|SSM Cardinal Glennon Children's Medical Center|
No doubt about it, getting an operation can be stressful for kids and adults alike. If your child is scheduled for surgery, you may have questions or concerns about anesthesia, in particular. The thought of your child being unconscious or temporarily losing sensation can be downright unnerving, whether your child is 7 months or 17 years old.
From a minor procedure with a shot to numb the area to a more serious surgery in which your child will be "asleep," knowing the basics about anesthesia may help answer your questions and ease some concerns — both yours and your child's.
Basically, anesthesia is the use of medicine to prevent the feeling of pain or sensation during surgery or other procedures that might be painful (such as getting stitches or having a wart removed). Given as an injection or through inhaled gases or vapors, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.
In today's hospitals and surgery centers, highly trained professionals use a wide variety of safe, modern medications and extremely capable monitoring technology. An anesthesiologist is a doctor who specializes in giving and managing anesthetics — the medications that numb an area of the body or help your child fall and stay asleep. A pediatric anesthesiologist has additional specialized training that certifies him or her to care for children.
In addition to administering anesthesia medications in preparation for the surgery, the anesthesiologist will:
A specially trained nurse anesthetist, resident physician, or student nurse anesthetist, who work with the anesthesiologist and surgeon, may also assist with giving your child anesthesia (although the anesthesiologist will be the one to manage the anesthesia and make all major anesthesia-related decisions during the operation).
Types of Anesthesia
Anesthesia is broken down into three main categories: general, regional, and local, all of which can be administered using various methods and different medications that affect the nervous system in some way. The American Society of Anesthesiologists (ASA) compares the nervous system to an office's telephone system — with the brain as the switchboard, the nerves as the cables, and the body parts feeling pain as the phones.
General anesthesia. The goal is to make and keep the person completely unconscious (or "asleep") during the operation, with no sensations, feeling of pain, awareness, movement, or memory of the surgery. General anesthesia can be given through an IV (which requires a needle stick into a vein, usually in the arm) or by inhaling gases or vapors.
Regional anesthesia. An anesthetic drug is injected near a cluster of nerves, numbing a larger area of the body (such as below the waist). A child who receives regional anesthesia is usually asleep before the procedure is done. However, older kids or those who would be at unacceptable risk by being asleep may be awake or sedated during the procedure. For example, if a child is overweight, it may be difficult for the anesthesiologist to feels the bones that help guide correct placement of the needle.
Local anesthesia. An anesthetic drug numbs only a small, specific part of the body (for example, a hand or patch of skin). Depending on the size of the area, local anesthesia can be given as a shot, spray, or ointment. With local anesthesia, a person may be awake, sedated, or asleep. Local anesthesia is often used for minor surgeries and outpatient procedures (when patients come in for an operation and can go home that same day). If your child is having surgery in a clinic or doctor's office (such as the dentist or dermatologist), this is probably the type of anesthetic that will be used.
Anesthesiologists may also give children a sedative to help them feel sleepy or relaxed before giving a general, regional, or local anesthetic. Why? Because many kids are afraid of needles and may have a hard time staying still and calm, so doctors may need to help them relax first. That way, they just need to breathe themselves to sleep by inhaling into a mask. This approach helps ease some anxiety about needles and the overall procedure or surgery.
The type and amount of anesthesia will be specifically tailored to your child's needs and will depend on various factors, including your child's age and weight, the type and area of the surgery, any allergies your child may have, and your child's current medical condition. You and your anesthesiologist can decide what's best for your child.
Common Side Effects
Your child will most likely feel disoriented, groggy, and a little confused when waking up after surgery. Some other common side effects, which should go away fairly quickly, include:
What Are the Risks?
Anesthesia today is very safe. In very rare cases, anesthesia can cause complications in children (such as strange heart rhythms, breathing problems, allergic reactions to medications, and even death). The risks depend on the kind of procedure, the condition of the patient, and the type of anesthesia used. Be sure to talk to your child's doctor, surgeon, and/or anesthesiologist about any concerns.
Most complications can usually be prevented by simply providing the anesthesiologist with complete information before the surgery about things like:
To ensure your child's safety during the surgery or procedure, it's extremely important to answer all of the anesthesiologist's questions as honestly and thoroughly as possible. Things that may seem harmless could affect how your child reacts to the anesthesia.
It's also important that your child follow the doctor's recommendations about what not to do before the surgery. Your child probably won't be able to eat or drink (usually nothing after midnight the day before) and may need to stop taking herbal supplements or other medications for a certain period of time before surgery.
The thought of surgery and anesthesia can certainly be scary for parents and kids alike. But you can rest assured that the safety of anesthetic procedures has improved a lot in the past 25 years, thanks to advances in technology and the extensive training anesthesiologists receive.
The more informed, calm, and reassuring you are about the surgery and the safety of anesthesia, the easier the experience will probably be for both you and your child.
Reviewed by: Judith A. Jones, MD