The Use of Oral Midazolam to Facilitate the Ophthalmic Examination of Children with Autism and Developmental Disorders

McBride, Geraldine; Stephenson, Kirk; Comer, Gail M.; Flanagan, Orla

doi:10.1007/s10803-020-04658-2

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…17 Therefore, ensuring the sufficient effect of midazolam, often used as a premedication in patients with ASD, is advisable. 11,18 However, as high doses of midazolam may cause respiratory depression 19,20 and delayed recovery after anesthesia, 21 administering an appropriate dose is essential. The need for intervention for snoring was observed in $15% of the patients with an OAA/S score of 1.…”

Section: Discussionmentioning

confidence: 99%

Effect of midazolam in autism spectrum disorder: A retrospective observational analysis

Hanamoto

Hirose²,

Toyama

et al. 2023

Acta Anaesthesiol Scand

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Background: While midazolam is commonly used as premedication for uncooperative patients, its effects are difficult to predict in patients with autism spectrum disorder for whom abnormalities in gamma-aminobutyric acid have been reported. This study aimed to investigate the influence of autism spectrum disorder on the effect of midazolam when used as premedication.Methods: This retrospective observational study was performed between April 2017 and August 2018. Before inducing general anesthesia with sevoflurane for dental treatment, 390 uncooperative patients received premedication with midazolam.Ordinal logistic regression analysis was performed with the Observer's Assessment of Alertness/Sedation score 30 min after premedication as the objective variable.Age, sex, American Society of Anesthesiologists physical status class, premedication route, dose per body weight, presence of specific disorders (autism spectrum disorder, intellectual disability, epilepsy, cerebral palsy, and other psychiatric disorders), and regular benzodiazepine or non-benzodiazepine psychotropic administration were included as explanatory variables. Kendall's rank correlation coefficient was used to assess the correlation between the Observer's Assessment of Alertness/Sedation score and cooperation level (1, obvious negative response; 2, negative response; 3, positive reaction; 4, obvious positive reaction) during admission and inhalation induction. All data were extracted from anesthesia and medical records.Results: Age (odds ratio 1.437 [95% confidence interval (CI) 1.213-1.708], P < .001), autism spectrum disorder (1.318 [1.079-1.612], P = .007), benzodiazepine medication (0.574 [0.396-0.827], P = .002), and intramuscular route (1.478 [1.137-1.924], P = .004) were significantly associated with the Observer's Assessment of Alertness/ Sedation score, while the score was negatively associated with cooperation levels during admission (τ = À0.714, P < .001) and inhalation induction (τ = À0.606, P < .001).Conclusions: Patients with autism spectrum disorder may be susceptible to premedication with midazolam; however, regular benzodiazepine administration may reduce the effect.

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Section: Discussionmentioning

confidence: 99%

Effect of midazolam in autism spectrum disorder: A retrospective observational analysis

Hanamoto

Hirose²,

Toyama

et al. 2023

Acta Anaesthesiol Scand

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“…For example, a clear explanation using simple sentences and demonstration of instrumentation prior to the eye examination may greatly reduce anxiety (Parmar et al, 2022). For children with ASD who are unable to cooperate during ophthalmic examinations, oral midazolam (0.5 mg/kg, maximum 15 mg) may be considered a safe alternative to general anesthesia for ophthalmological examinations (McBride et al, 2021). Some evidence exists suggesting that the treatment of visual disorders can improve social function and behaviors in some children with ASD, including the improvement of social interaction (69% of the treated children), school performance, motor skills, anxiety/fear, and attention (Reynolds et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Ophthalmologic diagnoses in youths with autism spectrum disorder: Prevalence and clinical correlates

Wu,

Tsai,

Chen

et al. 2023

Autism Research

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Autism spectrum disorder (ASD) is associated with a high prevalence of visual dysfunction. This study aimed to investigate the rates of amblyopia, refractive errors, and strabismus, as well as their clinical correlates in ASD. This population‐based matched‐cohort study used data from the Taiwan National Health Insurance Research Database. A total of 3,551 youths with ASD and 35,510 non‐autistic control participants matched by age and sex were included. All the participants were followed‐up until they were 18 years old. The prevalence of amblyopia, refractive errors, and strabismus was compared between the ASD and control groups. Effect modifiers, including sex, ASD subgroup, and co‐diagnosis of intelligence disability, were examined. Compared to the control group, youths with ASD had a significantly increased risk of amblyopia (adjusted odds ratio [aOR] = 1.75), anisometropia (aOR = 1.66), astigmatism (aOR = 1.51), hypermetropia (aOR = 2.08), exotropia (aOR = 2.86), and esotropia (aOR = 2.63), but a comparable likelihood of myopia according to age. Males with ASD had a significantly lower likelihood of exotropia, but a higher likelihood of myopia than females with ASD. The autism subgroup had a higher OR for hypermetropia, but a lower OR for myopia than the other ASD subgroups. ASD youths with intelligence disabilities demonstrated significantly higher ORs for amblyopia, hypermetropia, and all types of strabismus and lower OR for myopia than those without intelligence disabilities. In conclusion, the rates of amblyopia, refractive errors, and strabismus were higher in youths with ASD. Ocular abnormalities in youths with ASD require a comprehensive assessment and management.

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“…However, they have been characterized as challenging to sedate or anesthetize (Li et al, 2019). A variety of anesthetics, such as ketamine, fentanyl, midazolam, dexmedetomidine, and propofol, either alone or in combination, have been used in ASD (Brown et al, 2019; Kamat et al, 2018; Li et al, 2019; McBride et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Comparison of propofol‐esketamine versus propofol‐sufentanil for deep sedation and analgesia in children with autism: A randomized double‐blind clinical trial

Miao,

Zheng,

et al. 2024

Autism Research

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Propofol sedation, routinely used for endoscopic procedures, is safe and acceptable for children. Adjuvants, such as esketamine or sufentanil, are commonly added to improve the efficacy and safety of propofol sedation. This study aimed to compare the clinical efficacy and safety of propofol‐esketamine (PE) versus propofol‐sufentanil (PS) for deep sedation and analgesia in children with autism undergoing colonoscopy procedure. One hundred and twenty‐four children with autism undergoing colonoscopy procedure were included in the study. Patients were randomly assigned to receive one of the two adjuvants: esketamine (0.3 mg/kg) or sufentanil (0.2 μg/kg), subsequently administered propofol 2.0 mg/kg to induce anesthesia. Additional doses of propofol (0.5–1.0 mg/kg) were administered as needed to ensure patient tolerance for the remaining duration of the procedure. Movement during the procedure, hemodynamic variables, the total dose of propofol, recovery time, and adverse events were recorded. The PE group exhibited a significantly lower incidence of severe movement during the procedure compared with the PS group (14.52% vs. 32.26%, p = 0.020). The PE group showed significantly lower incidence of respiratory depression, hypotension, and severe injection pain of propofol than the PS group during the procedure (all p < 0.05). The mean arterial pressure (MAP) decreased significantly after anesthesia induction in the PS group and remained lower than baseline (all p < 0.05). Compared with the combination of low‐dose sufentanil (0.2 μg/mg) with propofol, the low‐dose esketamine (0.3 mg/kg) combined with propofol provided more stable hemodynamics, higher quality of sedation, and fewer adverse events in children with autism undergoing colonoscopy procedure.

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The Use of Oral Midazolam to Facilitate the Ophthalmic Examination of Children with Autism and Developmental Disorders

Cited by 5 publications

References 10 publications

Effect of midazolam in autism spectrum disorder: A retrospective observational analysis

Effect of midazolam in autism spectrum disorder: A retrospective observational analysis

Ophthalmologic diagnoses in youths with autism spectrum disorder: Prevalence and clinical correlates

Comparison of propofol‐esketamine versus propofol‐sufentanil for deep sedation and analgesia in children with autism: A randomized double‐blind clinical trial

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