Paediatric Anaesthesia

Your child is having an anaesthetic. This can potentially be a stressful time for the child, parents, and rest of the family. However, the anaesthesia will be very safe. With preparation of the child, the experience of anaesthesia should not be traumatic.

TYPE OF ANAESTHESIA

Your child will almost certainly be given a General Anaesthetic. This means that your child will be deeply unconscious during the operation or medical procedure. They will not feel pain and they will not remember anything during the anaesthesia.

After a painful operation or procedure, the child is made comfortable with a combination of pain relieving medications.

SAFETY OF ANAESTHESIA

Your child's anaesthetic will be given by a medical doctor who has specialised in paediatric anaesthesia. This specialist training takes at least five years to complete, in addition to several years of training as a junior doctor, and several years in Medical School.

The anaesthesia for your child is very safe because of the high level of training and years of practical experience of the anaesthetist.

PREPARATION OF THE CHILD

Adequate preparation of your child before arriving in hospital is very important. A calm and informed child before an operation usually translates into a happier child after an operation.

Anxiety in a parent is normal behaviour when a child comes for an operation or anaesthetic. However, negative emotions or opinions in the parent will be picked up by the child. The child will then become upset before the operation. A child is then much more likely to be upset after the anaesthetic.

Preparation of your child for their anaesthetic and operation will help. Suitable techniques include the following.

1) Make it a fun or novel experience

a. Be excited and positive about the new experiences in hospital

b. Practice giving a "space mask" to a favourite teddy or doll to make them go to sleep

c. Tell stories about fairy gas (for girls) or smelly gorilla gas (for boys)

d. Talk about magic cream on the hand

Be honest but positive

e. If the child is having a painful operation, tell them that they will be sore, but they will be given medicine to help take away the soreness.

f. Tell the child that you (as a parent) will be there before they go to sleep and have pleasant dreams and will also be close when they wake after their operation

g. For the cannula or intravenous drip, tell them that they will wake up with a large sticker (bandage) on their hand.

FASTING TIMES

Fasting before an operation is important as it minimises the chance of food or large amounts of liquid from being regurgitated into the lungs (aspiration) during an anaesthetic. Aspiration can make a child very sick or sometimes result in death.

Fasting times will generally be dependent on the nature of the food or drink. As a guideline,

1) Solid food, bottle milk, drinks with solid material (eg juice pulp) stop at least 6 hours before the operation

2) Breast milk stop at least 4 hours before the operation

3) Water or clear fluids (like clear cordial) stop 2 hours before the operation

A small amount of oral medication may be prescribed by the anaesthetist about an hour before the operation.

BEFORE THE ANAESTHETIC

Your child will be seen by the Anaesthetist. The anaesthetist will try their best to put your child at ease. They will take a medical history about your child. This may include any medical illnesses, allergies, medication, past anaesthetic concerns, loose teeth, prematurity, fasting times, or family history of problems. The anaesthetist may also examine your child, especially their hearts and lungs.

A premedication is often (but not always) given before an anaesthetic. This is most commonly pain relief such as paracetamol. If given before the operation, it will have time to reach maximal effect for after the operation.

Sedative medication is less frequently given before an operation. Adequate explanation and preparation of the child is usually sufficient to allay anxiety. A sedative medication before the operation will make the child sleepy after the operation and may have other side-effects. If a child has had past traumatic experiences with anaesthetics or operations, a sedative medication may be prescribed. This may be more likely in children who have had multiple treatments for cancer or for chronic disability.

INDUCTION OF ANAESTHETIC

Induction of anaesthetic means putting the child off to "sleep" or rendering them unconscious. There are two main methods

1) Cannula

A cannula is a soft tube that is fed inside a vein with a needle. A local anaesthetic cream is placed on the skin of the child to stop the needle from hurting. The child will still feel touching so distraction is important during needle insertion. The cream generally needs to be on for at least an hour prior to the operation for it to work.

2) Gas

This involves placing a mask over your child's nose and mouth. A gas is given to put your child to sleep. The main gas is sweet and quite smelly.

A cannula is inserted when the child is "asleep" / unconscious.

The chosen method is dependent on several factors, including the health of the child, the age of the child, the cooperation of the child, and the preference of the anaesthetist. A younger or uncooperative child is likely to receive gas.

MAINTENANCE OF ANAESTHESIA

General anaesthesia is continued through the use of gases or intravenous medication. Numerous other medications may be given, including pain relief, drugs to stop vomiting after the operation, and antibiotics.

The anaesthetist keeps your child safe throughout the anaesthetic. They are in the operating room at all times. A breathing tube is often inserted when your child is under an anaesthetic to assist breathing and to protect the lungs. Intravenous fluid is often given to stop dehydration from fasting, or to replace fluid losses during the operation.

AFTER THE OPERATION

Your child will go to a Recovery Room for approximately 30 minutes after an anaesthetic. This is to ensure the child is relatively alert, medically stable, and comfortable before going back to the ward. The Recovery Room is staffed by nurses who specialise in caring for children who have just had an anaesthetic. There is at least one nurse for each child. The anaesthetist is either with the child or immediately available during this time in the Recovery Room.

Parents are not routinely allowed in the Recovery Room. One reason is to maintain the confidentiality of the other children who have just had an operation. Another reason is to allow the staff to care for sick children without distraction. However, parents are sometimes asked to go to the Recovery Room if their child is upset after an anaesthetic but it is not yet safe for them to be transferred to the ward. Everyone who cares for children in hospital is aware that it is best for a child to be with their parents as soon as possible. You will be reunited with your child as soon as it is safe to do so.

THE WARD

Treatment of your child is dependent on the nature of their operation.

A lot of children can go home on the same day as their operation. An overnight stay is also common (eg after tonsillectomy to monitor for bleeding or breathing problems).

Pain relief is provided for home if necessary. Ibuprofen or Nurofen is avoided for operations which involve bleeding (eg tonsillectomy) as it will make the bleeding worse.

By
Dr Adam Harmon MBBS FANZCA
Wesley Anaesthesia and Pain Management