Abstract
In this chapter, we will discuss the perioperative anesthetic concerns of
children with autism, attention-deficit hyperactivity disorder (ADHD), cystic fibrosis,
epidermolysis bullosa, and von Willebrand disease. Children with autism and ADHD
are at high risk for having severe anxiety and distress when undergoing anesthesia due
to difficulty in adjusting to the changes in daily routine and new environment. Careful
planning to limit waiting time in the preoperative area and appropriate premedication
are critical to minimizing distress. Children with cystic fibrosis may have involvement
of pulmonary, gastrointestinal, and pancreaticobiliary organ systems. Due to the
increasing longevity of this population, both children and adults may present for a
variety of surgical procedures; pulmonary status is a key concern when formulating an
anesthetic plan. Children with epidermolysis bullosa present special challenges when
undergoing anesthesia because both airway devices and the equipment used to monitor
vital signs can cause serious postoperative complications. Von Willebrand disease is
the most common congenital bleeding disorder encountered in pediatric anesthesia.
Safe perioperative management requires interdisciplinary coordination to create a plan
for prophylaxis prior to surgery, intraoperative and postoperative management to
maintain hemostasis.
Keywords: Aggressive child emergencies, Autism spectrum disorder, Asperger’s syndrome, Attention-deficit hyperactivity disorder, Anxiety, Cystic fibrosis, Desmopressin, Dystrophic epidermolysis bullosa, Epidermolysis bullosa, Hemostasis, Perioperative care, premedication, Postoperative aggression, Von Willebrand disease.