Sedation and General Anesthesia

Sedation is sometimes necessary for patients with intellectual disability. Sedation may be necessary for individuals with extreme phobia concerning medical treatment; those with involuntary movements - such as tics or other neuromotor symptoms; and patients whose intellectual disability is such that they cannot comprehend the need for medical care, nor understand the intent of the healthcare provider, despite attempts to explain procedures and gain compliance. Types of sedation range from light, or conscious, sedation, to general anesthesia. It is important for the healthcare practitioner to limit the use of sedation only to specific instances when there is no recourse. Light oral sedatives commonly used include diazepam (Valium™), Ativan™, and Benadry™.

General anesthesia is occasionally used to facilitate pelvic examination when other strategies to obtain the exam have been exhausted. Patients may also require IV sedation or general anesthesia for more invasive procedures such as colposcopy or cone biopsy. It is important that the practitioner obtain informed consent before administering anesthesia, independent from consent obtained for the gynecological exam. In the event the woman refuses oral or IV sedation, under NO circumstances should she be held down to receive medication. The exam should be rescheduled in order to allow the issue to be addressed by the caregiver/agency staff in the interim.

Note: The above document contains general legal information; it is not legal advice and it does not create an attorney/client relationship. As laws and circumstances differ, the prudent health care practitioner should discuss these issues with his or her attorney before proceeding.

Dougherty, N., Romer, M., & Perlman, S.P. (2004). The use of sedation. In S. Fenton, S. Perlman, & H. Turner (Eds.), Oral health care for people with special needs: Guidelines for comprehensive care. River Edge, NJ: Exceptional Parent, Psy-Ed Corp., 2003.

Toub, D.B., & Nettle, J.W. (n.d.) Gynecological care of women with developmental disabilities and other special needs. OBGYN.net, retrieved online 7/27/06 from http://www.obgyn.net/displayarticle.asp?page=/ENGLISH/PUBS/FEATURES/special_needs