By Leslie Sims, MD
Pediatric Anesthesiologists Are Specially Trained
Infants and children are not simply small adults, and in the operating room, their needs are different. Pediatric anesthesiologists – who are responsible for the general anesthesia, sedation, and pain management aspects of surgery – are specially trained to provide the safest care for infants and children.
After four years of general anesthesiology residency, these specialists undergo at least a full year of extra training in anesthetic care and protocol for pediatric patients and are dual-certified by the American Board of Anesthesiologists. They have the expertise and experience families need to handle all anesthetic needs for children before, during, and after surgery, or during an MRI, CT scan, or radiation therapy.
Anesthesia Will Put Your Child to Sleep Temporarily
Simply put, anesthesia is a medicine and/or gas that ensures that your child experiences a surgery, medical test, or other procedure without pain, memory, or movement. Your child will remain asleep – with careful monitoring of heart rate, blood pressure, breathing, temperature, and blood oxygen level – until the pediatric anesthesiologist takes away the medicine.
Meeting with Your Pediatric Anesthesiologist in Advance Can Be Helpful
If your child’s surgery or procedure is scheduled in advance, and not an emergency, you may have the opportunity to meet and talk with your pediatric anesthesiologist before the day of surgery. It is also not uncommon for advance discussions to be conducted over the phone with a pre-op nurse in consultation with the anesthesiologist.
Your discussions should cover the procedure itself, the timing of anesthesia as part of the procedure, and the various types of anesthesia options that are available.
If an in-person visit is required, bring your child, since this is an ideal time for parents and patients to raise worries or concerns and for the anesthesiologist to address these uncertainties. It’s quite common, for instance, for kids (and some adults) to worry about waking up and feeling pain in the middle of surgery. Your pediatric anesthesiologist is well-equipped to address such fears by explaining the process in terms that are age appropriate and understandable.
While anesthesia is very safe and serious complications are rare, it is not unusual for people to experience minor side effects such as a sore throat, nausea, and vomiting. Knowing about potential side effects in advance should be reassuring and prevent surprises – and anxiety – during recovery.
Communicate About Your Child’s Health History and Any Current Health Issues
Discuss every aspect of your child’s health with your pediatric anesthesiologist, ideally in a meeting or phone call prior to the day of surgery. Be sure to share the following in advance:
- Every prescription and over-the-counter medicine your child takes.
- Any chronic illnesses your child may have.
Your doctor will also ask about allergies, breathing problems, recent illnesses, heart problems, family history of bleeding, and any past problems with anesthesia or surgery, in order to minimize risk and plan appropriately.
Follow the pre-operation drinking and eating guidelines carefully, as some call for no food or liquid after midnight before the day of surgery. Depending on the procedure, some patients may have clear liquids (apple juice, cranberry juice, plain tea, Pedialyte, but no orange juice) two hours before surgery. Your child should not ingest protein (cream, milk) or gum, candy, mints, or lozenges, or brush his/her teeth two hours prior to surgery. The reason for an empty stomach (or limited clear liquids) is to reduce the risk of aspiration (breathing in contents from the stomach).
Your Team Can Help Provide Comfort to Your Child on Surgery Day
A pediatric anesthesiologist is an expert at providing comfort for your child before, during, and after a procedure. Tell him or her if your child has a fear of needles. The pediatric anesthesiologist may choose to use a mask and gas (with flavored gases) or use oral sedatives before inserting an IV. Also, if your child is thumb-sucker, the IV may be inserted in the foot to allow your child to suck his or her thumb for comfort.
Children who are 10 or older or adult-sized will require an IV before anesthesia. Numbing cream applied 30 minutes to one hour before the procedure will lessen the pinch of the needle that is needed to set up the IV.
When possible, ask to be one of the first cases of the day. This limits the time your child has to go without eating, allows less time for worrying, and lets you bring your child in his or her pajamas straight from bed into the hospital or surgery center.
Ask if you can bring a favorite stuffed animal or blanket to the hospital. If it cannot be taken into the operating room, have it ready for the recovery area.
Know beforehand what is allowed at your facility so you can prepare yourself and your child for whether you can accompany him or her to the operating or procedure room.
Post-Surgical Discomfort is Not Uncommon During Recovery
Depending on what type of procedure your child has had, typically he or she will go to a recovery room following surgery. Parents are encouraged to be in the recovery room with the child when the anesthesia wears off. For young children, have a trusted “lovey” (toy or blanket), favorite book, or video loaded on your iPad. The familiar helps to make the unfamiliar less frightening to a young child.
Children may react differently to the anesthesia, but most will feel some post-surgical discomfort and/or pain. Common side effects include headaches, nausea and vomiting, jaw pain, and sore throat from the tube that may be used to assist breathing during surgery. Your child may be restless and dizzy.
During recovery, most children will be thirsty and hungry. Your team will decide when and what your child may eat or drink post-surgery. Encourage your child to drink liquids but don’t force a child to eat. A prepared bottle of what your child takes and nursing also is encouraged, depending on the circumstances.
Talk to the pediatric anesthesiologist, surgeon, and recovery room nurses about ways to ease your child’s discomfort during recovery and at home. Follow these instructions carefully regarding types of medication, dosages, and the timing of doses.
Honesty is the Healthiest Policy
Don’t fib to your child about the procedure. If your son or daughter is old enough to ask where he or she is going, your child is old enough to handle an honest discussion in age-appropriate language about the surgery or procedure. For a preschooler who needs ear tubes, you might say, “You have an ow-ie in your ears, but it will be okay. We’re going to fix that today.” Explain that doctors and nurses are going to help him or her feel better and that you will be there afterward – maybe even with a special treat.
Children typically mirror their parents’ anxiety. How you react to your child’s upcoming surgery sets the tone for his or her reaction. The more you know, the better prepared you are, and the better you can prepare your child for a worry-free, safe procedure.
Learn more about pediatric anesthesiology and how you can prepare yourself and your child by visiting MAPMG’s Information About Pediatric Anesthesia article.