Anesthesia for Children Having Surgery

What Types Of Anesthesia Can Be Given?

Anesthesia is necessary during all surgery in order to eliminate pain and eye surgery is no exception. Anesthesia can be given as a "local" or "general".Local anesthesia is rarely appropriate for eye surgery in children. Commonly, general anesthesia is used and involves putting the whole body "to sleep" for surgery. The child is not conscious, is unable to move and does not perceive sensations including pain.

How Is Anesthesia Given To Children?

General anesthesia is usually given in two stages. Typically, children are given a short acting drug intravenously or rectally or an anesthetic gas by mask. This causes them to drift off to sleep.

A breathing-tube is placed in the windpipe after the child is asleep to allow the anesthesiologist to help the child breathe during surgery. This tube is usually removed at the end of surgery before the child is fully awake.

After the child has fallen asleep, the anesthesia is maintained during the surgery. This is accomplished either by having the child breathe anesthetic gases (inhalation agents) and/or by giving the child a combination of drugs intravenously.

Anesthetic "sleep" is quite different from normal sleep because the medications affect every organ of the body simultaneously and are very potent. The achievement of the desired effect while minimizing side effects requires continuous monitoring and adjustment. Your anesthesiologist has the experience and knowledge to decide which agents are best for your child and to administer them in as safe a manner as possible.

What To Do Before Surgery?

It is extremely important that children do not eat or drink anything, even water, before their surgery because the stomach needs to be empty to avoid possible anesthesia complications. The doctor will indicate exactly how many hours or at what time all eating and drinking is to stop. A full stomach during anesthesia could lead to serious problems, even death. What Happens After The Surgery?

Once the surgery is complete the anesthetic gases are stopped and the effect wears off quickly allowing the child to breathe by him/herself and to start moving. Then the child is moved from the operating room to the recovery room. Over the next hour or so the child gradually wakes up. During this time children are often groggy and confused. Recovery room personnel also monitor the heart rate, blood pressure, and breathing rate. Once the child is fully awake they are moved from the recovery room to a room where they can be with their parents. Often during the next few hours the child will still be sleepy, sometimes cranky, and have a lowered tolerance for discomfort or pain. Calm reassurance and the use of mild pain medication when needed are helpful. Most children are back to normal activities by the day after eye surgery. Occasionally a child will sleep for hours after surgery.This is more common if preoperative sedation is utilized or if the child requires strong postoperative pain medications.

What Side Effects Can Occur?

It is not unusual for a child to be nauseated or even to vomit after eye surgery, particularly muscle surgery. Usually it happens only once or twice in the hospital, but may last longer. It is rarely serious, but everything possible should be done to reassure the child and make him/her comfortable. Medication may be helpful to counteract the nausea or vomiting.

Are There Risks To Anesthesia?

Families are often very concerned about the effect of anesthesia on their child and the possible complications. Anesthetic complications are very rare in healthy children and are not more common than in adults. Whenever possible, surgical procedures should not be performed when the child is ill. Anesthesiologists and surgeons should be informed of all medical conditions and of all medications the child is taking. They should also be informed of any anesthetic problems the child or any blood relative has experienced previously. There are some rare hereditary conditions which are associated with a greater risk for anesthetic complications.

How Can You Prepare Your Child?

The hospital and anesthesia experience can be made more positive by the doctors and hospital staff. Most children are inquisitive and fascinated by all the machines in the operating room. Parents should tell children old enough to understand why they are going to the hospital and why they are having surgery. If possible, visit the hospital beforehand with the child. Many hospitals have tours or are willing to show their facilities and explain what will happen. Children should be encouraged to ask questions.

Practices vary among doctors and hospitals as to whether parents can stay with the child during the administration of anesthesia or the treatment in the recovery room. Discuss your concerns and those of your child with your anesthesiologist or Dr. Fierson to better understand the hospital or surgery center procedure.