Your Child’s General Anaesthetic

Children’s Anaesthesia

Produced by Joondalup Health Campus

What Is anaesthesia?

General anaesthesia is a state of controlled unconsciousness and freedom of pain.

Anaesthetics are the drugs (gases and injections) that are used to start and maintain anaesthesia.

Anaesthetists are specialist doctors who give the anaesthetic and look after the health of your child during surgery. They will also be involved with your child’s pain relief after surgery.

As a parent, you will be reassured to know that modern anaesthesia is very safe and complications are extremely rare.

On the day of admission

Unless you have had prior contact an anaesthetist should come and visit you on the ward before the procedure to discuss your child’s anaesthetic. The anaesthetist needs to find out about your child’s general health, previous experiences of anaesthesia, any medicines your child may be taking and any allergies they might have. It is important that your child is not suffering from any other illnesses that will make it harder for them to recover from their surgery. A cold, cough, runny nose, or sore throat can become much worse after an anaesthetic, or make it harder for your child to breathe during or after the procedure. It is important for you to also inform your anaesthetist if your child has any loose teeth.

Delaying The Operation

Occasionally the anaesthetist may learn something about your child that means that it would be safer not to do the procedure on that day. This could happen if your child has a bad cold, has a rash or has eaten food too recently.

Fasting For General Anaesthesia

The hospital should give you clear instructions about fasting. It is important for your child to follow these.

If there is food or liquid in your child’s stomach during the anaesthetic, it could come up into the back of the throat and damage their lungs. These are the latest times that you should give your child anything to eat or drink:

6 hours before your child can have a light meal, a glass of milk or a fizzy drink. Bottle fed babies can have a formula feed.
4 hours before babies can have breast milk.
2 hours before all children and babies can have a small drink of water but not a fizzy drink.
No lollies or chewing gum should be given at all on the day of surgery.

Premedication

Premedication (premed) is the name of drugs which are sometimes given before an anaesthetic. Some premeds help your child to relax, and some are given for their pain relieving properties (eg: paracetamol).

If your child does need a premed, this will usually be given as a liquid.
Occasionally an injection is essential.
Premeds are given some time before the anaesthetic.

The drugs used can be:

Sedatives to ease your child’s anxiety.
Local anaesthetic creams (numbing creams) can be applied to your child’s hands. This makes insertion of an intravenous drip at the start of the anaesthetic painless for most children.
Pain relieving drugs such as paracetamol that can help at the end of the procedure.
Medicines to protect your child from the side effects of the anaesthetic (eg: nausea).
Going To Theatre
Most hospitals provide colourful gowns for your child to wear. Your child will be able to keep their underwear/nappy on.

Most children stay relaxed if a parent goes with them to theatre. Your child will travel to theatre on a hospital bed and in some cases you will be able to travel on the bed with your child. The nurse from the ward will accompany you and your child to theatre.

At the discretion of the anaesthetist you will be welcomed to stay with your child until they are unconscious. Your child may have either an anaesthetic gas to breathe or an injection through a small needle (cannula/drip).

If the anaesthetic is given by gas, it will take a little while for your child to be anaesthetised and they may become restless as the gases take effect.

If an injection is used, your child will normally become unconscious very quickly indeed. Watching your child go to sleep may be upsetting or stressful. Some children may roll their eyes, twitch, snore and go limp very quickly. This is all perfectly normal. Once your child is asleep you will be asked to leave and a member of staff will be with you as you leave.

What Happens Next?

Throughout the anaesthetic period, your anaesthetist remains with your child and will monitor your child’s blood pressure, pulse, temperature and breathing closely, ensuring that they are safe and fully unconscious. Anaesthetic gases and/or drugs given into the vein will be used to keep your child anaesthetised.

After Surgery

Most children will go to the recovery ward. Each child is cared for by a specialist nurse until they have regained consciousness and are comfortable enough to return to the ward. Pain relieving drugs are given during the anaesthetic to ensure your child is as comfortable as possible after surgery. The type and strength of pain relief given will depend on the procedure. The right dose of pain medicine for a child is the dose that reduces the pain with the fewest side effects. It may not be possible to eliminate all pain, but there are strategies (medicines, as well as physical and psychological means) that can reduce pain to acceptable levels.

Side Effects And Complications

Minor side effects from anaesthesia are common and some are listed below:

Pain – pain after surgery varies greatly from child to child and techniques to help with pain are mentioned in earlier pages.
Nausea And Vomiting – this can occur in about one in ten children but generally stops within the day. The risk is much greater if the child has a history of vomiting with anaesthesia or motion sickness, or if there is a strong family history of vomiting with anaesthesia. You should tell the anaesthetist about any of these prior to them going to surgery.
Allergic Reactions – allergic reactions to anaesthetic drugs are extremely rare in children and mostly fully reversible.
Sore Throat – this can occur after anaesthesia, most commonly due to a tube placed in the throat to allow breathing during surgery. This settles quickly after 24 hours.
Local Anaesthetic Block Effects – side effects from local anaesthetic blocks are uncommon. Some children dislike the numbness or weakness that happens with the block. If the block is unsuccessful another method of pain relief may be needed.
Epidural/Spinal/Caudal Blocks – major complications are extremely rare but include permanent nerve damage, epidural infection and convulsions due to local anaesthetic. In modern anaesthesia, serious problems are uncommon. Risks cannot be removed completely, but modern equipment, training and drugs have made it a much safer procedure in recent years. About one in twenty children in Australia are anaesthetised each year. Reliable figures show that Australia is one of the safest countries in the world for children’s anaesthesia.

Relieving Pain

Ways Of Giving Pain Relief

Syrups and tablets – just like home.

Melts – medicines that ‘melt in your mouth’ – these are especially suitable for older children.
Suppositories – some pain relieving medicines like paracetamol can be given rectally (into the bottom). These are often given whilst your child is anaesthetised and last for several hours. Suppositories are very helpful when children cannot take medicines by mouth.
Local anaesthetics – these are injected near the nerves around the operation site to numb the area. The injections are given while your child is anaesthetised and the pain relief lasts for several hours.
Caudal injections – Caudal anaesthesia is given with general anaesthesia to block pain in the legs, low back, belly and lower trunk area. It is an injection of local anaesthetic that is given in the part of the back where your child sits. A caudal allows the anaesthetist to give a smaller amount of general anaesthetic during the surgery, and also provides up to four hours of pain relief in that area after the surgery.

Some Common Terms Used With Medicines:

IV – intravenous – when a drug is given into a vein through a cannula.
IM – intramuscular – when drugs are given by injection into the muscles of the bottom or upper arm.
S/C – subcutaneous – when drugs are given just under the skin, either as a one off or through a cannula.
Infusion – when drugs are given continuously, usually by a special pump.
PCA – Patient Controlled Analgesia – an infusion of pain relieving drugs controlled by a pump with a button which your child can push when extra doses are needed. This is usually restricted to older children who are able to understand how to use the pump.
Epidural – local anaesthetic is injected through a thin tube placed close to the spine – used after major surgery.
Caudal – an injection of local anaesthetic near the nerves as they leave the spine, similar to an epidural.

References

Phillips, S., Daborn AK, Hatch DJ. Preoperative fasting for paediatric anaesthesia. Br J Anaesth 1994; 73:529–536.
Thompson, N. et al. Pre-operative parental anxiety. Anaesthesia 1996; 51:1008–1012.
Royal College of Anaesthetists – Raising the Standard: Information for patients- principles, samples of current practice RCoA, London 2006
Tait, A.R. et al. Parents’ preferences for participation made in decisions regarding their child’s anaesthetic care. Paed Anaes 2001; 11:283–290.
Setting standards for children undergoing surgery. Action for Sick Children, London 1994.
Schechter, N.L., Berde, C.B., Yaster, M. Pain in infants, children and adolescents. Lippincott Williams and Wilkins, Philadelphia 2003.

Acknowledgements: Dr Merlin Nicholas and Fiona Crawford, Joondalup Health Campus.

Disclaimer: The advice and information contained herein is provided in good faith as a public service. However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquiries as to the accuracy and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed.