Midazolam before operation for autistic child or not?

[elliejjtiny]

Ds5 is 7 and going to have an operation on his eye next week. It will be his first operation although I've done this many times before with his older siblings. He has autism with no learning difficulties. We've been offered the choice of having midazolam beforehand to prevent a meltdown in the anaesthetic room. Sounds like a good idea but midazolam tastes absolutely vile and he'll be nil by mouth so not allowed a sweet or a bit of juice to help take the taste away afterwards. I'm worried that he'll find the midazolam more traumatic than having a general anaesthetic without it. Also worried that his operation will be cancelled if we don't have midazolam and then he has a meltdown in the anaesthetic room. This has happened twice before with one of my older children.

Could you ask him what he'd prefer?

Could you write a social story for him to prepare him for the operation? (This would be good for any child tbh even without autism)

Can he have it IV?

I think it would be a good idea if he has it - it might not be pretty getting him under anaesthetic, but he won't really remember it which means if he ever needs an anaesthetic again there won't be bad memories (and indeed there might be the positive effect of knowing he's been though it once and been OK)

His anaesthetists will be able to make a plan in the day - it’s quite a common scenario. If he needs it he should be able to have it with some squash if it’s the prep that tastes bad. There is an alternative prep available that’s more palatable that they may have on formulary, in which case there’s no problem at all. (DOI: anaesthetist)

Same as @Greybeardy; that's what the anaesthetists do in our dept (dental), put into a drink of squash.

This study refers to mixing it with orange juice for use pre anaesthesia in dental situations with a positive outcome. Don't know if they will allow that? It makes sense tbh.
clinmedjournals.org/articles/ijodh/international-journal-of-oral-and-dental-health-ijodh-2-036.pdf

With my autistic son they gave him an iPad, laid him down and covered his arm with a towel, he was chatting away about the game and I was asking him questions. They managed to do it so quickly and painlessly it was such a relief.

Thankyou. I have done a social story. He isn't verbal enough to have a conversation about it, although I will try. I'll ask about orange juice as well.

What are his favourite things? He’ll be able to have his favourite teddy, favourite film etc you’ll be with him to comfort him.