Anesthetic Strategy for 30 Radiotherapy Sessions in a Child With Autism Spectrum Disorder (ASD) and Severe Behavioral Dysregulation: A Case Report

Autism spectrum disorder (ASD) refers to a spectrum of neurodevelopmental conditions characterized by challenges in social interaction and communication, which coexist with repetitive behaviors and narrowly focused interests. Autistic patients, particularly children, often present with heightened sensitivity, which must be considered when anesthesia is necessary. A six-year-old child with ASD was diagnosed with rhabdomyosarcoma of the left lower limb, and after surgical treatment, was indicated for 30 radiotherapy sessions. The routine technique for radiotherapy in children involves inhalation anesthesia with sevoflurane. After the first session, there were undesirable side effects, and it was decided to use sedation with clonidine as pre-anesthesia and ketamine and dexmedetomidine intranasally in the radiotherapy room. The remaining 29 sessions were all performed with this technique, achieving ease during radiotherapy and awakening without aggression in the post-anesthesia care unit (PACU). Clonidine is used as a pre-anesthetic medication in pediatrics due to its sedative and analgesic properties, providing preoperative sedation and preventing postoperative pain and vomiting. Ketodex is a combination of ketamine and dexmedetomidine. The combined use of ketamine and dexmedetomidine offers several clinical advantages, including cardiovascular stability, preservation of spontaneous ventilation, effective postoperative analgesia, and smooth recovery.