Induction of anesthesia in a combative child; management and issues

Paediatr Anaesth. 2005 May;15(5):421-5. doi: 10.1111/j.1460-9592.2005.01501.x.


A developmentally delayed, 13-year old autistic boy required management of multifocal cerebral and pulmonary tumors, involving several anesthetics over a 4-month period. At each anesthetic he refused premedication, displayed increasing anxiety and became more combative. With parental guidance and involvement, a variety of anesthetists tried a range of techniques to achieve induction, each ultimately resorting to the use of physical restraint. Principles essential to the care of such a child include early recognition, parental support, multi-disciplinary planning of procedures requiring general anesthesia, continuity of anesthesia care, and clear guidelines about the perioperative management of uncooperative children, including the ethical use of restraint.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anesthesia, General*
  • Anxiety / psychology
  • Autistic Disorder / complications*
  • Autistic Disorder / psychology*
  • Brain Neoplasms / complications
  • Brain Neoplasms / surgery
  • Catheters, Indwelling
  • Child Behavior Disorders / psychology*
  • Humans
  • Lung Neoplasms / complications
  • Lung Neoplasms / surgery
  • Male
  • Parents
  • Patient Care Planning
  • Preanesthetic Medication
  • Restraint, Physical / ethics