Let me start this post by saying that I am the farthest thing from an expert on this subject and that my intention is simply to share our recent experience with anesthesia for our son, who has autism.
Given the fact that my son’s biochemical pathways are already compromised, I was definitely concerned when his dentist recommended a surgical procedure to remove four baby teeth that needed to come out.
First of all, I didn’t want to assume that surgery was automatically the best answer. I mean, why should I assume that we couldn’t work with him to handle the procedure in the dentist’s office? It might take a bit longer or need to be stretched over multiple visits, but shouldn’t be dismissed without consideration.
We did end up choosing the surgical option, partly because we were worried about whether a negative or even traumatic experience would set us back in the future for dental care and partly because I was concerned about the multiple exposures to medications and other toxic substances in the doctor’s office if this took a few visits.
And that led me to the question of how safe anesthesia would be for my son, not just in terms of the actual procedure but also with regard to the possibility of regression or negative impact on his health.
I had read a couple of great articles on the topic of anesthesia and autism in The Autism File magazine, one of them specifically about dental work. I had loaned my copy to a friend and didn’t have the opportunity to get it back from her in time, but thankfully was able to find both articles on the Autism Research Institute’s website.
Anesthesia and the Autistic Child by Sym C. Rankin, RN, CNRA was the first article I looked at. It is fairly lengthy and in-depth, so I won’t attempt to summarize it. Here are a couple of statements that struck me as critically important:
An anesthetic may represent yet another toxic insult our children get exposed to. Therefore, we must help anesthesia providers understand the physical and biomedical problems our children have so that the providers may minimize the insults.
The most important thing to discuss with the providers is detoxification pathways. Let them know that your child may have a problem with glutathione production and have defects in the methlylation pathways. A child’s liver is not able to detox as much as an adult. The need is to “keep it simple.”
From this article, I was able to get a lot of information on specific drugs in terms of how they might affect my son, which was tremendously helpful. I would highly recommend reading this article if you are facing any type of procedure which requires anesthesia. The information on nitrous oxide is especially enlightening.
The second article, Anesthesia and Fluoride, was written by Annette Van Dyke, RPh, MPH, a registered pharmacist and mom to a child on the spectrum. Her son had experienced an extremely bad reaction to swallowing fluoride at the dentist’s office and later responded very badly after the use of sevoflurane during a tonsillectomy.
Turns out that sevoflurane can metabolize to fluoride. This information left me in a bit of a quandry, since Ms. Rankin had recommended sevoflurane as a fairly safe option since very little is absorbed into the body.
When we spoke to the anesthesiologist, I was relieved that he was willing to take the time to discuss all of our questions and address our concerns. First of all, he planned to give Versed to help Michael relax before going back. This medication appeared to be fairly safe based on what I had read, so we were okay with that.
He did want to use sevoflurane, but would not be using nitrous oxide with it. He could not speak to the issue of regression but felt that it would be safe because it would be low-flow and for a very short time. After discussing our options for a bit, we decided to go with his recommendation and trust that we had done our very best to prepare and that God would take care of him.
Michael did wake up not too long after coming out of the procedure, which lasted about 35 minutes, but then he immediately went back to sleep and took quite a long nap (exactly the same thing that happened when he had surgery as a baby). Once we finally got him changed and in the car, however, he merely dozed off and on for the hour-long ride, and then he was awake and ready to play and watch videos for the rest of the day.
For pain management, we used dye-free ibuprofen every six hours (acetaminophen/Tylenol can cause problems with sulfation). The surgery was done on Friday, and by Sunday afternoon, he was not having any more pain and we stopped the medication.
Over the last few days, he has continued to be alert and social, with no sign of any regression or difficulties. And he’s just so darn cute with all those missing teeth!