Table 1.

Autistic sensory differences, adapted from Autistic SPACE.¹³

Sensation
Sight	Visual sensitivities are common. Bright lighting (particularly fluorescent) is a common challenge. Visual stimuli that may go unnoticed by non-autistic people, such as the flickering of fluorescent lighting or screens, may cause sensory stress. Operating theatres often have bright ceiling lighting, operating lights and many flashing lights and warning alarms associated with monitoring equipment.
Sound	Auditory sensitivities and auditory processing differences are common. Environmental noise, particularly when sudden or unexpected, can cause intense distress. Theatres are inherently noisy environments, with anaesthetic machine and monitoring alarms, clashing of metal surgical trays during preparation and background chatter. Environmental noise can make conversations difficult to process and will exacerbate autistic overwhelm.
Smell	Autistic people are often highly sensitive to smell and may perceive odours that others do not. Common and usually inoffensive smells may be perceived as highly noxious. Diathermy cauterisation, surgical prep, chlorhexidine cleaning sticks may cause difficulties for autistic staff and patients.
Touch	Tactile sensitivities range from inability to tolerate the sensation of certain fabrics including theatre gowns, sheets and blankets to an inability to be touched, particularly by strangers. Monitoring attached on arrival is often cold (BP cuff/ECG electrodes); interventions we perform are uncomfortable or painful.
Temperature	Sensitivity to temperature is common. Theatres are often cold so patients may benefit from additional blankets, but the range of easily tolerated temperatures is likely to be person-specific. Many prefer a cold environment and will reject interventions such as forced air warmers.
Interoception and pain	Some autistic people have difficulty interpreting internal bodily sensations. This can lead to difficulties noticing hunger, thirst, tiredness, or a need to urinate or defecate.
	Patients can sometimes have reduced pain sensitivity, but more commonly they have increased pain sensitivity coupled with difficulty communicating their pain.