The Autism Society Event and Education Recordings Archive

Individuals with autism spectrum disorder (ASD) have a range of medical problems involving many organ systems. A subgroup of these individuals have abnormal mitochondrial energy production and function that contributes to their physical, cognitive and behavioral impairments. The presence of mitochondrial dysfunction increases the risk for potential damage to the brain, which is dependent on oxidative metabolism. Unfortunately, this risk is increased during procedures that require general anesthesia

Individuals are often scheduled for procedures that require anesthesia, such as MRI’s, endoscopies, tonsillectomies, adenoidectomies, ear tube placement and other procedures. Anesthesia team members such as anesthesiologists and Certified Registered Nurse Anesthetists need to be made aware of these issues in this population.

Research shows that individuals with the mitochondrial dysfunction have specific defects in the mitochondrial oxidative phosphorylation. Unfortunately, people with this disorder are clinically indistinguishable from others without it. It would be wise to treat all ASD patients as if they have it.

Complications that may occur in ASD patients with mitochondrial dysfunction following anesthesia

1.  Excessive time to wake up after anesthesia
2. Developmental regressions, which could include loss of expressive and/or receptive language, gross motor skills, fine motor skills, cognitive function, and overall neurologic deterioration. In some ASD individuals, skill loss may be permanent
3. Excessive fatigue and reduced energy levels: temporary (for days or weeks) or permanent
4. Possible death

Measures that can be taken to minimize these risks

Even for healthy individuals there are risks associated with getting anesthesia. Even with caution, there are no guarantee that the outcome will be free of complications. There are measures that can be taken to minimize dangers.

Whenever a parent’s child is scheduled for surgery or a procedure that requires anesthesia, the parent can advocate for their child with the anesthesia providers. They might meet some resistance, as typically health care providers don’t like to be told what to do. However, if done nicely, the parent should be able to convince the Nurse Anesthetist or anesthesiologist to listen to the facts presented and make the necessary changes to help prevent deleterious effects. There are no costs involved, just simple changes that anyone can do. Simple things that can save the ASD patient from catastrophic events.

What a Parent Can Do:

1.  Discuss that the patient has ASD and may possibly have mitochondrial dysfunction
2. Ask that the anesthesia provider does NOT use nitrous oxide for any reason. Nitrous oxide can have deleterious effects on overall oxidative stress and homocysteine levels.
3. Prior to the day of the procedure, request that your child is the first appointment of the day. There are several reason for this, but for this purpose it’s to minimize length of fasting
4. Ask the anesthesia providers to avoid using Lactated Ringer’s as the IV fluid since it contains lactic acid. ASD individuals with mitochondrial dysfunction have elevated lactate levels
5. Avoid, if possible, succinylcholine for muscle relaxation

In conclusion, if these simple precautions are followed, there is far less chance of a bad outcome.