Pediatric Hospital Sedation
What is general anesthesia?
General anesthesia is a combination of medications that ensure loss of consciousness, prevent memory formation, and eliminate pain. This enables a patient to have surgery without any memory of the event and to be completely pain-free during the procedure.
Are there other types of anesthesia? Can I choose the type my child receives?
Other than general anesthesia, there are regional, epidural/spinal, local anesthesia, and monitored anesthesia care. Choosing the type of anesthesia is a shared process in which the anesthesiologist takes into consideration the parents’ and the patient’s wishes. Ultimately, the anesthesiologist will choose the safest, most comfortable, and best option for your child.
Can anesthesia and sedation affect my child’s brain development?
Learn more here: What to Know About Anesthesia
What is the purpose of a pre-operative visit?
A preoperative visit with a nurse practitioner and/or anesthesiologist can occur days or even a week before the scheduled surgery. If your child is very healthy, this visit may be on the day of the surgery.
During this visit, we will obtain a medical history, perform a physical exam, and determine whether any further testing is needed, such as a laboratory blood draw, ECG, echocardiogram, chest X-ray, CAT scan, or MRI.
Your questions can be answered at this time. This will prevent delays in caring for your child on the day of the surgery.
What should I do before anesthesia? Can my child eat or drink?
Before anesthesia, there are certain protocols that allow for safe care of your little one, including the timing of food, drinks, and medications and the preparation of your child to tolerate the experience of undergoing surgery. We have a guideline which includes the latest time that it’s okay to eat and drink before surgery to make sure your child’s stomach is empty.
This significantly reduces the risk of having aspiration, which happens when food comes up from the stomach and into the lungs.
Before Surgery
- NO solid food after midnight on the scheduled surgery day, including gum or candy
- NO milk, juice, or formula after midnight before the scheduled surgery day
- NO clear liquids four hours before scheduled surgery time; clear liquids include water, Pedialyte®, Gatorade®, apple juice, Jell-O® (without fruit), Kool-Aid®, and tea
- NO breast milk after 3:30 a.m. the day of surgery
- Preparing Your Child for Surgery (English)
- Preparing Your Child for Surgery (Spanish)
What about my child’s medications?
We recommend for your child to get certain types of medications on the day of surgery with a small sip of water (preferably at least 2 hours prior to the time of surgery).
It’s important to continue respiratory medications, such as albuterol, on the morning of the surgery. This reduces the risk of an asthma attack while your child is under the anesthesia.
Anti-reflux medications such as Prevacid or Pepcid can also be taken prior to surgery. Your child can take anti-hypertensive medication the night before surgery, but ask your anesthesiologist about taking it on the morning of the procedure, because each situation is different.
If your child is on specialized medication, it’s crucial to speak to the anesthesiologist to find out if your youngster should take it the morning of surgery.
What happens during general anesthesia?
Your child will have received silly juice in the pre-operative area that will help him or her relax and tolerate separation from you. Once in the operating room, our experienced nurses and OR staff, as well as the anesthesiologist, will work very hard to keep your child calm with use of games and distraction techniques.
Given a mask with anesthesia air, your child will fall asleep and then receive an intravenous line (IV) after he or she is asleep. For older children, and if it is safer for smaller children, an IV may be started in the preoperative area.
Once your youngster is asleep and being monitored closely by your anesthesiologist, surgery starts. Appropriate medications will be administered to make sure the patient remains asleep for the duration of the procedure and is comfortable upon awakening.
The amount of medications is based on your child’s weight and other factors which the anesthesiologist will take into consideration to keep your child safely pain-free and asleep.
Can I be with my child during the operation?
Our operating rooms are sterile rooms. For your child’s safety, we don’t have parents stay during the surgery. On occasion, we may ask you to accompany your child into the operating room until he or she falls asleep, and then escort you back to the waiting area. We will provide you with a uniform to put on in that situation.
What is a consent form?
A consent form is a document that lists the type of anesthesia your son or daughter is expected to receive and the potential complications associated with it. The complication list is comprehensive, but it does not mean the risk of those complications happening is high. The anesthesiologist will go over those with you and allow you time to ask questions.
What is a breathing tube?
A breathing tube is a tube that is placed after your child is asleep. It passes through the mouth and into the trachea. We have ultramodern equipment that uses the latest technology, including video laryngoscopes, fiberoptic scopes, and laryngeal mask airways (including the Supreme) to secure your youngster’s airway and prevent damage to the lungs from aspiration.
What are the risks of general anesthesia?
Modern general anesthesia is very safe. The risk of having a fatal event is on the order of 1:200,000 surgeries. Risk is proportional to the severity of illness and other congenital disorders and the invasiveness of the surgery.
A liver transplant surgery in a child with bad heart function is a much higher risk than fixing a broken arm in a healthy child. Regardless of the risks, be assured that your anesthesiologist will do everything possible to keep your little one safe and comfortable even during the riskiest of surgeries.
What if my child is very nervous?
We will administer a premedication (sometimes referred to as silly juice or giggle juice) while they are with you in the pre-operative area. This will prevent your son or daughter from remembering the separation from you and will help keep the patient calm.
Will my child feel any pain or remember anything during surgery?
No. It is extremely rare for someone to remember their surgery or feel pain during surgery. In the very rare situation where your child undergoes a life-saving surgery after a catastrophic accident, it may be impossible to administer anesthesia without harming the child (due to lower blood pressure), but even in those situations, the anesthesiologist will do everything possible to keep your child pain-free.
How will the anesthesiologist know how much anesthesia to give my child?
We base the amount of anesthesia on your child’s age, weight, the amount of pain known to be associated with each surgery, and the patient’s heart rate, blood pressure, and respiratory rate. This has been set over years of training under close supervision. Your anesthesiologist is an expert in controlling pain and the level of anesthesia for various surgeries and different patient needs.
What if there is bleeding?
Most often, expected blood loss is based on the surgery. In these situations, we often utilize special tools such as arterial lines and/or central venous catheters to monitor your child closely.
We ensure that we are able to administer blood and replace blood loss with well-functioning intravenous lines. When blood loss is anticipated, blood that has been matched to your child will be readily available. In cases of unexpected blood loss and emergency situations, blood can quickly be obtained from the blood bank.
What is an IV? An a-line? A central line?
An intravenous line is a catheter (plastic straw) that sits in a vein in the hand, foot, or arm that allows us to give fluids to your child. An arterial line is a catheter that sits in the artery of the hand or foot that allows us to measure your child’s blood pressure with every beat of the heart and to draw special blood tests to help us monitor your child’s condition during a major surgery.
In addition to an arterial line, a central line may also be placed for major surgery. A central line is a catheter that sits in one of the large central veins of the body in the neck, chest, or groin. All these are placed after your child is asleep, and your anesthesiologist will discuss them with you, if we plan to place them.
What is a PCA?
PCA, or patient-controlled analgesia, is a pump that allows us to deliver pain medications through an intravenous line. Most often the patient, will have a button to press that will deliver the medication from the pump into a vein through his or her IV. In smaller children, the parents can be educated to press the button when their child is complaining of pain in the post-operative period.
What about waking up from general anesthesia?
Once the surgery is finished, we will turn off the anesthesia gas and assure that your child is comfortable and breathing well prior to removing the breathing tube. Your child will not remember the breathing tube coming out and will likely remain drowsy for a while after leaving the operating room as he or she continues to breathe off the anesthesia gas.
In certain severe situations, it may be safer to keep the breathing tube in place and to recover in the intensive care unit. Your anesthesiologist will discuss this with you if the doctor thinks this may be a possibility.
How about recovery after anesthesia?
If you are here for an outpatient procedure, once your child is fully awake and drinking liquids with stable vital signs, he or she will be discharged. We have experienced nurses in the recovery room (also known as the PACU), who will only discharge your youngster if it is safe to do so.
If your child is here for more major surgery or needs further monitoring, he or she may be admitted to the floor or the intensive care unit as needed.
When can I be with my child after surgery?
Soon after your child arrives in the recovery room, and as soon as the nurse believes the patient is stable, we will call to have you escorted to your child’s bedside. In certain cases, this may be immediately upon arrival and in other cases it may take over an hour to stabilize a child who is more sick and needs more medical attention.
When can my child start eating and drinking again?
We recommend to have your child start with liquids, which will be provided by the recovery room nurse. Once the patient tolerates clear liquids, breast milk or formula may be attempted. It is generally better to start regular food after arrival at home or the hospital room if your little one is admitted.
When will my child be ready to be sent home after surgery?
For outpatient procedures, once your child is awake and able to drink liquids with pain under control and vital signs stable, he or she will be discharged. Your recovery nurse and anesthesia team will determine when discharge is appropriate.
Discharge instructions will be provided and your questions will be answered prior to your departure. For more involved procedures or in cases when there are specific health concerns, observation overnight or even admission for several days of recovery may be required prior to discharge.
Are there any complications of anesthesia that may happen after I leave the hospital?
If your child is at risk for a particular problem after surgery, you will be informed. It is rare for a child who has met the discharge criteria to have a complication at home that requires a return to the hospital.
Occasionally, if a child is ill with an upper respiratory infection for instance, but the procedure is necessary, the anesthesiologist may tell you to see your pediatrician in case your child becomes sicker and develops a postoperative fever. This usually a rare situation.
Also, if your child refuses to drink prior to leaving the hospital, your anesthesiologist will recommend that you come back to the hospital if your child doesn’t drink anything within a certain time frame. This is recommended to avoid possible dehydration due to poor intake of liquids.
Should I watch out for anything once I’m home with my child?
You will be given discharge instructions prior to leaving the hospital. Nausea and vomiting are common after anesthesia, but do not become major issues unless your child is not keeping any food or drink down and is becoming dehydrated. In that rare situation, you should bring your youngster back to the emergency department.