Patient education: Anesthesia in children (The Basics)

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What is anesthesia? —

These are different types of medicine given before and during surgery or another procedure. The medicines make sure your child does not feel pain during the procedure. In some cases, the medicines also prevent them from remembering it afterward.

A doctor called an "anesthesiologist" gives the medicines. A "pediatric anesthesiologist" is specially trained in giving anesthesia to children. Sometimes, a "nurse anesthetist" is also involved. This is a nurse with special training in anesthesia.

What are sedatives? —

Your child might be awake when they get anesthesia. Or they might get medicines first to make them relax and feel sleepy, called "sedatives." These are most often given as a liquid or pill, or through a thin tube that goes into a vein called an "IV." In some cases, a sedative medicine can be sprayed into your child's nose to help them relax.

What types of anesthesia are used for children? —

There are 3 main types of anesthesia:

●Local or topical – This numbs just a small part of your child's body so they do not feel pain. It can be given as a cream, gel, or spray on the skin, or by an injection (shot) into the skin. Local anesthesia is often used to reduce pain when placing an IV. Doctors might also give it before a procedure such as stitches.

●Regional – This blocks pain in specific areas of your child's body. They might be awake, or they might get sedatives first.

There are different types of regional anesthesia. Examples include:

•Nerve block – This blocks pain in 1 area of the body, like an arm or leg.

•Spinal block – This blocks pain in the lower half of the body. The anesthesiologist puts a small needle into your child's lower back, and injects medicine to numb the nerves in their spine. A spinal block can be used for surgery on the legs or inside the belly. It is usually given as a single injection.

•Epidural – The anesthesiologist uses a needle to put a small tube called a "catheter" into your child's lower back, near the nerves in their spine. The catheter can sometimes be used to control pain after surgery. An epidural can numb the area from the chest to the upper legs.

●General – This makes your child unconscious so they can't feel, see, or hear anything during surgery.

Younger children might breathe in gases through a mask placed over their nose and mouth to help them go to sleep. Then, when they are asleep, the doctor places an IV and gives them other medicines.

Older children might get medicine through an IV to help them fall asleep very quickly.

During general anesthesia, your child might also get a breathing tube to help them breathe. If so, the anesthesiologist will carefully place the tube in their throat while they are asleep. For most surgeries, they will remove the tube before your child wakes up. After some types of major surgery, such as heart surgery, your child might need to stay in an intensive care unit, or "ICU," for a day or longer. If your child is heavily sedated in the ICU, the breathing tube is kept in place until they are ready to wake up.

In some cases, the doctor might use regional anesthesia along with general anesthesia to help control pain.

What is monitored anesthesia care? —

During monitored anesthesia care, or "MAC," regional or general anesthesia is not planned. But the anesthesia specialist is there to monitor your child closely, keep them safe, and make sure they have the right medicines to be comfortable.

With MAC, your child might get local anesthesia as well as sedative and pain medicines. The anesthesia specialist will be ready to give your child general anesthesia if it becomes necessary.

What happens before surgery? —

An anesthesiologist or nurse anesthetist will meet with you and your child and do an exam. They will ask you and your child many questions, including:

●Does your child have any health problems?

●Do they have any dental problems, such as loose teeth or false teeth?

●What medicines do they take, including over-the-counter medicines and supplements?

●Do they smoke, drink alcohol, or use any drugs?

●Do they have any allergies to foods or medicines?

●Have they or any of their relatives ever had a problem with anesthesia?

The type of anesthesia your child will get depends on:

●The answers to the questions above

●The type of surgery or procedure they will have

The anesthesiologist will decide the best type of anesthesia to use, based on your child's health and the surgery or procedure. The anesthesiologist will always explain how the anesthesia will be given and answer your and your child's questions.

You will get instructions about what your child needs to do before the procedure. This includes information about:

●Eating and drinking – For some types of anesthesia, your child needs to "fast" before the procedure. This means not eating or drinking anything for a period of time. Or they might be allowed to have liquids until a short time before the procedure.

●When to arrive for the procedure

●If your child should take their usual medicines

What happens during anesthesia? —

When it is time for the procedure, your child will get an IV. This is used to give them fluids and medicines. The IV might be placed before or after your child is asleep.

During the procedure, the anesthesiologist will continually check your child's breathing, blood pressure, and heart rate. If your child is getting general anesthesia, the anesthesiologist will also make sure your child stays unconscious. Some children worry they might wake up during general anesthesia. But this is very rare. The anesthesiologist constantly adjusts the medicines to keep your child from waking up.

If your child is having local anesthesia, regional anesthesia, or MAC with sedation, they might be awake during surgery. Or they might drift in and out of sleep.

What happens after anesthesia? —

The medical staff will monitor your child as the medicine wears off. Your child might be taken to a recovery room. You can usually be with your child as their anesthesia wears off.

As your child recovers:

●They will get medicine if needed to help with pain. They might need other medicines, too.

●When they are ready to eat, they will usually start with clear liquids, like juice or a popsicle. Then, they can start eating as they are able. They might feel better if they start with bland foods.

What are the risks of anesthesia? —

Each type of anesthesia has possible side effects. Your doctor will talk to you about all the possible risks, and answer your questions.

After general anesthesia, your child will likely feel a little groggy or confused for a short time after waking up. This can also happen if they were heavily sedated during local or regional anesthesia.

Other side effects can include:

●Nausea and vomiting – The anesthesiologist can give your child medicines to help.

●Trouble breathing – This is more common in children with asthma or a recent upper respiratory infection like a cold. If needed, the doctors can give your child medicines or oxygen to help them breathe more easily.

●Sore throat – This can happen if your child had a breathing tube. It usually gets better quickly.

If your child had a spinal block or epidural, the numbness might last for another few hours before wearing off. There is a very small chance of headache or trouble urinating for a short while.

The staff will make sure your child is feeling better before you go home.

What else should I know? —

Keeping your child safe is the anesthesiologist's main concern. Before surgery, ask them any questions about the risks and benefits of anesthesia, and the type of anesthesia that is best for them. After surgery, the staff will check on your child as they recover. Tell them how your child is feeling.

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Patient education: Anesthesia in children (The Basics)