Anaesthesia and children

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 day surgery 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.

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.

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.

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.

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.

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.

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.

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.

In accordance with instructions from your anaesthetist and surgeon, the recovery nurse may offer food and fluids after your child is awake.

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.

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.