Children and Anaesthesia
This information leaflet is intended to provide you with general information. It is not a substitute for advice from your child’s Anaesthetist. You are encouraged to discuss the benefits and risks of anaesthesia with the Anaesthetist.
Even young children respond well to information about anaesthesia. Give your child a simple explanation of the procedure, preferably at least several days ahead. Unnecessary distress is caused when the child is not informed until arrival at the hospital. Encourage your child to ask questions. It is important that no one lies to the child about the procedure.
It is in your child’s best interests that you reduce your anxiety by consenting to anaesthesia only after your concerns and requirements for information are fully addressed.
Your Child is in Good Hands
Most Anaesthetists in Australia are highly trained medical specialists, having spent at least 5 years undergoing training in anaesthesia, pain control, resuscitation and the management of medical emergencies after graduation and internship.
The Role of the Anaesthetist
People often think of anaesthesia as being “put to sleep”. However, that’s not strictly true. Usually the Anaesthetist puts the patient into a state of carefully controlled unconsciousness. This is done so that they will be unaware and not feel pain. No chance is taken during this period. The patient’s major bodily functions are carefully and constantly monitored by the Anaesthetist. This is “general anaesthesia”. After the operation, we want your child to experience as little pain and discomfort as possible and here again, the Anaesthetist will help.
Your Role Before the Procedure
Your child is less at risk of problems from an anaesthetic if they do the following:
Increase their fitness before the procedure (if possible). This improves their blood circulation and lung health.
If you are breast feeding your child and drink alcohol, you need to stop drinking alcohol for at least 24 hours before your child’s procedure.
If your child smokes, they need to stop smoking at least 6 weeks before the procedure to give their lungs and heart a chance to improve. Smoking reduces the oxygen in the blood and increases breathing problems during and after a procedure.
Bring all their prescribed drugs and show them to the Anaesthetist. Tell the Anaesthetist about any allergies or side effects to tablets that your child may have.
Non-prescription or herbal medicines can sometimes cause problems including increased bleeding. Please stop them a week before and tell the Surgeon and Anaesthetist if your child is taking these medicines.
If your child drinks any alcohol they need to stop for at least 24 hours before surgery as alcohol may alter the effect of the anaesthetic drugs.
If your child takes any recreational drugs (including marijuana) they need to stop before surgery as these may effect the anaesthetic.
If your child is on a contraceptive pill let the Surgeon and the Anaesthetist know.
On the Day of the Procedure
You will receive information about fasting. If you have not met with the Anaesthetist, he or she will see you and your child in the preoperative ward to outline the plan for anaesthesia. A preoperative sedative may be necessary. Local anaesthetic cream may be applied to the hands of toddlers and children. This allows painless insertion of an intravenous needle to start the anaesthetic procedure.
Children can become anxious, uncooperative and combative. Bring any special toys or comfort objects that may help to reduce your child’s anxiety. The Anaesthetist and other medical and nursing staff are experienced in reassuring and settling the child so the procedure can continue.
You will usually meet your child’s Anaesthetist on the pre-operative ward. The Anaesthetist will examine your child and ask a number of questions to help plan appropriate and safe anaesthesia care. The Anaesthetist will discuss the best plan and any options for your child’s procedure.
This is the time to bring up any of your own concerns or anxieties. It is very important to mention any previous traumatic or bad medical experiences, or specific fears your child may have (eg fear of needles or masks).
Your child’s anaesthetic will usually begin in an anaesthetic room next to the operating theatre. Many children stay relaxed if a parent comes with them into the anaesthetic room, so usually a parent is allowed to be present right until the child is asleep. Babies younger than 6 months and many older children separate easily from parents and do not benefit from having a parent present. The final decision on permitting the parent to be present at the start of the anaesthetic rests with the Anaesthetist.
Watching your child go to sleep may be upsetting and stressful. Children often roll, their eyes, twitch, snore and go limp very quickly. This is all perfectly normal. Occasionally, for both the safety of the child and the staff, your child may need to be briefly restrained whilst going to sleep. Once your child is asleep you must leave quickly.
The Anaesthetist is in constant attendance, adjusting the level of anaesthesia and monitoring vital signs. The child will awaken with as little pain as possible.
Recovery From Anaesthesia
After the procedure, the Anaesthetist takes the child to the recovery area and into the care of specially trained nurses. Any distress is usually due to being in an unfamiliar place. Distress is more common in children who have repeated procedures, or who received little information from parents/guardians.
Pain Relief After Surgery
Minor pain is often relieved by paracetamol or paracetamol and codeine. Stronger painkillers are used after major surgery. This can be controlled by a nurse or in older children may be self administered. These techniques are safe and are not associated with narcotic addiction.
Local anaesthesia is often used for pain relief. Local anaesthetic is injected near the surgical incision or into the epidural space surrounding the spinal cord. If more major surgery is planned, a catheter may be left in place in the epidural space to allow continuous infusion of local anaesthetic, providing pain relief for days.
The child can usually eat and drink small amounts within several hours after most surgery. Eating and drinking too much, too quickly can result in vomiting, often in the car on the way home.
Types of Anaesthesia
Pre-medication is sedation given before an anaesthetic that may be given to your child to help reduce or relieve anxiety.
A general anaesthetic is a mixture of drugs to keep your child unconscious and pain free during the procedure. Drugs are injected into the vein through a cannula and/or breathed in as gases into the lungs. A breathing tube may be put into your child’s windpipe to help them breathe whilst under the anaesthetic. The tube is removed as your child wakes up after the procedure. A cannula and drip may be inserted into your child’s arm to inject drugs and provide fluid replacement (usually a salt solution drip).
A local anaesthetic is used to numb a small part of your child’s body. It is used when nerves can be easily reached by drops, sprays, ointments or injections.
Local anaesthetic cream may be applied to your child’s hands approximately 1 hour prior to the procedure. This allows painless insertion of an intravenous needle to start the anaesthetic. Putting an intravenous needle into children requires a lot of skill and it is not uncommon for several attempts even by an experienced Anaesthetist, especially in small babies and infants.
Regional anaesthesia is where a large part of the body is numbed, eg epidural and spinal anaesthetics. These techniques are used to stop pain during the operation and/or for stopping pain afterwards.
With local and regional anaesthetics your child can stay awake or they can sleep during the procedure (by giving sedation or a general anaesthetic as well), but whether your child is awake or asleep they are free from pain.
For an infant, the Anaesthetist usually uses a mask that delivers the anaesthetic gas. Some older children may prefer to have the mask rather than the intravenous anaesthetic.
Possible Risks and Complications
Modern anaesthesia is generally very safe. All medical procedures including anaesthesia have a small risk of complications and side effects. Many of these risks cannot be predicted beforehand and can occur with skilled Anaesthetists without any error or mistake in judgement or technique.
Common side effects and complications of anaesthesia can include:
nausea or vomiting
headache
pain and/or bruising at injection sites
sore or dry throat and lips
blurred/double vision and dizziness
problems in passing urine.
Less common side effects and complications of anaesthesia can include:
muscle aches and pains
weakness
mild allergic reaction – itching or rash
Uncommon side effects and complications from anaesthesia can include:
chest infection
damage to teeth
damage to the voice box and cords which may cause a temporary hoarse voice
allergic reactions and/or asthma
damage to nerves and pressure areas
epileptic seizure
worsening of an existing medical condition.
Fortunately the risk of major disability or death in a child after anaesthesia is extremely low in Australia. The risk of a disastrous outcome in an otherwise healthy child having routine elective anaesthesia in Australia is extremely low. Death due to a complication of anaesthesia is very rare.
References
“Anaesthesia for Children”, Australian Society of Anaesthetists.