Is Oral or IV Sedation best for Autistic Patient?

A DOCS Education Gold Member writes:
I have no experience sedating people with autism. A mother of a 19-year old with severe autism came in to my office requesting sedation for her son. He is otherwise very healthy, although he is overweight. I do not have his weight yet, but my guess is that he is around six feet tall and close to 300 pounds. He is generally sweet and compliant, but can become combative. He is non-verbal. He is on no medications. If anyone has experience with autism and sedation, I would appreciate your comments and insights. I would expect that he would respond normally to the medication, but I still would like to know what people have experienced.

Dr. PJ Goyal, DOCS Education faculty member, responds:

I have found that autistic patients are not very good OCS candidates. Since you are assuming that he is very big I am picturing him being obese and possibly having sleep apnea. If he is also very combative, his level of sedation will need to be deep. I would recommend bringing in an anesthesiologist or referring.

Dr. Anthony S. Feck, DOCS Education Dean of Faculty, adds:

Aside from what Dr. Goyal has written, being non-verbal presents a challenge in determining level of consciousness. If it were not for this, I would have allowed for a test sedation appointment. Even in my IV sedation practice, I would manage expectations of the caregiver by preparing them for the need for deep sedation provided by a dedicated anesthesiologist.

The DOCS Education member responds:
Tony, thank you for addressing this. I should have clarified better. The mother and I discussed the very real possibility of her son needing IV sedation for treatment. We are wondering about doing a test sedation and gathering our records and doing an exam. If we are unable to do the exam, then I will have the anesthesiologist in for the exam and treatment. It would just be nice to give the mother an idea of the financial outlay she will be looking at for dental treatment for her son.

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