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Induction of anesthesia in a combative child; management and issues.

Christiansen E, Chambers N

Department of Anaesthesia, Princess Margaret Hospital For Children, Perth, WA, Australia.

A developmentally delayed, 13-year old autistic boy required management of multifocal cerebral and pulmonary tumors, involving several anesthetics over a 4-month period. At each anesthetic he refused premedication, displayed increasing anxiety and became more combative. With parental guidance and involvement, a variety of anesthetists tried a range of techniques to achieve induction, each ultimately resorting to the use of physical restraint. Principles essential to the care of such a child include early recognition, parental support, multi-disciplinary planning of procedures requiring general anesthesia, continuity of anesthesia care, and clear guidelines about the perioperative management of uncooperative children, including the ethical use of restraint.

Published 14 April 2005 in Paediatr Anaesth, 15(5): 421-5.
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