When your child is having any kind of procedure or surgery,
it's understandable to be a little uneasy. You probably have
plenty of questions about everything - from how the anesthesia is
given, to what your child will experience, to where you're
allowed to be.
What happens will, of course, depend on the type of procedure
your child is getting and the kind of anesthesia that will be used,
either:
-
general
- in which your child would be "asleep"
-
regional
- when one large area of the body is numbed
-
local
- when one small part of the body is numbed
To ease your mind and feel better informed, here's a quick
look at what may happen before, during, and after on the day of
your child's procedure at a hospital or surgery center.
Before Surgery
Although you may be able to talk to the anesthesiologist a day
or two prior to the operation, you may not meet until that day.
Either way, the anesthesiologist will go over your child's
medical history and information thoroughly, so that he or she can
give the right amount of anesthetic medications tailored
specifically to your child's individual needs.
The anesthesiologist may also order additional tests (such as
X-rays or blood or laboratory tests) to help figure out the best
possible personalized anesthetic plan for your child.
In addition to doing a physical examination of your child's
airways, heart, and lungs, the anesthesiologist will also want to
get your child's medical history, which will include asking
about:
- your child's current and past health
- your family's health
- any medications, supplements, or herbal remedies your child
is taking (consider bringing a list of exactly what your child
takes, detailing how much and how often)
- any previous reactions your child or any blood
relative has had to anesthesia
- any allergies (especially to foods, medications, or latex)
your child may have
- whether your child smokes, drinks alcohol, or takes
recreational drugs (this usually applies to older teenagers)
The anesthesiologist and/or surgeon will also let you know
whether your child can eat or drink before surgery. It's
important to make sure that your child doesn't eat anything
prior to surgery (usually nothing after midnight the day before the
operation). You'll get specific instructions based on your
child's age, medical condition, and the time of day of the
procedure.
Why is eating before surgery an issue? Because the body normally
has reflexes that prevent food from being aspirated (or inhaled)
into the lungs when it's swallowed or regurgitated (thrown up).
But anesthetic medications can suspend these reflexes, which could
cause food to become inhaled into the lungs if there is vomiting or
regurgitation under anesthesia. Sometimes, though, the
anesthesiologist will say it's OK to drink clear liquids or
take specific medications a few hours before surgery.
To ensure your child's safety during the surgery, it's
extremely important to answer all of the anesthesiologist's
questions as honestly and thoroughly as possible. Things that may
seem harmless could interact with or affect the anesthesia and how
your child reacts to it.
Questions to Ask
You can also ask plenty of your own questions. If you don't
meet the anesthesiologist before the day of the operation, you may
want to ask your doctor or surgeon these questions days, or even
weeks, beforehand so you and your child can have all the answers
you need:
- Am I allowed to be with my child before surgery? If so, for
how long?
- Am I allowed to be with my child while the anesthesia is
being given?
- What kind of anesthesia will my child be given?
- How will the anesthesia be administered - with an injection,
through an IV, or with a breathing mask or tube in the
throat?
- Will my child be sedated before the anesthesia is given?
- Approximately how long will the surgery take?
- Will my child still have an IV in or be hooked up to any
monitors or equipment after the surgery is over?
- How long will it take my child to fully wake up from general
anesthesia or feel the area if local or regional anesthesia was
used?
- Will my child feel pain and/or discomfort (such as nausea or
vomiting) after surgery? If so, how long will it last and what
can be done about it?
- How soon after the surgery can I see my child?
- How soon after the surgery can my child eat, drink, go to
school, or drive [if you have a teen]?
- How soon after the surgery can my child come home?
When you meet with the anesthesiologist, you'll also be
asked to sign an
informed consent form
, which authorizes the use of anesthesia. It's important to
make sure to have all of your questions answered before signing the
form.
Just before going into the operating room and drifting off to
sleep, young children may be given a special, sweet-tasting drink
(that kids may call "silly medicine"). Depending on your
child's age or ability to cooperate, it may be appropriate to
administer this "silly medicine" by spraying it into the
nose or by using a small, soft, lubricated catheter to squirt it
into the rectum (which might be used if a child won't cooperate
by drinking). The medicine is absorbed well through the stomach,
nose, or rectum, and allows your child to be sedated before going
into the operating room.
For minor procedures, a sedative may not be needed. In fact,
some children may prefer not to be sedated. Depending on what's
best for your child, the decision of whether or not to sedate him
or her beforehand is made by the anesthesiologist, using your
input.
In the Operating Room
If general anesthesia is used, the anesthesiologist will start
transitioning your child from the normal awake state to the
sleepy state of anesthesia. This is referred to as
induction
, which is usually done by either injecting medication through an
IV or by inhaling gases through a mask.
If, like many kids, your child is afraid of needles, the
good news is that he or she may not have to get one while awake.
Anesthesiologists often will begin the induction process on fairly
healthy kids using a mask. Why? Because not only are children often
afraid of needles, they may have a hard time staying still and
calm. So, the mask delivers medication to make kids sleepy and help
them relax before and during the surgery. That way, they won't
be awake when the IV is inserted for general anesthesia or when a
shot is given to numb a certain part or area of the body for local
or regional anesthesia.
When using general anesthesia, the anesthesiologist will
monitor your child's vital signs, continue to deliver
anesthesia, and keep your child as comfortable as possible
throughout the operation.
To help your child breathe and/or to help deliver general
anesthesia during the operation, the anesthesiologist may use an
endotracheal tube
(a plastic tube that's placed down your child's throat into
the windpipe through the mouth or nose) or
laryngeal mask airway
(LMA - a mask with a tube that fits into the back of the
throat).
After Surgery
Once the operation or procedure is over, the anesthesiologist
will reverse the anesthesia process and help your child "wake
up" (if your child received general anesthesia).
Your child will then be taken to the recovery room, which is
sometimes called the
post-op (post-operative) room
or
PACU (post-anesthesia care unit)
. In the PACU, nurses and the anesthesiologist will monitor your
child's condition very closely for a few hours to make sure he
or she is making a smooth and comfortable transition from an
anesthetized state to an awakened state. When your child's
medical condition is stable, you'll be asked to come to the
PACU to be with him or her during the recovery period.
If your child had general anesthesia or was sedated, don't
expect him or her to be fully awake right away - it may take a
while and he or she may doze off for a bit. It usually takes about
45 minutes to an hour for kids to recover completely from general
anesthesia. Depending on the type of medication used, numbing
medicine may wear off anywhere from 2-4 hours. The recovery time
from regional anesthesia varies depending on the type of anesthetic
used.
Although every person has a different experience, your child may
feel groggy, confused, chilly, nauseated, scared, alarmed, or even
sad as he or she wakes up. Depending on the procedure or surgery,
your child may also have some pain and discomfort afterward, which
the anesthesiologist can relieve with medications.
In many outpatient procedures, kids are allowed to come home
soon after the surgery is done. In the few cases in which
hospitalization is required, most hospitals avoid separation
anxiety by permitting at least one parent to stay with the child
day and night.
Before you leave the hospital, you'll receive instructions
for further recuperation at home and for a follow-up visit with the
surgeon. Be sure to talk to the surgeon and/or the anesthesiologist
about what to expect after the surgery and how you can help your
child be as comfortable as possible.
After discharge, call the hospital or surgeon's office if
you have any concerns at all regarding your child's medical
condition or if your child:
- has unusual bleeding from the surgical site
- has a fever greater than 101º Fahrenheit (38.3º Celsius)
- has unusual redness on or discharge from the surgical
site
- has unusual pain
- is unable to keep anything down
- is unable to take fluids by mouth
As you prepare for the surgery or procedure, it may help to
remember that anesthesia is very safe. In today's hospitals and
surgery centers, highly trained professionals use a wide variety of
modern medications and extremely capable monitoring technology to
ensure that kids are OK and as comfortable as possible before,
during, and after their procedure.
Reviewed by:
Judith A. Jones, MD
Date reviewed: April 2009
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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