aasc

Anesthesia Associates of Southern Connecticut

Pediatric Anesthesia FAQ's

What can I do as a parent to help my child in this stressful period?

The anesthesiologist, surgeon, nurses and operating room personnel will do everything possible to make your child's visit as pleasant as possible. However, there are many ways you as a parent can help.

Children do far better when they are well-prepared. Beyond the infant stage, they develop a healthy fear of the unknown, and anything you can do to inform your child about what to expect will improve his or her experience. It is essential that you understand what your child will be experiencing, so that you can convey this information in a way that is understandable to the child.  Explain everything that you can, including simple things such as the walks through the corridors, the walk to the operating room, the adult-sized hospital beds, the cold environment, the IV (almost never necessary), the facemask (almost always necessary), the taking of vital signs, the presence of other children. Your child will gain confidence if you seem knowledgeable to him. Explain to your child that everything will be explained beforehand and that there will be no surprises.

You know best what works with your child to comfort her and to inform her. Please use this website to inform yourself of the anesthetic your child will receive.  If you have questions, contact our department and an anesthesiologist will be happy to speak with you. 

Your calmness is essential. A child needs a composed, confident parent to remain calm and relaxed. Even though you may be feeling intense anxiety, it is critical that you not convey this to the child. We are constantly amazed at the incredible composure of almost all parents going with their children to the O.R. The tears flow (from the parents, that is), but almost never until the child has calmly fallen asleep.

What will the anesthesiologist need to know?

The anesthesiologist wants to be sure that your child is in the best possible condition for surgery. You will be asked questions about allergies, medical conditions, medications, history of adverse reactions to anesthesia, family history of serious reactions to anesthesia, last food and/or liquids, and recent illnesses.

Any history of serious anesthetic reactions in the family needs to be shared. The 2 serious reactions that the anesthesiolgist will be most interested in are malignant hyperthermia and abnormal reactions to muscle relaxant.

When will I meet the anesthesiologist?

In most cases, you will meet the anesthesiologist on the day of surgery. If your child is already in the hospital, an anesthesiologist will speak with you in your child's hospital room.

In some cases, the anesthesiologist will contact you by phone if there are any specific instructions you need or if there are any special concerns regarding your child's care.

As always, an anesthesiologist is available 24 hours a day to answer your questions. Use the Contact Us page on this website to speak with our office or directly to an anesthesiologist.

Is there a tour for my child and me?

Norwalk Hospital no longer offers a tour. Please contact the anesthesia department if you would like to meet an anesthesiologist. He or she will be happy to show you the facility.

What if my child is ill before the procedure?

Sometimes, illnesses such as colds and sniffles may cause problems during surgery, especially a general anesthetic. Your anesthesiologist will discuss with you if proceeding with surgery is safe. Many of our patients are coming to the O.R. for ear tubes, tonsillectomies, and other ENT surgeries, and seem to always have a cold or sniffle. This will be taken into account in your discussion with the anesthesiologist.

Does my child have to fast before the procedure?

Yes. For all elective procedures, we require a fasting period. We strictly adhere to the guidelines of the American Society of Anesthesiologists (ASA). These are as follows:

American Society of Anesthesiologists
Summary of Fasting Recommendations to Reduce
the Risk of Pulmonary Aspiration
Clear Liquids
Breast Milk
Infant Formula
Non-human Formula
Light Meal
Regular Meal
2 hours
4 hours
6 hours
6 hours
6 hours
8 hours

These recommendations apply to healthy patients who are undergoing elective surgery. They are not intended for women in labor. Following the guidelines does not guarantee a complete gastric emptying has occurred. The fasting periods above apply to all ages.

Examples of clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. Since non-human milk is similar to solids in stomach emptying time, the amount ingested must be considered when determining an appropriate fasting period.

A light meal typically consists of toast and clear liquids. Meals that include fried or fatty foods or meat may prolong gastric emptying time. Both the amount and type of foods ingested must be considered when determining an appropriate fasting period.

What are considered clear liquids?

Clear liquids are any liquids that you can see through. If you can read the newspaper through the liquid, it is a clear liquid. Some examples are water, electrolyte solutions (e.g. pedialyte), apple juice, carbonated and non-carbonated clear soft drinks, clear tea, black coffee.

Liquids that are NOT considered clear liquids are orange juice, milk, coffee/tea with milk or cream. These liquids empty from the stomach much more slowly and should be considered as a "light meal" in terms of fasting.

What kind of anesthesia will my child receive?

The foremost concern of your anesthesiologist is your child's safety, and nothing will be done to compromise that. Almost without exception, however, the experience can be made pleasant and easy for your child,without sacrificing safety. There are several ways anesthesia can be given to patients. They are listed below.

  • General Anesthesia for outpatient surgery - if your child is coming for an elective surgery, and has fasted the recommended time, he or she is a candidate for a "mask induction".  This anesthetic can be started without an IV and with a parent present in the operating room.  The child and one parent walk to the operating room and the child is placed on a warm blanket on the operating table. If the child is uncomfortable with this, he or she can remain in the parent's arms. A mask, flavored with the child's favorite flavor, is placed over the child's face and the child begins breathing the anesthetic. After only a few breaths, the child is asleep. At this point, the parent is escorted to the waiting room. An IV is then started (unless the surgery is ear tubes).
    In some cases, the child will already have an IV in place. In these cases, the child will be sedated through the IV. This makes the child extremely calm and causes total amnesia for the events that follow. These children separate easily and peacefully from the parents and can often be taken to the operating room without a parent. The anesthetic is then started through the IV.
    Finally, there will be rare cases in which the anesthesiologist feels that an IV must be started before surgery. See the next question in this FAQ - Will my child need an IV?
  • General Anesthesia for emergency surgery - for emergency surgery, especially if the child's stomach is full, it is absolutely necessary to start an IV before the anesthetic is begun. In these cases, sedation is given through the IV which allows for a very peaceful separation from the parents. The child is then taken to the operating room and the anesthetic is induced in a rapid fashion through the IV. A breathing tube is always placed - this is to protect the lungs from the contents of the stomach.
  • Regional Anesthesia - these techniques are usually reserved for older children and adolescents. They include spinal anesthetics, epidural anesthetics, and nerve blocks. Please see the "Types of Anesthesia" section in Patient Info.
  • Sedation - this is the most common type of anesthesia used for procedures taking place outside the operating room. These include MRI's, CAT scans, EEG, Xray procedures, and procedures in the GI lab (colonoscopy and upper endoscopy). For these procedures, an IV is placed after EMLA cream (see below) has been applied. An IV infusion is begun with the parent present; when the child is asleep, the parent is taken to the waiting room. No breathing tube is necessary. The child breathes oxygen through a nasal cannula. Remember that the child must have an empty stomach to use this technique.
  • Will my child need an IV?

    If your child is having elective surgery, and has an empty stomach, the anesthetic can be started with a mask only. The IV can be started after the child is asleep. Ear tube surgery does not require an IV at all.

    If your child's stomach is full (usually with emergency surgery), then an IV must be started. This allows for the rapid induction of anesthesia and immediate placement of a breathing tube to protect the lungs from the stomach contents.

    If your child is having a procedure outside the operating room (e.g. colonoscopy, endoscopy, MRI, CAT scan, X-Ray procedure), these procedures are done with sedation only. An IV must be started to give the sedation. A wonderful invention, EMLA cream, is applied to the area where the IV is to be started. This virtually eliminates pain with the IV insertion.

    What is EMLA?

    EMLA is a local anesthetic cream that is specially formulated to penetrate the skin. When applied to the site where the IV is to be started, it makes the area numb, and virtually eliminates the pain of IV insertion. It must be applied 20-30 minutes in advance.

    Can I be with my child when he goes to sleep?

    Please see the above answer to "What kind of anesthesia will my child receive." If your child is having a mask induction, then you may present when he or she goes to sleep. If your child is having IV sedation for a procedure such as MRI, Xray procedure, endoscopy or colonoscopy, then you may be present as he orshe drifts off to sleep.

    If your child is having emergency surgery or has a full stomach, and your anesthesiologist feels that a rapid induction of anesthesia through the IV is necessary, then you will not be allowed to be present as your child goes to sleep. In these cases, though, the child has an IV and can be sedated before going to the operating room

    Will I be with my child when she wakes up?

    Almost without exception, the child will be awakened in the operating room before being brought to the recovery room. When the child reaches the recovery room, oxygen is applied and vital signs are taken. As soon as it is clear that the child will recover smoothly, the parents are allowed to come into the recovery room. Children are generally sleepy at this point, and their first memories of the recovery room are those with their parents.

    How is pain controlled after surgery?

    In most cases (excluding ear tubes), pain medicine is given through the IV during surgery. If appropriate, the surgeon will inject local anesthetic into the incision - this is extremely helpful. In older patients, regional anesthesia can be used (usually nerve blocks).

    If there is pain in the recovery room, IV medications are used to quickly alleviate pain. If the child is being admitted, and is old enough, PCA (patient controlled analgesia) can sometimes be used. See section on PCA under "Pain Management".

    Will there be nausea and vomiting?

    Nausea and vomiting is an unfortunate side-effect of general anesthesia. It is extremely rare in cases involving only sedation or regional anesthesia (spinal, epidural, nerve block, etc.)

    We do everything possible to prevent this miserable condition. Children receiving general anesthesia receive Zofran and usually a small dose of Decadron and these two drugs have proven extremely effective in preventing nausea and vomiting.

    What are the risks of anesthesia?

    The vast majority of complications from anesthesia are minor and temporary. These include sore throat, hoarseness, nausea/vomiting, bruised or cut lips.

    The major complications include aspiration pneumonia, stroke, nerve damage, anaphylactic shock, and rarely death. Fortunately, the incidence of these major complications is extraordinarily low. The incidence of anesthesia-related death is approximately 1:200,000 in healthy patients.

    Your child's risk for complications will vary with your medical condition, the procedure he or she is having, and if it is emergency surgery. Some of the medical conditions that may increase risk are current illnesses (such as bronchitis, pneumonia, bad chest cold), asthma, and obesity. Allergic reactions, drug interactions, and rare hereditary disorders such as malignant hyperthermia Malignant Hyperthermia (MH) is a rare, life threatening disorder, developing during or after general anesthesia. It is a genetic disorder (autosomal dominant). Both a genetic predisposition, and one or more triggering agents are necessary to evoke MH. Triggering agents include all inhaled anesthetics and one muscle relaxant (succinylcholine). In classical MH a hypermetabolic state develops, caused primarily by muscles of the skeletal system. Elevated heart rate, breathing rate, and temperature (to 110 degrees) develop. Untreated, muscle breakdown occurs with release of massive amounts of potassium, and resultant death.

    Fortunately, with early recognition, MH can be treated effectively with Dantrolene, and the mortality reduced to about 10%. Better yet, if a patient is known to have a history of MH, or a family history, steps can be taken to avoid all triggering agents and prevent MH altogether. This is why you will be asked about any family history of MH. The anesthesia department of AASC has a dedicated MH cart with all necessary drugs and protocols for the treatment of MH. Every anesthesiologist and CRNA is expected to be familiar with this cart.
    may also contribute to anesthetic risk.

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