Autism and Anesthesia
Autism and Anesthesia
Maria Dalamagka
Chapter 1
Autism and general anesthesia for dental care
GSC Advanced Research and Reviews, 18 (2): 283–285 (May 2024)
DOI: 10.30574/gscarr.2024.18.2.0065
DOI:10.30574/gscarr.2024.18.2.0065
Corpus ID: 268009101
https://explore.openaire.eu/search/publication?pid=10.5281/zenodo.11216470
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https://doi.org/10.5281/zenodo.11216470
https://zenodo.org/records/11216470
https://www.bibsonomy.org/bibtex/28203997f3884f4307f13cbcd373cede2/gscarrjournal
www.worldcat.org
https://www.scilit.net/publications/9897d376ad58b6ab87c0d691af6039fa
Abstract: 05-06/06/2024: Global webinar on Pharmaceutics and Drug Delivery Research. Global Scientific guild. https://www.globalscientificguild.com/pharmaceutics/abstracts.php
www.iator.gr
Microsoft bing
Author: Maria I. Dalamagka
Greek version
Ο αυτισμός είναι η ταχύτερα αναπτυσσόμενη σοβαρή αναπηρία. Ο παιδικός αυτισμός συνδέεται με χαρακτηριστικά γνωστικά, γλωσσικά και συμπεριφορικά. Οι διαταραχές του φάσματος του αυτισμού (ΔΑΦ) έχουν μακροχρόνια αποτελέσματα σε τομείς της ατομικής καθημερινής λειτουργίας, όπως η μάθηση, οι σχέσεις και η ανεξαρτησία. Το μέλλον της αναισθητικής διαχείρισης της ΔΑΦ θα εξαρτηθεί από το πόσο καλά κατανοούμε την αιτιολογία, τα ψυχο-κοινωνικά και ιατρικά ζητήματα της νόσου. Ένα ευρύ φάσμα ιατρικών και συμπεριφορικών συμπτωμάτων παρουσιάζουν τα παιδιά με αυτισμό, γεγονός που καθιστά πολύ δύσκολη τη συνήθη οδοντιατρική φροντίδα. Ο αυτισμός είναι μια νευροσυμπεριφορική και γνωστική διαταραχή που χαρακτηρίζεται από μειωμένη ανάπτυξη διαπροσωπικών και επικοινωνιακών δεξιοτήτων, περιορισμένα ενδιαφέροντα και επαναλαμβανόμενες συμπεριφορές. Οι οδηγίες της Αμερικανικής Ακαδημίας Παιδιατρικής Οδοντιατρικής σχετικά με την Εκτίμηση Κινδύνου Τερηδόνας τις έχουν κατηγοριοποιήσει στις κατηγορίες Υψηλού κινδύνου για τους γιατρούς και άλλους παρόχους μη οδοντιατρικής υγειονομικής περίθαλψης και Μέτριου κινδύνου για οδοντιατρικούς παρόχους. Η στάση και η γνώση των επαγγελματιών της στοματικής υγείας είναι υψίστης σημασίας κατά την παροχή φροντίδας στοματικής υγείας σε τέτοια παιδιά. Η θεραπεία που παρέχεται επί του παρόντος παρέχει μακροπρόθεσμο όφελος για τον ασθενή. Πρέπει να δοθεί περισσότερη έμφαση στη μακροπρόθεσμη διατήρηση της στοματικής υγείας στα ειδικά παιδιά.
Ο επιπολασμός των διαταραχών του αυτιστικού φάσματος (ΔΑΦ) εκτιμάται ότι είναι 1% παγκοσμίως. Η πλειονότητα των μελετών που εξέτασαν τις διαφορές των φύλων σε άτομα με ΔΑΦ διαπίστωσαν αυξημένο κίνδυνο στους άντρες, κάτι που είναι σύμφωνο με τον υψηλότερο επιπολασμό στους άνδρες για ΔΑΦ στο γενικό πληθυσμό. Αυτά τα αποτελέσματα υποστηρίζουν την ισχυρή σύνδεση μεταξύ της διανοητικής αναπηρίας, της επιληψίας και της ΔΑΦ. Τα χαρακτηριστικά γνωρίσματα του αυτισμού είναι η άτυπη ανάπτυξη συμπεριφορικών και κοινωνικών δεξιοτήτων και η αδυναμία επικοινωνίας. Τα συμπτώματα του αυτισμού περιλαμβάνουν, αλλά δεν περιορίζονται σε κακές κοινωνικές σχέσεις, υπανάπτυκτες δεξιότητες επικοινωνίας, επαναλαμβανόμενες συμπεριφορές, ασυνήθιστα ενδιαφέροντα και δραστηριότητες, μεταβλητό βαθμό νοητικής αναπηρίας, αποφυγή οπτικής επαφής, αποφυγή κοινωνικής επαφής, μη κατανόηση των άλλων ανθρώπων συναισθήματα και ανάγκες, σωματική επιθετικότητα, αυτοκαταστροφική συμπεριφορά και εκρήξεις όταν προκαλούνται. Οι διαφορετικοί τύποι διαθέσιμων θεραπειών αναλύονται γενικά στις κατηγορίες της προσέγγισης συμπεριφοράς και επικοινωνίας. Τα φάρμακα που έχουν εγκριθεί από τον FDA για τη θεραπεία πτυχών της ΔΑΦ είναι τα αντιψυχωτικά ρισπεριδόνη (risperidal) και aripripazole (abilify). Η ρισπεριδόνη είναι ένα νέο άτυπο νευροληπτικό με ευνοϊκό προφίλ παρενεργειών λόγω της μοναδικής φαρμακολογικής του δράσης: εμφανίζει ισχυρή δράση αναστολής της ντοπαμίνης και των υποδοχέων, καθώς και υψηλή συγγένεια με τους άλφα 1 και άλφα 2 αδρενεργικούς υποδοχείς και τον υποδοχέα ισταμίνης 5-HT3. Αυτά τα φάρμακα μπορούν να βοηθήσουν στη μείωση της ευερεθιστότητας (επιθετικότητας) και των πράξεων που βλάπτουν τον εαυτό τους.
Η αναισθησία συνοδεύεται από σημαντικές ανεπιθύμητες ενέργειες όπως: πλήρης παλινδρόμηση στον αυτισμό, μεγάλη δυσκολία αφύπνισης, υπέρβαση ενός κανονικού χρονικού πλαισίου για «ανάρρωση», αναπτυξιακές παλινδρομήσεις. Παράγοντες κινδύνου για ανεπιθύμητες ενέργειες από την αναισθησία είναι: ιστορικό επιληπτικών κρίσεων, αυτισμός ή άλλη νευροαναπτυξιακή διαταραχή όπως ADD/ADHD, μαθησιακές δυσκολίες ή διαταραχή αισθητηριακής επεξεργασίας, προεγχειρητικά αναπνευστικά προβλήματα, κακή κλινική κατάσταση του ασθενούς πριν από τη διαδικασία, μη διαγνωσμένο ή διαγνωσμένο μιτοχονδριακό δυσλειτουργία (διαταραχή παραγωγής ενέργειας) όπως μιτοχονδριακή οξειδωτική φωσφορυλίωση (OXPHOS), γενετικό ελάττωμα MTHFR. Πολλά παιδιά με αυτισμό έχουν ανεπάρκεια βιταμίνης Β12 και το υποξείδιο του αζώτου μειώνει τα επίπεδα Β12.
Τα αυτιστικά παιδιά θεωρούνται δύσκολοι ασθενείς λόγω αυξημένου άγχους των ασθενών και μελών της οικογένειας, μη συνεργάσιμης ή μαχητικής συμπεριφοράς ή σε ακραίες περιπτώσεις πολύ βίαιης συμπεριφοράς ασθενών. Είναι κρίσιμο για τον αναισθησιολόγο, να αναγνωρίσει αυτές τις δύσκολες περιπτώσεις και να προετοιμαστεί για τις απαραίτητες παρεμβάσεις εκ των προτέρων. Μετά την ταυτοποίηση, πρέπει να υπάρχει κατάλληλη προ-αναισθητική διαβούλευση και προσεκτικός σχεδιασμός, ο οποίος θα πρέπει να περιλαμβάνει συζήτηση με τους γονείς για το σχέδιο και τις επιλογές της αναισθησίας.
Τα παιδιά με αυτισμό έχουν πολλαπλά ιατρικά προβλήματα και προβλήματα συμπεριφοράς, που καθιστούν την οδοντιατρική τους θεραπεία εξαιρετικά δύσκολη. Τα προβλήματα επικοινωνίας και οι φτωχές νοητικές ικανότητες αποτελούν βασικές ανησυχίες κατά τη θεραπεία παιδιών με αυτισμό. Αυτά τα παιδιά παρουσιάζουν μεγάλες διαφορές στην ικανότητά τους να συνεργάζονται κατά τη διάρκεια της οδοντιατρικής θεραπείας. Τα παιδιά με αυτισμό που έχουν ήπια έως μέτρια νοητική υστέρηση και απουσία σοβαρών προβλημάτων συμπεριφοράς μπορούν να αντιμετωπιστούν με επιτυχία στο πλαίσιο της γενικής πρακτικής. Ωστόσο, προβλήματα συμπεριφοράς όπως η υπερκινητικότητα και η γρήγορη απογοήτευση μπορούν να εμποδίσουν την παροχή φροντίδας στοματικής υγείας σε ασθενείς με αυτισμό. Επιπλέον, η επεμβατική φύση της στοματικής φροντίδας μπορεί να πυροδοτήσει βίαιη και αυτοτραυματιζόμενη συμπεριφορά, όπως εκρήξεις θυμού.
Autism is the fastest growing severe disability. Childhood autism is associated with cognitive, language and behavioral characteristics. Autism spectrum disorders (ASD) have long-term effects on areas of an individual's daily functioning, such as learning, relationships and independence. The future of anesthetic management of ASD will depend on how well we understand the etiology, psychosocial and medical issues of the disease. Children with autism present with a wide range of medical and behavioral symptoms, making routine dental care very difficult. Autism is a neurobehavioral and cognitive disorder characterized by impaired development of interpersonal and communication skills, limited interests, and repetitive behaviors. The American Academy of Pediatric Dentistry guidelines on Caries Risk Assessment have categorized them as High risk for physicians and other non-dental health care providers and Moderate risk for dental providers. The attitude and knowledge of oral health professionals is of utmost importance when providing oral health care to such children. The treatment currently provided provides long-term benefit to the patient. More emphasis should be placed on the long-term maintenance of oral health in special children.
The prevalence of autism spectrum disorders (ASD) is estimated to be 1% worldwide. The majority of studies that have examined gender differences in individuals with ASD have found an increased risk in males, which is consistent with the higher male prevalence of ASD in the general population. These results support the strong link between intellectual disability, epilepsy and ASD. The hallmarks of autism are the atypical development of behavioral and social skills and the inability to communicate. Symptoms of autism include, but are not limited to, poor social relationships, underdeveloped communication skills, repetitive behaviors, unusual interests and activities, varying degrees of intellectual disability, avoidance of eye contact, avoidance of social contact, failure to understand other people's feelings and needs, physical aggression , self-destructive behavior and outbursts when provoked. The different types of therapies available are generally broken down into the categories of behavioral and communication approaches. FDA-approved medications to treat aspects of ASD are the antipsychotics risperidone (risperidal) and aripripazole (abilify). Risperidone is a new atypical neuroleptic with a favorable side effect profile due to its unique pharmacological action: it exhibits strong dopamine and receptor blocking activity, as well as high affinity for alpha 1 and alpha 2 adrenergic receptors and the histamine 5-HT3 receptor. These medications can help reduce irritability (aggression) and self-injurious actions.
Anesthesia comes with significant side effects such as: full regression to autism, great difficulty waking up, exceeding a normal time frame for "recovery", developmental regressions. Risk factors for adverse effects from anesthesia are: history of seizures, autism or other neurodevelopmental disorder such as ADD/ADHD, learning disability or sensory processing disorder, preoperative respiratory problems, poor clinical condition of the patient before the procedure, undiagnosed or diagnosed mitochondrial dysfunction (disorder of energy production) such as mitochondrial oxidative phosphorylation (OXPHOS), MTHFR genetic defect. Many children with autism are deficient in vitamin B12, and nitrous oxide lowers B12 levels.
Autistic children are considered difficult patients due to increased anxiety of patients and family members, uncooperative or combative behavior or in extreme cases very violent patient behavior. It is critical for the anesthesiologist to recognize these difficult cases and prepare for the necessary interventions in advance. After identification, there should be appropriate pre-anesthetic consultation and careful planning, which should include discussion with the parents about the anesthetic plan and options.
Children with autism have multiple medical and behavioral problems that make their dental treatment extremely difficult. Communication problems and poor cognitive abilities are major concerns when treating children with autism. These children show great differences in their ability to cooperate during dental treatment. Children with autism who have mild to moderate mental retardation and the absence of severe behavioral problems can be successfully treated in general practice. However, behavioral problems such as hyperactivity and quick frustration can hinder the provision of oral health care to patients with autism. Additionally, the invasive nature of oral care can trigger violent and self-injurious behavior such as angry outbursts.
https://www.researchgate.net/publication/382428764_ebookpdf.
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Chapter 2
Corpus ID: 268669839
World Journal of Advanced Research and Reviews, 2024, 21(03), 1656–1658
Article DOI: 10.30574/wjarr.2024.21.3.0918
DOI url: https://doi.org/10.30574/wjarr.2024.21.3.0918
https://explore.openaire.eu/search/publication?pid=10.30574/wjarr.2024.21.3.0918
Autistic Spectrum disorder and Anaesthesia
https://www.researchgate.net/publication/382428764_ebookpdf.
Maria I. Dalamagka
Abstract:
One of the groups of patients which may require the greatest flexibility of approach is those with autistic spectrum disorder (ASD). ASD is a lifelong developmental disability, affecting four times as many males than females, which affects how a person communicates with, and relates to, other people and the world around them. Challenging behaviors may be triggered by the unfamiliar perioperative environment and may make anesthesia related procedures difficult or impossible. Children with more severe ASD may exhibit verbal or physical aggression, antisocial or disruptive behavior, temper tantrums, screaming, panic attacks, and self-injurious behavior, and may have aberrant responses to sensory stimuli. Although anaesthesia and sedation do not present a problem for most children with ASD, unpredictable regression in skills and behaviour is noted in a small number of patients after general anaesthesia. A 10- year-old child, 53 kg, with autism under treatment, came for a dental abscess and related dental work under general anaesthesia. The pediatric neurological assessment indicated hyperactivity and lack of cooperation. Post-operatively, during resuscitation, the child showed agitation and an attempt to withdraw oxygen, with the physical presence of his family environment.
https://www.researchgate.net/publication/383402376_Autism_and_Anesthesia
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Chapter 3
Acta Scientific Nutritional Health 5.2 (2021): 01-05. ISSN: 2582-1423
General anesthetics
Abstract
General anesthetics are administered to approximately 50 million patients each year in the United States. Anesthetic vapors and gases are also widely used in dentists' offices, veterinary clinics, and laboratories for animal research. All the volatile anesthetics that are currently used are halogenated compounds destructive to the ozone layer. These halogenated anesthetics could have potential significant impact on global warming. The widely used anesthetic gas nitrous oxide is a known greenhouse gas as well as an important ozone-depleting gas. These anesthetic gases and vapors are primarily eliminated through exhalation without being metabolized in the body, and most anesthesia systems transfer these gases as waste directly and unchanged into the atmosphere. Little consideration has been given to the ecotoxicological properties of gaseous general anesthetics. Our estimation using the most recent consumption data indicates that the anesthetic use of nitrous oxide contributes 3.0% of the total emissions in the United States. Studies suggest that the influence of halogenated anesthetics on global warming will be of increasing relative importance given the decreasing level of chlorofluorocarbons globally. Despite these non negligible pollutant effects of the anesthetics, no data on the production or emission of these gases and vapors are publicly available.. Since Fox et al. first published their warning in 1975, concern has been repeatedly expressed about the potential harm that the release of halogenated general anesthetic gases poses to the global environment.All the volatile anesthetics that are currently used (halothane, isoflurane, enflurane, sevoflurane, and desflurane) are halogenated compounds potentially destructive to the ozone layer. The widely used anesthetic gas nitrous oxide (N2O) is an established greenhouse gas.A recent report suggests that N2O is also an important ozone-depleting gasAs the world population continues to grow and as modern anesthesia becomes available to more regions of the world, the global use of volatile anesthetics and N2O will rapidly grow. General anesthetics were administered to approximately 50 million patients in the United States in 2006, according to data released by the National Center for Health Statistics Anesthetic vapors and gases are also widely used in dentists' offices, veterinary clinics, and laboratories for animal research. A key attribute that differentiates all of these anesthetic gases from other medical drugs is that they are substantially eliminated through exhalation, without being metabolized in the body. At present, most anesthesia systems transfer these waste gases directly and unchanged into the atmosphere. Although the introduction of scavenging systems has significantly reduced spillage of general anesthetics into the operating room, they are still exhausted into the environment. Little consideration has been given to the ecotoxicological properties of gaseous general anesthetics.
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Chapter 4
Corpus ID: 272686340
Magna Scientia Advanced Research and Reviews, 2024, 12(01), 001–004. Article DOI: 10.30574/msarr.2024.12.1.0141. DOI url: https://doi.org/10.30574/msarr.2024.12.1.0141
https://srcmeetings.com/profile/international-conference-on-neurological-disorders-and-stroke-maria-i-dalamagka-331.html
Antipsychotics and anesthetic drugs
Maria Dalamagka
Abstract
Psychiatric illness is common, affecting up to 10% of the population, with around 1 % diagnosed with a major psychiatric disorder. An increased mortality rate in the postoperative period for schizophrenic patients receiving chronic antipsychotic therapy has been demonstrated. According to the Diagnostic and Statistical Manual of Disease, schizophrenia-associated psychotic disorders are characterized by disturbances in emotional, behavioral and cognitive arenas, impeding on nearly every aspect of life functioning in the form of thought disorders, delusions and hallucinations. Chronic schizophrenic patients lack pain sensitivity,, and have pituitary-adrenal and autonomic nerve dysfunction, abnormalities of the immune system, and water intoxication. These alterations may influence postoperative outcome. Psychotropic drugs often given in combination with each other or with other non-psychiatric drugs generally exert profound effects on the central and peripheral neurotransmitter and ionic mechanisms. The increased complications are associated with physical disorders, antipsychotic or hazardous health behaviour and interactions between antipsychotics and anaesthetic drugs. Adverse responses during anaesthesia include arrhythmias, hypotension, prolonged narcosis or coma, hyperpyrexia, post-operative ileus and post-operative confusion. Although drug interaction probably remains the most potentially serious problem current evidence suggests that psychiatric medication need not be discontinued prior to anesthesia.
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Chapter 5
Epilepsy in children and anesthesia
Maria I Dalamagka
Magna Scientia Advanced Research and Reviews, 2024, 12(02), 033–038
Article DOI: https://doi.org/10.30574/msarr.2024.12.2.0180
Corpus ID: 273976948
Abstract
Epilepsy, also called seizure disorder, is the most common childhood brain disorder in the United States. The aetiology of epilepsy in children is multifactorial with congenital, metabolic, infective, and problems associated with prematurity being common causes. Nearly 3 million Americans have epilepsy. About 450,000 of them are under 17 years old. About 1 in 200 children (0.5%) have epilepsy, a neurological condition where children have a predisposition to recurrent, unprovoked seizures. There are many different types of epilepsy, especially in infancy, childhood and adolescence. Epilepsy can be thought of in terms of either: the site of seizure origin in the brain (generalised or focal seizures), or the underlying cause. Genetic epilepsies (formerly called idiopathic or primary epilepsies) occur in an otherwise normal person and are due to a genetic predisposition to seizures. Some epilepsies are due to an underlying abnormality of the brain structure or chemistry (formerly called symptomatic or secondary epilepsies). Other epilepsies have no known cause. Epilepsy is commonly diagnosed in children and can be confused with other conditions. An accurate diagnosis is essential. A seizure is an excessive surge of electrical activity in the brain that can cause a variety of symptoms, depending on which parts of the brain are involved. Seizures can be provoked or unprovoked. Provoked seizures, caused by fever in a young child or severe hypoglycemia, are not considered to be forms of epilepsy. Unprovoked seizures have no clear cause but can be related to genetics or brain injury. When a child has two or more unprovoked seizures, epilepsy is often the diagnosis. Despite advances in antiepileptic medication therapy, a significant number of pediatric patients with epilepsy have seizures that are not well controlled. Antiepileptic medications interact with anesthetic agents, and common anesthetics can precipitate or suppress seizure activity. There are important pharmacokinetic and pharmacodynamic interactions between AEDs and drugs commonly used in anaesthesia. These affect both drug efficacy and the risk of seizure activity intraoperatively.
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