Anaesthesia and children Children of all ages, including newborn babies, may require anaesthesia. Your child’s age; illness or developmental concerns; and the nature of the procedure all make a difference to what skills and experience are required by medical staff and the type of hospital needed to ensure your child will receive the care they need. If your child needs an anaesthetic, your anaesthetist will be with you every step of the way. Your child’s anaesthetist will meet you and your child before the procedure to get to know them; what’s important to them; their current health; and anything else that may affect how they care for your child. You will be able to ask questions and talk about anything that concerns you about the anaesthetic or anything else related to the day of the procedure. The anaesthetist will discuss the anaesthesia and how you can best help in caring for your child, including pain relief after the procedure, and how to best care for them at home. Following your child’s pre-anaesthesia consultation, the anaesthetist will prepare your child for anaesthesia. This may include giving sedation (pre-medication) to your child to help with anxiety; applying local anaesthetic cream to numb a patch of skin where a cannula/ intravenous (IV) drip will be inserted to deliver the anaesthesia medicines; and providing distractions such as stories, videos, or toys. After your child’s surgical procedure is over, your anaesthetist will stop administering anaesthetic medicines and begin the wake-up process. When it is safe to do so, the anaesthetist will escort your child to the post-anaesthesia care unit (PACU) and hand care over to a trained recovery room nurse, who will continue to monitor your child throughout the wake-up period and will make sure that your child is comfortable and safe. Where can my child have a procedure under anaesthesia? Most hospitals will have set patient age limits while others may not perform surgery or procedures on children at all. Routine procedures, such as tonsillectomy, grommets, or dental treatment may take place in many hospitals and daysurgery units that are set up for children. But children who are very young, have complex multiple illnesses, and/or who require major surgery are likely to be cared for in a larger hospital with children’s services or a children’s hospital. Who will look after my child during anaesthesia? Anaesthetists are highly qualified specialist doctors with unique clinical knowledge and skills. Their role is to ensure your child’s safety and comfort. The anaesthetist will meet you before the procedure to get to know you and your child and anything about the care that is important to either of you. They will stay with your child to observe and monitor them closely throughout their anaesthesia. What types of anaesthesia can be used for children? Most children will be anaesthetised with medications that put them into a carefully controlled state of unconsciousness where they are not aware of what happens during the procedure until the medications are stopped. This is called general anaesthesia (GA) and, to them, this will feel like a deep sleep. General anaesthesia can be supplemented by local anaesthetic medicine which, when injected into a specific area, will make the operated area numb so your child is as comfortable as can be on waking up. Other medicines may be given or prescribed to help your child feel ready to drink or eat after waking. What can I do to help my child prepare? It is very helpful for your child if they know what is going to happen in the hospital. Be prepared to answer their questions and focus on the good reasons for having the procedure. Bring along any items such as toys or devices that will help make your child feel more comfortable during their hospital stay. What questions will the anaesthetist ask me? To reduce the risk of complications during anaesthesia, your anaesthetist will usually ask: When your child last had anything to eat or drink. It’s important to have stopped as instructed. If your child has any current medical problems such as a cough, cold, or fever. If your child has any history of asthma, heart problems, loud snoring, anxiety or other medical problems. If your child is taking any any medications, supplements, or herbal preparations. If your child has any allergies to medicine. If your child has any loose teeth, dental braces, dental plates, or other orthodontic devices. Whether anyone in the immediate family smokes. Whether anyone in the family has had problems with anaesthesia. How is general anaesthesia administered to children? General anaesthesia (GA) for children begins with them either breathing anaesthetic gas through a face mask, or by injecting anaesthetic medicine into a vein through an IV drip. Starting general anaesthesia by IV injection is usually faster than by breathing anaesthetic gas. In some situations, such as for older children or in an emergency, IV injection is the preferred method. Can I accompany my child into the operating room? If it's helpful to your child and safe to do so, you may be able to accompany your child for the start of their anaesthesia. It is helpful if you remain calm and keep your child happy. As the anaesthesia takes effect, you may notice twitching type movements, eye rolling, snoring and other changes to breathing. This is normal. Once your child is anaesthetised, staff will escort you to a nearby waiting area. They will also make sure they have your phone number so they can call you to be with your child in the recovery area when they are waking up. What happens after I leave the operating room? Your child will remain anaesthetised, monitored and cared for by the anaesthetist. You will have the opportunity to rest and refresh yourself, and prepare for the time you are reunited with your child following the procedure. When will my child be able to eat and drink again after surgery? In accordance with instructions from your anaesthetist and surgeon, the recovery nurse may offer food and fluids after your child is awake. Will my child experience side effects from the anaesthesia? Recovery room nurses are skilled at assessing issues such as discomfort, hunger, and thirst. Occasionally, children are agitated or confused upon waking from general anaesthesia. This condition is not serious, stops relatively quickly, and the child does not usually remember this. It is often helpful for smaller children to have a familiar toy with them at this stage. If necessary, a sedating medicine may be given to settle this agitation. Will my child need any post-anaesthesia care? Following a day procedure, your child will be able to go home when the surgeon and anaesthetist are happy with your child’s condition and confirm that it is safe to do so. The recovery nursing staff will give you information about your child’s post-procedure care, including repeating the instructions given to you by the anaesthetist before the procedure. This will help you assess and care for your child’s comfort at home. Please note: This information is a guide and should not replace information supplied by your anaesthetist. If you have any questions about your anaesthesia, please speak with your treating specialist. ANZCA acknowledges the contribution of the Society for Paediatric Anaesthesia in New Zealand and Australia (SPANZA).