Oral ketamine for the management of combative autistic adult

Abstract

Autistic patients with symptoms necessitating operative procedures can be challenging. They frequently cannot communicate their needs or desires. Cooperating in unfamiliar environments with unfamiliar individuals can accentuate the difficulties for the patient. The two cases presented herein represent the difficulties of achieving adequate premedication to allow the patient to be safely anesthetized. The administration of ketamine orally as a premedication for operative procedures has been reported frequently for children. The use of oral ketamine as an analgesic also has been described in adults for postamputation stump pain, postherpetic neuralgia, phantom limb pain, neuropathic pain, and cancer pain. The use of ketamine as a sedative in adult patients has not been described. Sedating uncooperative patients in a nonforceful manner is difficult. Attempts to either physically restrain or administer intramuscular injection in uncooperative or violent adults can be dangerous. The use of oral benzodiazepines, barbiturates, and butyrophenones is not always successful in achieving sedation and cooperation of the patient. The administration of ketamine in a drink to mask the drug may be an acceptable alternative in some autistic or uncooperative adult patients.