This study aimed to examine differences in the occurrence of short- and long-term adverse behavioral outcomes following general anesthesia (GA) between neurotypical children and those with moderate to severe autism spectrum disorder (ASD). A total of 40 neurotypical children and 37 children with ASD, aged 3–17 years, who underwent GA for dental procedures were included. Anesthesia records were analyzed, and parental telephone surveys evaluated changes in activity levels, sleep patterns, gastrointestinal symptoms, central nervous system manifestations, and respiratory issues. Assessments were conducted at 8 hours, 24 hours, and 3 months postoperatively. Within the first 8 hours post-surgery, 455 adverse behavioral events were reported. Children with ASD exhibited significantly higher rates of gait instability (P = 0.016) and nausea (P = 0.030), whereas neurotypical children more frequently displayed snoring during the return journey (P = 0.036) and referenced the dental procedure verbally (P = 0.027). At 3 months post-discharge, concerning behavioral changes were noted in six children with ASD, compared with none in the neurotypical group (P = 0.008). Overall, the incidence of adverse behavioral effects declined significantly between 8 and 24 hours. The majority of postoperative behavioral disturbances manifest within 8 hours of surgery. While children with ASD may experience potential long-term adverse behavioral effects from GA, such occurrences are infrequent and typically transient.
