Anaesthesia in children
It is understandable to be a little worried and anxious when your child is having any kind of procedure or surgery that requires anaesthesia.
Kinds of Anaesthesia
General — in which your child would be “asleep” – this is the commonest especially in the smaller children
Regional — when one large area of the body is numbed
Local — when one small part of the body is numbed
Let us give you a brief overview of anaesthesia in children to settle your nerves
The child is assessed thoroughly by the Paediatric Surgeon. The presence of allergies to medication or other substances , associated medical illnesses if any and records of previous surgery and anaesthesia are noted and documented. Relevant blood tests, X-Rays and other scans if required are ordered.
Children undergoing major and complex surgery are usually admitted a day before the actual surgery and will be seen by the anaesthesiologist. Any further tests that they require will be carried out in order to get the child optimised and well prepared for safe surgery and anaesthesia.
Children undergoing day surgical procedures are seen and assessed on the morning of the surgery, by the anaesthesiologists. Most minor procedures or surgeries do not require any other preliminary tests prior to surgery.
It is vital to come to hospital on an empty stomach. For infants and children who are being fed formula milk or solids the last feed must be completed 6 hours prior to surgery, whilst those fed on breast milk need just 4 hours of fasting prior to their surgery. Water maybe permitted up to 2 hours before surgery. These instructions will be provided to you clearly at your first visit to the clinic, and will be reiterated over a phone call a day prior to the surgery by the clinic assistant.
Having food in the stomach at the time of induction of anaesthesia carries the risk of the food being regurgitated up the oesophagus and entering the lungs, which is dangerous.
When you meet with the anesthesiologist, you’ll also be asked to sign an informed consent form, which authorizes the use of anesthesia. It’s important to make sure to have all of your questions answered before signing the form.
The children are usually given a mild sedative to decrease their anxiety before they are wheeled to the operation suite.
In the Operating Room
A parent is allowed to enter the operating room and sit beside the child, till the child drifts off to sleep, after which the parent is lead out to the waiting area,
The anaesthesia is usually started off by getting the child to breathe the anaesthetic gas. Most children are afraid of needles and injections and therefore the intravenous needles are inserted only after the child is asleep and not when awake to minimise anxiety, pain and fear.
To help your child breathe and to deliver general anesthesia during the operation, the anesthesiologist may use an endotracheal tube (a plastic tube that’s placed into the windpipe through the mouth or nose) or a laryngeal mask airway (LMA — a mask with a tube that fits into the back of the mouth).
It is common practice to infiltrate the wound area with a local anaesthetic whenever possible so the child doesn’t feel too much pain or feels none upon waking up from the surgery.
Once the operation or procedure is over, the anesthesiologist will reverse the anesthesia process and help your child “wake up” (if your child received general anesthesia).
Your child will then be taken to the recovery room or PACU (post-anesthesia care unit). Here, nurses and the anesthesiologist will monitor your child’s condition very closely to make sure he or she is making a smooth and comfortable transition from an anesthetized state to an awakened state.
When your child’s medical condition is stable, you’ll be asked to come to the PACU to be with him or her during the recovery period. If general anesthesia or sedation were used, your child might not be fully awake right away. It usually takes about 45 minutes to an hour for kids to recover completely from general anesthesia.
In some cases, it may be a bit longer depending on medicines given during or after surgery.
Your child may feel groggy, confused, chilly, nauseated, scared, alarmed, while waking up.
Pain medication is started as soon as your child is fully awake and this keeps them comfortable, pain free and confident.
For Day Care procedures, kids are allowed to come home the same day after the surgery.
In cases where hospitalization is required, our hospital is parent friendly and allows at least one parent to stay with their child day and night.
Before you leave the hospital, you’ll get instructions for further care and recovery at home and for a follow-up visit with the surgeon.
Talk to the surgeon and/or the anesthesiologist about what to expect after the surgery and how you can help your child be as comfortable as possible.
After discharge, call the hospital or surgeon’s office if you have any concerns at all about your child’s medical condition or if your child:
has unusual bleeding from the surgical site
has a fever higher than 101°F (38.3°C)
has unusual redness on or discharge from the surgical site
has unusual pain
can’t keep anything down
can’t take fluids by mouth
In summary, as you prepare for the surgery or procedure, it may help to remember that general anesthesia carries only an infinitesimally small risk, but is overall very safe.
Almost 40% of minor surgeries in childhood for children above 6 months of age are today done as Day Care Procedures.
This is thanks to the advances and safety of general anaesthesia as well as the experience of our anaesthetists who are well trained and capable of providing safe anaesthesia for children.
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