Anaesthesia for Children

Anaesthesia for children guide

by Dr Clarence Lim BSc(Med) MBBS(Hons) FANZCA

Dr Clarence Lim is a specialist anaesthetist who is a medical graduate of the University of New South Wales. He completed his specialty training at the Prince of Wales and Sydney Children’s Hospitals. Dr Lim routinely provides anaesthesia for children and he works at Prince of Wales Private Hospital.

What can I do to prepare my child for ENT surgery?

• We recommend parents talk to their child about their ENT operation
• Answering their questions and gentle reassurance often works better than surprising them on the day of surgery
• Packing your child’s favourite pyjamas, dummy or toy for their hospital stay is often a good idea
• Please follow the fasting guidelines provided
• Breaking these guidelines will increase the risk of complications

Anaesthesia for children

Being told that your child requires surgery and anaesthesia can be very stressful for parents. Many people are understandably anxious about the possible side effects of general anaesthesia for children. Handing the responsibility for the care of your child to your anaesthetist, surgeon and nurses can be stressful. This page aims to provide general information about anaesthesia. It is not a substitute for a medical consultation. We encourage you to speak with your anaesthetist and ask questions. Being informed will help you to reduce the normal anxiety about anaesthesia and surgery.

Help to inform your child

Young children usually respond well to information about anaesthesia and surgery. Talk with your child about the procedure that’s planned, preferably several days in advance. Unnecessary distress may be caused when children are not informed about their procedure until arrival at hospital.

Encourage your child to ask questions. It is important that they are well informed. Also a child is more likely to be distressed if their parent / carer is very anxious. It is in your child’s best interests to reduce your anxiety by ensuring your concerns and questions are fully addressed by your anaesthetist.

Being present when your child is anaesthetised is often helpful. The presence of a calm parent at the beginning of anaesthesia can be beneficial for your child. However, this may be unsettling for some parents. It is perfectly normal for you to choose not to be present. Discuss this with your anaesthetist so that any distress can be minimised.

On the day

Fasting greatly reduces the risk of vomiting during and after anaesthesia. You will receive specific information about fasting times the night before the operation – the hospital staff will call you on the phone number you provided regarding fasting times. In general your child should not eat any solids or drink milk for four hours and no clear fluids for two hours before a general anaesthetic. Infants and breastfed babies may have shorter fasting times.

Bring a favourite toy to hospital. Usual medications may be given with a little water as needed. If you have not me your anaesthetist, he or she will see you and your child in the ward or pre-op area to ask about your child’s medical history. The anaesthetist will examine your child and explain the plan for anaesthesia.

A pre-med sedative may be given – especially if your child is anxious. Local anaesthetic cream will be applied to the backs of the hands to allow painless drip insertion. In the operating room it is not uncommon for children to become uncooperative. Your anaesthetist, surgeon and nurses are experienced in settling children so the procedure can go ahead safely.

General anaesthesia for children

Your anaesthetist will start the anaesthetic with a mask that delivers anaesthetic gases. An injection may also be used. One parent can usually be present – once your child is anaesthetised you will be taken to the waiting area.

Once the procedure is completed your child will be taken to the recovery area where a specially trained nurse will monitor your child.  Your nurse will take you to your child in the recovery area once they awaken. When recovery is satisfactory your child will return to the ward. Your surgeon and anaesthetist will come and speak with you in the recovery or on the ward after surgery.

Pain relief after surgery

Local anaesthesia is commonly used to control postoperative pain. Local is injected around the nerves or near the surgical site to numb the area. Pain is often relieved by paracetamol or paracetamol and codeine mixtures. Stronger pain killers such as morphine may also be needed. Distress may occur after the operation and is usually due to disorientation. Distress is more common in younger children.

Discharge from hospital

Your child can usually eat and drink small amounts within a few hours after most types of surgeries. A drink or ice block is offered first followed by sandwiches later on. Eating and drinking too much may cause vomiting. Some children may have a temporary change in behaviour which should pass within 24-48 hours.

Possible complications after anaesthesia

Modern anaesthesia is safe, effective and routine. As with all medical procedures side effects and complications are possible. It is important that you ask your anaesthetist about possible complications so that you have enough information to fully weigh up the benefits and risks of anaesthesia.

The following risks are listed to inform you.

Nausea and vomiting

Nausea and vomiting affects one in ten children after anesthesia. Medication may be needed to stop persistent vomiting. If your child is prone to vomiting or has a history of motion sickness tell your anaesthetist so appropriate medication can be given to alleviate this.

Pain

Children vary in their requirements for pain relief after surgery. Children who awaken with pain usually settle quickly after receiving more painkiller as needed.

NOTE: Aspirin should not be given to a child under the age of 14 unless specifically prescribed by your doctor.

Sore throat

A sore throat and hoarse voice may be caused by the breathing tube. This will usually pass in a day or two.

Bruising

The skin may bruise at the site of the IV or other sites of injection. This will normall fade within 14 days.

Allergic reaction

An allergic reaction to an anaesthetic drug is uncommon. If you know about any allergies make sure you tell your anaesthetist before surgery. It is rare that an allergic reaction develops in children having their first anaesthetic.

Chest infection

Infrequently fluid may pass into the lungs during anaesthesia. This may cause pneumonia which can be severe and require intensive care. This risk is reported in one in 10,000 children after general anaesthesia. Infants and children having emergency surgery are at greatest risk.

Frequently asked questions about anaesthesia for children

My child has fallen ill before the operation day – what should I do?

If your child is ill before the operation day visit your local doctor who will be able to contact your anaesthetist and ENT surgeon.

Can I accompany my child into theatres?

• We usually agree to one parent accompanying their children to the operating room
• Separation anxiety is a well known problem and children may (particularly the younger ones) feel more secure with their parents present
• We believe that it is calming for the parent as well – it’s a case of mutual support
• Calm parents often mean calmer children
• Once the child is asleep, the parent is escorted to the waiting area

It is okay if you do not want to accompany your child into the operating room?

There is no short or long term harm to your child.

Why can’t my partner accompany my child as well?

• Our priority is to your child during this time
• Staff resources are needed to direct and look after parents
• One parent is manageable, not two

What happens when we get to hospital?

• There will be an early start and there will be long periods of waiting
• Bringing your child’s favourite book or colouring pencils will make the wait less stressful
• Generally, we like to visit you and your child before surgery
• This may occur in the ward or in the holding area in the operating room
• This is a good chance to ask any questions you still may have

Will there be a premedication?

• Yes – we usually prescribe some Panadol syrup and an oral sedative called midazolam just before the child goes to the operating theatres
• Both medications are mixed with some apple juice or cordial to make it more palatable
• The Panadol starts the pain relief process and the sedative makes the children calmer and less anxious

How will my child go to sleep? Will there be needles?

• In non-emergency cases and with children less than 12 or 13 years old, we use a gas to get kids off to sleep
• A drip (needle) will be placed only when your child is asleep
• The gas we use is called Sevoflurane; a vapour several generations down from chloroform
• Sevoflurane is often mixed with some nitrous oxide (often called laughing gas) and it takes about 2 to 3 minutes for the gas to work
• Some children find the facemask a little frightening but with reassurance and distraction, most children will drift off to sleep quite readily
• Parents are notified that during the process of going off to sleep, their child may exhibit some involuntary movements – we’ve had some parents comment after an operation that the sight of their child rolling their eyes just as they fell asleep frightened them. Yawning, rolling of eyes and wriggling are all normal behaviours as your child progresses through the different stages of sleep.
• One of our staff will escort you out of the operating theatre and the operation will proceed

There are a few other points:

• A well-informed parent is a calm parent
• A calm parent often has a calm child
• Ask questions, we are here to help
• Children are resilient
• They often bounce back quickly
• Often we underestimate how tough they are and how quickly they recover from anaesthesia and surgery

Can I stay with my child for the duration of the operation?

No – but you will be able to accompany your child to the operating room and be with them in recovery after the operation is completed.

What happens after the operation?

• Your child will wake up in an area called recovery
• There are specially trained nurses who work there and one will be looking after your child
• We usually observe your child for at least 10 to 15 minutes before getting you to join them
• It is normal for some children to be cranky and upset when they wake up
• With reassurance and comfort, most children settle within half an hour
• Your recovery nurse will be there to help and provide support

Where can I obtain more information?

Your anaesthetist is readily contactable by phone or in the hospital preadmission clinic before the operation day to answer any questions.