Anesthesia for intellectually disabled

Chaudhary, Kapil; Bagharwal, Preranna; Wadhawan, Sonia

doi:10.4103/joacp.joacp_357_15

Cited by 17 publications

(9 citation statements)

References 47 publications

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“…Increasing provider and caregiver awareness of resources, such as modified pain assessment tools, adaptive communication devices, transportation services, and additional clinical support, is one simple way to improve care. 22,[44][45][46] Increasing both provider and caregiver awareness of these resources is one simple way to improve EGS outcomes. Further, surgical services should implement protocols for patients with intellectual disabilities aimed at preventing common postoperative complications, such as prolonged respiratory monitoring and routine care coordinator consults, or employ the use of individualized perioperative care plans.…”

Section: Discussionmentioning

confidence: 99%

Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery

Zondlak

Neiman

et al. 2023

Annals of Surgery

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Objective: To examine the association between intellectual disability and both severity of disease and clinical outcomes among patients presenting with common emergency general surgery (EGS) conditions. Background: Accurate and timely diagnosis of EGS conditions is crucial for optimal management and patient outcomes. Individuals with intellectual disabilities may be at increased risk of delayed presentation and worse outcomes for EGS; however, little is known about surgical outcomes in this population. Methods: Using the 2012-2017 Nationwide Inpatient Sample, we conducted a retrospective cohort analysis of adult patients admitted for 9 common EGS conditions. We performed multivariable logistic and linear regression to examine the association between intellectual disability and the following outcomes: EGS disease severity at presentation, any surgery, complications, mortality, length of stay, discharge disposition, and inpatient costs. Analyses were adjusted for patient demographics and facility traits. Results: Of 1,317,572 adult EGS admissions, 5,062 (0.38%) patients had a concurrent ICD-9/-10 code consistent with intellectual disability. EGS patients with intellectual disabilities had 31% higher odds of more severe disease at presentation compared with neurotypical patients (aOR 1.31; 95% CI 1.17-1.48). Intellectual disability was also associated with a higher rate of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs. Conclusion: EGS patients with intellectual disabilities are at increased risk of more severe presentation and worse outcomes. The underlying causes of delayed presentation and worse outcomes must be better characterized to address the disparities in surgical care for this often under-recognized but highly vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery

Zondlak

Neiman

et al. 2023

Annals of Surgery

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“…In this study, this did not seem to be the case, as these patients underwent much longer durations of mechanical ventilation despite the use of less medication. Possible explanations for this finding include the higher burden of prior comorbidities, previous sedentary lifestyle with prior muscle wasting, and/or greater sensitivity to sedative drug effects [22,23].…”

Section: Table 3 Intubation Characteristics and The Weaning Process A...mentioning

confidence: 99%

Intellectually disabled patients’ intensive care admission characteristics, weaning from mechanical ventilation, and sedative drug use: a single-center retrospective case-control study

Bineth

Barel

Bdolah‐Abram

et al. 2022

J Anesth Analg Crit Care

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Background Intellectually disabled (ID) patients present unique therapeutic challenges. We aimed to describe the characteristics of ID patients admitted to a general intensive care unit (ICU). Results We conducted a retrospective cohort study comparing critically ill adult ID patients to matched patients without ID (1:2 ratio) in a single ICU (2010–2020). The main outcome measure was mortality. Secondary outcomes included complications during admission and characteristics of weaning from mechanical ventilation. The study and control groups were randomly selected based on similar age and sex. ID patients nonetheless had an average APACHE score of 18.5 ± 8.7 vs. 13.4 ± 8.5 in controls (p < 0.001). ID patients had more hematological (p = 0.04), endocrinological (p < 0.001) and neurological (p = 0.004) comorbidities and used more psychiatric medication before admission. No difference was found in mortality rates. Differences were found as there were more secondary complications, such as pulmonary and sepsis (p < 0.03), frequent requirement of vasopressors (p = 0.001), significantly higher intubation rates with more weaning attempts, tracheostomies and longer ICU and hospital admissions (p < 0.019). Conclusions Critically ill adult ID may have more comorbidities and be sicker at the time of admission compared to their age- and sex-matched counterparts. They require more supportive treatment and their weaning from mechanical ventilation may be more challenging.

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“…Due to their clinical history, and the lack of collaboration, in pediatric non-cooperative patients with Special Needs (SN), the anesthesiological risk may result difficult to assess, despite the fact that they meet the criteria of the outpatient management applied for the patient without disabilities [ 7 ].…”

Section: The Non-cooperative Pediatric Patient With Special Needsmentioning

confidence: 99%

The Perioperative Anesthetic Management of the Pediatric Patient with Special Needs: An Overview of Literature

Ciccozzi

Pizzi²,

Vittori

et al. 2022

Children

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The perioperative management of pediatric patients with psycho-physical disorders with related relational and cognitive problems must be carefully planned, in order to make the entire hospitalization process as comfortable and as less traumatic as possible. This article reports an overview of the anesthetic management of non-cooperative patients between 6 and 14 years old. The pathologies most frequently responsible for psycho-physical disorders can be summarized into three groups: (1) collaboration difficulties (autism spectrum disorders, intellectual impairment, phobia); (2) motor dysfunction (cerebral palsy, epilepsy, other brain pathologies, neuromuscular disorders), and (3) craniofacial anomalies (Down syndrome, other genetic syndromes). Anesthesia can be performed safely and successfully due to careful management of all specific problems of these patients, such as a difficult preoperative evaluation (medical history, physical examination, blood sampling, evaluation of vital parameters and predictive indices of difficult airway) and the inapplicability of a “standard” perioperative path (timing and length of the hospitalization, anesthetic premedication, postoperative management). It is necessary to ensure a dedicated perioperative process that is safe, comfortable, tailored to specific needs, and as less traumatic as possible. At the same time, all necessary precautions must be taken to minimize possible complications.

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Anesthesia for intellectually disabled

Cited by 17 publications

References 47 publications

Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery

Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery

Intellectually disabled patients’ intensive care admission characteristics, weaning from mechanical ventilation, and sedative drug use: a single-center retrospective case-control study

The Perioperative Anesthetic Management of the Pediatric Patient with Special Needs: An Overview of Literature

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