Botox/Anesthesia Reaction

Evan had his 3rd round of Botox today. He had a really bad reaction(in my opinion) to the anesthesia called Emergence Delirium:



Delirium is a complex psychiatric syndrome that includes perceptual disturbances, hallucinations, and psychomotor agitation (6). At present, there is no unique definition of ED because of its heterogeneous clinical presentation. Some authors have described such an event as a dissociated state of consciousness in which the child is irritable, uncompromising, uncooperative, incoherent, and inconsolably crying, moaning, kicking, or thrashing (7,8). Typically, these children do not recognize or identify familiar objects or people. Paranoid delusions are also possible (9). Combative behavior has been more often described than simple restlessness and incoherence (5). Sikich and Lerman (10) defined ED as "a disturbance in a child's awareness of and attention to his/her environment with disorientation and perceptual alterations including hypersensitivity to stimuli and hyperactive motor behavior in the immediate postanesthesia period." ED usually occurs within the first 30 min of recovery from anesthesia, is self-limited (5–15 min), and often resolves spontaneously.



He was crying/screaming and kicking his legs, hitting and trying to get off the bed. It was like he was in a lot of pain and trying to get out of his body. I do not think he was in pain but he may have been having some pain from the injections. Evan has been put under with IV anesthesia 4 times and then 3 times with the gas method they use at Shriner's. He is usually a little cranky when he wakes up and is usually fine about 5 minutes afterward. This reaction today was so over the top compared to what he usually goes through. I held it together while I was in the room with the Drs. and nurses but once on the elevator I just had to cry. I was alone with Evan because I felt that since this is pretty routine Rudy does not need to miss work to be with us. Well, Rudy must have had a 6th sense that he needed to be there. He called me during Evan's episode to let me know that he was out in the lobby of the 4th floor. It was good because the child life specialist took Evan for a little walk and he calmed down a bit after he saw Rudy. He was starting to come out of it anyway but by that time it had been the full 3o minutes. So if he ever reads this "Thank you honey for being there today". I never want to see Evan go through that again. So I talked with both the anesthiologist and his orthopedic Dr. about other options because I do not want him to go through this again. I cannot handle seeing it again.

So here are the options:

1. use an IV anesthesia next time

2. give Versed beforehand

3. Do Botox w/o anesthesia

4. Discontinue botox and go to an oral medication



For right now we are going with option #1 and see how he does with that. I am just so scared that he is going to start having bad reactions to the anesthesia, having a special needs child can mean that even if they did Ok the last time, things can change and they do change. I really cannot see him that way again. I know I will be scared the next time we go. I have already decided that if he has this reaction again then we will not do Botox anymore. Maybe in the leg where he does not have to be put under, he can try oral medications.

Evan goes back next Wednesday for us to start his serial casting.


I leave you with this pic of Evan and his Daddy