoprotein disorders and some form of ataxia.. Anesthesia considerations would be 1. dDifficult intubation due to the deposition of fat.. Rrule of a difficult intubation case or keep ready a difficult intubation cart. 2. Malignant hyperthermia, avoid using agents which predispose the patient to malignant hyperthermia like halothane.. 3. Might have deranged liver profile., Keep in mind to use the agents which have first pass metabolism. 4. Might have associated hypothroidism, dosage of drugs should be borne in mind. The procedure can be done in day care, just extra precautions should be taken for administration of drugs as well as halogenated flouro carbons. Back to All Questions

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