Autism and Dental Anesthesia

Below is information on the effects of children with autism and dental anesthesia, mandatory requirements for the operating suite and dentist office, which drugs are commonly used, and how emotionally uncooperative patients are treated.

Richard John Novak, M.D. Clinical Associate Professor, Stanford Department of Anesthesiology offers information on the effects of children with autism and dental anesthesia, standards of care, drugs commonly used, and how emotionally uncooperative patients are treated.

Based on our experience with our loved one with autism and dental anesthesia, parents tips and suggestions are also shared here. View our visual picture schedule example made specifically for a child with autism and dental anesthesia.

Dental Anesthesia and Autism

I am a member of the anesthesiology faculty at Stanford University Hospital, writing in response to the question of autistic children requiring anesthesia for dental procedures.

There are no data that any anesthetic drug(s) cause or worsen autism, nor are there any published data on preferred drugs for anesthetizing autistic children.

Dental anesthesia is usually performed in the dentist’s office. The mandatory requirements are: (1) that an M.D. (or sometimes a D.D.S.) anesthesiologist experienced in dental and in pediatric anesthesia does the anesthesia care, and (2) that standard hospital operating room monitoring instruments (e.g., pulse oximetry, ECG, and blood pressure), and repulse oximetry, ECG, and blood pressure), and resuscitation equipment (including a defibrillator) are present in the dental suite.

(2) If the child is emotionally uncooperative, an injection is given into the muscle of the shoulder or thigh. We use a combination of midazolam, ketamine, and atropine. This combination reliably produces a sleeping child in 5 – 10 minutes. At this point, the child is separated from his parents, and the IV is started in the operating suite.

If the child has serious medical problems (e.g., heart problems, breathing problems, seizures, or airway problems) it is sometimes unsafe to give anesthesia care in the dental office, and the dentist will need to do the procedure in a hospital room setting. This decision is made by the anesthesiologist.

Our standard of care is to make a preoperative phone call to the parent(s), both to obtain information on the child’s medical history, and also to describe the anesthetic planned for the child.

The preferred technique for dental office anesthesia is ‘deep sedation,’ where the child is asleep, without awareness of pain, is breathing spontaneously, and has stable vital signs. The anesthesiologist is in constant attendance.

The anesthetic begins by sedating the child so that an intravenous (IV) can be inserted. There are two common ways to do this:

(1) If the child is cooperative, oral midazolam (Versed), a Valium-like sedative, is given. The child will become relaxed, sleepy, and will separate from the parents with minimal distress. The IV is then started in the operating suite, using a small amount of local anesthetic injected into the skin.

(2) If the child is emotionally uncooperative, an injection is given into the muscle of the shoulder or thigh. We use a combination of midazolam, ketamine, and atropine. This combination reliably produces a sleeping child in 5 – 10 minutes. At this point, the child is separated from his parents, and the IV is started in the operating suite.

The monitors of vital signs are applied to the child, including the pulse oximeter, the electrocardiogram, the blood pressure cuff, and a stethoscope.

Additional sedation is added via the IV as needed to maintain the deep sedation state safely. Typically we add narcotic pain relievers such as meperidine (Demerol), or the short acting sedative propofol. Local anesthetic is sometimes injected by the dentist.

When the dental procedure is finished, the child stays at the facility until safely aware. This usually requires a minimum of 30 minutes.

Post-anesthesia side effects are sleepiness, sometimes nausea, and in some children, aggressive behavior or agitation.

When dental sedation is done by an experienced anesthesiologist with modern monitoring equipment and medications, the rate of major complications should be low. The risk of driving in the car to the dental office should exceed the anesthetic risk. Please refer to our anesthesia website at: www.aamgpaloalto.com, particularly the sections on dental anesthesia and pediatric anesthesia. Email response is provided.

Source: Richard John Novak, M.D. Clinical Associate Professor, Stanford Department of Anesthesiology







Tips for Children with Autism and Dental Anesthesia

1. Make preoperative call or visit. Schedule a preoperative visit with your child's anesthesiologist if at all possible. Your visit may be with the anesthesiologist who will taking care of your child. If not, ask that your child's anesthesiologist call you before the date of surgery.

Learn what is expected to happen so that your child with autism and dental anesthesia can be prepared for the event. Discussing your child and their particular needs, fears, communication level, and ability to cooperate and understand what is happening will help to reduce stress and anxiety.

2. Patients taking medication. The anesthesiologist will have some very specific directions for your child on medication for the day of surgery. Listen very carefully to the instructions about not eating before surgery. It is very important for a child with autism and dental anesthesia not to have food prior to being anesthetized.

3. Social stories and Visual Cues. Help prepare your child with autism and dental anesthesia by introducing a social story and visual picture schedule. Use the information you learn at the preoperative visit or phone call with a nurse and anesthesiologist to use in the story and picture schedule.

4. Ask Questions. Remember to ask the sequence of events leading up to the surgery so that you and your child know what to expect. Ask lots of questions so that you know what will happen and can tell your child about the day of the event.

  • Will your child go into a holding area or induction room so that her parents can be present?
  • Will your child be given an injection or a mask? Our loved one became very agitated and fearful when a mask induction was given for a medical procedure. Some children are very afraid of needles. Can your child bring a comfort item into the operating suite or induction room?
  • Who will be there when your child wakes up? How soon can you visit him after the surgery?
5. Bring your child's favorite blanket, toy, stuffed animal and activities to comfort her and to help pass the time during the wait.

Autism and Dental
Anesthesia Resources:




To learn more about autism and dental anesthesia visit Dr. Richard Novak's site.

View a visual picture schedule used for our loved one with autism and dental anesthesia.


Return to Autism Articles page

Return to Home page