My name is Dr. Steve Yun, and I am a board-certified dental anesthesiologist in Southern California.
Taking care of autistic patients can be hard. Really hard. But it is also tremendously rewarding, and as a recent family demonstrated to me, a privilege to care for these patients.
“Robert” is a 19 year old with severe autism. He also has a seizure disorder, diabetes, and obesity. He is built like a tank, with a large, thick neck. But he is a gentle giant, and very scared of any procedure at the dental office.
Planning his anesthesia was a challenge. His obesity and thick neck meant that he was a “difficult airway,” and that I would probably have difficulty placing a life-saving breathing tube. His autism and dental phobia meant that he would be unable to cooperate with any attempts to start an IV or even get him to sit in the dental chair. His seizure medications and diabetic medications would have to be monitored closely.
The first challenge was to just get him into the dental chair. After multiple unsuccessful attempts by his parents to persuade him to sit in the dental chair, I was able to sedate him in the waiting room. Now sedated, he was calm and relaxed. In fact, a little bit too relaxed as he was now physically unable to move himself! As a result, his father and I had to physically move him into the procedure room. Unlike Robert, his father was a very small man and so moving Robert was a very heavy, difficult task. It was quite a workout!
But we did get Robert into the chair and now the challenge was to secure his airway with a breathing tube. Robert was obese and probably had sleep apnea. The dental procedure would end up being over 6 hours because he needed so much dental rehab. With such a long procedure in an obese, uncooperative patient, the safest option was to place a breathing tube. Easier said than done in patients with difficult airway. But using my 20+ years of experience and the latest most advanced equipment (video laryngoscope), I was able to secure the airway smoothly.
As I monitored Robert closely over the next 6 hours, I had time to reflect on his family’s situation. Taking care of Robert on a daily basis certainly cannot be easy, but his parents’ love was plainly obvious and they showed no signs of frustration or exasperation. I was even more astounded when I learned that they have not just Robert, but two other adult children with severe autism!
Despite the obvious difficulties they must face in caring for three autistic children, Robert’s parents were the model of patience, kindness and love. They humbled me with their gratitude and their gentle demeanor. I am not a particularly religious man, but talking to them about Robert reminded me of the beautiful Scripture verse: “I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.” (Psalms 139:14). As we approach the holiday season, I am reminded that autistic children like Robert are indeed wonderfully made and represent the very image of God. As a physician and as a parent, it is privilege to care for such wonderful patients and their families.
Well, one challenge still remained – waking Robert up as I really did not want to have to carry him out to his parents’ minivan! Fortunately, with thanks to modern anesthetics like Propofol, Robert woke up beautifully at the end of the case, sat right up in the chair and said he wanted to go home. And just like that, he walked himself out of the dental office!
Merry Christmas and Happy Holidays to all!