Dose Requirements for Propofol Anaesthesia for Dental Treatment for Autistic Patients Compared with Intellectually Impaired Patients

Abstract

We had clinical grounds to suspect that patients with autism had greater propofol requirements during dental procedures than patients with intellectual impairment without autism. This hypothesis was tested by an audit of a standard anaesthetic technique. The audit was approved by our Hospital Ethics Committee. We compared the propofol requirements and effect using a standardised protocol during dental treatment in 56 autistic patients (age range three to 35 years) and 56 intellectually impaired patients (age range four to 42 years). Patients in each disability group were divided into three subgroups by age: six years or younger, seven to 19 years and 20 years or older. Combative patients received oral midazolam premedication, other patients received a single intravenous bolus of midazolam at induction. Otherwise, standardised propofol boluses and infusion were the only anaesthetic agents used. The propofol infusion rates of the intellectually impaired group showed significant decline with age (propofol rate of requirement mg.kg−1.h−1 mean [SD]): <six years 13.6 (3.6), seven to 19 years 9.5 (3.0) (P=0.008 cf <six years group), >19years group 8.5 (2.4) (P=0.001 cf <six years group). The propofol requirement was greater in the autism group than in the intellectual disability group, and the proportion of the cases where bolus propofol administration was needed after induction was significantly higher in the autistic patient group than in the intellectually impaired patients (P <0.002). This suggests that autistic patients have greater propofol requirements for anaesthesia during ordinary dental treatment compared with intellectually impaired patients.

Experiences of Dental Care and Dental Anxiety in Adults with Autism Spectrum Disorder

“…The patients in the ASD group might also have a lowered pain threshold for some qualities of pain. During dental treatment under general anaesthesia the need of anaesthetic medication (the propofol requirement) was found to be greater amongst patients with autism than intellectually impaired controls [25]. …”

Sensitivity to isoflurane anesthesia increases in autism spectrum disorder Shank3 +/∆c mutant mouse model

“…7,41–43 A study by Asahi et al 42 showed that for dental procedures, autistic patients have greater requirements for propofol, an intravenous anesthetic, than do intellectually impaired patients. However, the mechanisms of action of propofol and inhalational anesthetics are substantially different.…”

An unexpected increase of entropy in a sleepwalking disorder patient during propofol and remifentanil anesthesia: a case report

“…Therefore, the aforementioned changes may lead to drug resistance and EEG changes. This possibility is supported by the finding that patients who present with autism spectrum disorder as a result of deficient neural development have greater propofol requirements for anesthesia during ordinary dental treatment compared with intellectually impaired patients [15]. …”