What to Expect Before Pediatric Surgery
What is a Pediatric Anesthesiologist?
A Pediatric Anesthesiologist is a doctor who specializes in providing comfort and safety to children during surgery and other invasive procedures that require stillness or would cause discomfort for an awake child. Though all anesthesiologists are trained to care for kids, these physicians have received advanced training in the anesthetic care of children and in Pediatrics as it relates to anesthetics, surgery, pain management and critical care. Some of our Pediatric Anesthesiologists were practicing Pediatricians. At our hospital the Pediatric Anesthesiologists provide anesthesia for children on a regular and ongoing basis. They take care of children of all ages from premature newborns to teenagers and they are experienced with the special needs of these children (and their families) in relation to surgery and invasive procedures. They evaluate each child to formulate a safe anesthetic plan that addresses the child’s preoperative attitudes and anxieties, intra-operative medical needs and postoperative pain relief. Their goal is to make the hospital experience as easy, pleasant, and stress free as possible for children and their families.
For more information please go to http://www.aap.org/sections/sap/he3003.pdf
Do Pediatric Anesthesiologists only work in the Operating Room (OR)?
Pediatric anesthesiologists may be involved in sedating or anesthetizing your child for many different procedures outside of the OR. Many children can’t lie still or cooperate enough to have a CT Scan or MRI, for example. Bone marrow biopsies and lumbar punctures are procedures that young cancer patients may have to endure. The right kind of anesthesia can make these procedures bearable. Pediatric anesthesiologists may also help prepare your child for surgery if they have complex medical problems. Many pediatric anesthesiologists will be involved with the Pain Service and are experienced with techniques and therapies to manage your child’s pain after surgery.
How Do I Find A Pediatric Anesthesiologist?
Most children’s hospitals have pediatric anesthesiologists, as do many community hospitals and medical centers. Our department currently has seven full time Pediatric Anesthesiologists and several addition Anesthesiologists with extra training and focus on anesthetics for children. If your child is having a procedure at any of our practice locations, please feel free to contact our department or ask your surgeon about our pediatrics team. We look forward to caring for your child.
What are the risks of anesthesia for children?
A natural concern of any parent or guardian is whether anesthetics can cause harm. Even though anesthesia today is much safer than it has ever been, all anesthesia has an element of risk. The anesthetic risk varies depending on the age of the child, whether the anesthesia is for emergency purposes and the child’s medical conditions. Rare, unexpected reactions to anesthetics do occur. In general, though, anesthetics are extremely safe for most children. There is limited evidence about the subtle effects of multiple anesthetic exposures on young children. The significance of this evidence is an area of ongoing research and concern. If your child is facing the need for multiple procedures we recommend discussing it with your surgeon and anesthesiologist and weighing the potential benefit of the procedure against the uncertainties of the anesthetic exposure. Because of the improved safety of today’s anesthetics and the extensive training of physician Anesthesiologists the main risks to pediatric patients involve the actual surgery in the setting of ongoing medical problems.
There are a few specific adverse effects related to anesthesia that are worth noting. These problems are neither intended nor expected. They include: dental trauma, croup (swelling of the windpipe), allergic reactions to drugs or latex products, wheezing, vocal cord spasm or injury, regurgitation of stomach contents with subsequent aspiration pneumonia, injury to arteries, veins or nerves, and irregular heart rhythms. Death and brain damage are the most feared of all anesthetic risks. Fortunately these complications are extremely rare. In the United States, the chance (risk) of a healthy child dying or sustaining a severe injury as a result of anesthesia is far less than the risk of traveling in a car. Temporary, treatable and benign side effects can occur from anesthetics and should not be confused with other more dangerous adverse effects. These potential side effects include: nausea, vomiting, drowsiness, dizziness, sore throat, shivering, aches and pains, discomfort during injection of drugs, and agitation upon awakening from anesthesia. Some side effects of anesthesia drugs and techniques can often be anticipated, but may be unavoidable. Although at times uncomfortable or distressing, most common side effects are not particularly dangerous. They will either wear off or can be treated easily.
The vast majority of children who undergo anesthesia will be comfortable and have no complications. They will often be able to go home the same day as their procedure if the surgery is not too extensive. The anesthesiologist will talk to you about the various types of anesthesia that may be used for your child, and the risks and benefits (advantages and disadvantages) of each.
Anesthesia takes away the pain and discomfort of surgery and allows a procedure to be accomplished both safely and optimally. These benefits and the need for surgery must be weighed against the collective risks of both the anesthetic and the surgery itself.
There are a few specific adverse effects related to anesthesia that are worth noting. These problems are neither intended nor expected. They include: dental trauma, croup (swelling of the windpipe), allergic reactions to drugs or latex products, wheezing, vocal cord spasm or injury, regurgitation of stomach contents with subsequent aspiration pneumonia, injury to arteries, veins or nerves, and irregular heart rhythms. Death and brain damage are the most feared of all anesthetic risks. Fortunately these complications are extremely rare. In the United States, the chance (risk) of a healthy child dying or sustaining a severe injury as a result of anesthesia is far less than the risk of traveling in a car. Temporary, treatable and benign side effects can occur from anesthetics and should not be confused with other more dangerous adverse effects. These potential side effects include: nausea, vomiting, drowsiness, dizziness, sore throat, shivering, aches and pains, discomfort during injection of drugs, and agitation upon awakening from anesthesia. Some side effects of anesthesia drugs and techniques can often be anticipated, but may be unavoidable. Although at times uncomfortable or distressing, most common side effects are not particularly dangerous. They will either wear off or can be treated easily.
The vast majority of children who undergo anesthesia will be comfortable and have no complications. They will often be able to go home the same day as their procedure if the surgery is not too extensive. The anesthesiologist will talk to you about the various types of anesthesia that may be used for your child, and the risks and benefits (advantages and disadvantages) of each.
Anesthesia takes away the pain and discomfort of surgery and allows a procedure to be accomplished both safely and optimally. These benefits and the need for surgery must be weighed against the collective risks of both the anesthetic and the surgery itself.
When Your Child is Going to Have Surgery
Do children of different ages have different coping skills when faced with surgery? How can I decide what kind of explanation my child needs?
Many parents logically ask, “What should I say to my child before surgery?” While this question has no clear-cut answers, some general principles can be helpful. Overall, be calm, confident and reassuring. Children of all ages are reassured knowing they will be with someone trustworthy such as parents, doctors or nurses, throughout their procedure. When speaking about the procedure, choice of words can make a difference too. For example, let your child know they may have some “soreness” after surgery, rather than “pain.” Calming and reassuring language is generally most effective. On other hand, parents occasionally try to hide from their young child that they will have surgery. This practice is not recommended, as it has been shown to foster mistrust and fear, and increase worries about medical procedures over time.
Young children ages 3-7 may be limited in their capacity to understand or imagine beforehand the process of having a surgery. Using language with which they are comfortable, it is usually acceptable to let these children know they will be with the doctors and nurses for a short time and then come right back to you, the parent. The anesthesiologist may present young children with a face mask or other anesthesia equipment to play with and become familiar before entering the operating room. Additionally, in this age group, anxiety reducing medications are are often used before surgery with good effect.
Elementary school children usually respond well to an upfront and honest explanation about their procedure and what will happen on the day of surgery, with language at their comfort and comprehension level. They generally understand that the surgery needs to be done to fix a problem that won’t go away by itself. Let these children guide most of the discussion by asking questions and try to answer them directly in language that is calming and reassuring.
Adolescents are capable of understanding things in a manner similar to adults. Their procedures can be explained to them openly and honestly to the extent that they are interested. Adolescents at times consider sophisticated concepts such as body disfigurement, pain, needles, diagnosis, prognosis, and even death. Sometimes they may be reluctant to ask questions even when interested and often they will hide their fears. At the same time, adolescents generally like to feel they have some control over events in their lives. Therefore, they may be comforted by participation in the decisions relating to their surgery. It may be helpful to discuss the surgery with an adolescent prior to meeting with the surgeon and anesthesiologist. Encourage and assist them in seeking answers to their concerns throughout the process leading up to surgery and adolescents usually handle their medical experiences very well.”
Many parents logically ask, “What should I say to my child before surgery?” While this question has no clear-cut answers, some general principles can be helpful. Overall, be calm, confident and reassuring. Children of all ages are reassured knowing they will be with someone trustworthy such as parents, doctors or nurses, throughout their procedure. When speaking about the procedure, choice of words can make a difference too. For example, let your child know they may have some “soreness” after surgery, rather than “pain.” Calming and reassuring language is generally most effective. On other hand, parents occasionally try to hide from their young child that they will have surgery. This practice is not recommended, as it has been shown to foster mistrust and fear, and increase worries about medical procedures over time.
Young children ages 3-7 may be limited in their capacity to understand or imagine beforehand the process of having a surgery. Using language with which they are comfortable, it is usually acceptable to let these children know they will be with the doctors and nurses for a short time and then come right back to you, the parent. The anesthesiologist may present young children with a face mask or other anesthesia equipment to play with and become familiar before entering the operating room. Additionally, in this age group, anxiety reducing medications are are often used before surgery with good effect.
Elementary school children usually respond well to an upfront and honest explanation about their procedure and what will happen on the day of surgery, with language at their comfort and comprehension level. They generally understand that the surgery needs to be done to fix a problem that won’t go away by itself. Let these children guide most of the discussion by asking questions and try to answer them directly in language that is calming and reassuring.
Adolescents are capable of understanding things in a manner similar to adults. Their procedures can be explained to them openly and honestly to the extent that they are interested. Adolescents at times consider sophisticated concepts such as body disfigurement, pain, needles, diagnosis, prognosis, and even death. Sometimes they may be reluctant to ask questions even when interested and often they will hide their fears. At the same time, adolescents generally like to feel they have some control over events in their lives. Therefore, they may be comforted by participation in the decisions relating to their surgery. It may be helpful to discuss the surgery with an adolescent prior to meeting with the surgeon and anesthesiologist. Encourage and assist them in seeking answers to their concerns throughout the process leading up to surgery and adolescents usually handle their medical experiences very well.”
Should I be concerned about my child having fear or anxiety before surgery?
It is not unusual for a child or parent to be anxious prior to surgery. Reassuring, age-appropriate communication, good interactions with your surgeon and medical professionals, being calm and confident as a parent, play therapy, the use of distracting or familiar objects on the day of surgery, and techniques used by the anesthesiologist and hospital staff including the use sedating medications can all be helpful to decrease a child’s fear of medical or surgical procedures.
Anxiety before surgery will vary from child to child. Studies have shown that children who may be at greatest risk for preoperative anxiety include those with a shy or inhibited personality, a history of previous surgeries and hospitalizations, and parents who have either separated or are very anxious themselves. However, all children, in fact all people, can have normal fears prior to undergoing a procedure. These feelings can be readily apparent, but at times are hard to detect. Young people when anxious before surgery may simply not talk. They may show signs of fearing separation or may seem angry, impatient or agitated. In these situations it is good to be patient, calm and supportive with the understanding that changes in a child’s behavior around or at the time of surgery may be related to the child’s underlying stress and concerns about their procedure even if the child is unable to explain this cause themselves. Preparing your child for surgery can begin in the surgeon’s office. It is beneficial to have good interactions with the surgeon and for you, the parent, to feel comfortable in their care. Ask questions so you feel you understand your child’s procedure. Pamphlets and videos may be available in the surgeons office to further inform you about the procedure. A parent’s calm, trust and understanding will often transfer to the child.
At some hospitals, operating room tours and instruction on coping skills by a Child Life Specialist are offered prior to surgery. In one example of play therapy, a child life specialist allows a child to play with a small anesthesia breathing mask or other medical equipment so that they become comfortable with them prior to entering the operating room. On the day of surgery, a child life specialist, nurses and your child’s anesthesiologist will work to establish trust with your child and may reassure and distract your child from their concerns using similar techniques. In younger children, sedative medications are also often used. Bringing a familiar item from home such as a stuffed toy, blanket, PSP or Gameboy may be comforting, distracting, and also help the process.
Remember, parents can help their child be ready for surgery by being ready themselves. Become informed through research and asking questions. Allow your child the opportunity to ask questions. Do your best to be calm and confident. Give reassurance without going overboard. Being accepting, brave and matter-of-fact is often effective at decreasing frightening uncertainly. Most likely, everything is going to be fine. ”
Anxiety before surgery will vary from child to child. Studies have shown that children who may be at greatest risk for preoperative anxiety include those with a shy or inhibited personality, a history of previous surgeries and hospitalizations, and parents who have either separated or are very anxious themselves. However, all children, in fact all people, can have normal fears prior to undergoing a procedure. These feelings can be readily apparent, but at times are hard to detect. Young people when anxious before surgery may simply not talk. They may show signs of fearing separation or may seem angry, impatient or agitated. In these situations it is good to be patient, calm and supportive with the understanding that changes in a child’s behavior around or at the time of surgery may be related to the child’s underlying stress and concerns about their procedure even if the child is unable to explain this cause themselves. Preparing your child for surgery can begin in the surgeon’s office. It is beneficial to have good interactions with the surgeon and for you, the parent, to feel comfortable in their care. Ask questions so you feel you understand your child’s procedure. Pamphlets and videos may be available in the surgeons office to further inform you about the procedure. A parent’s calm, trust and understanding will often transfer to the child.
At some hospitals, operating room tours and instruction on coping skills by a Child Life Specialist are offered prior to surgery. In one example of play therapy, a child life specialist allows a child to play with a small anesthesia breathing mask or other medical equipment so that they become comfortable with them prior to entering the operating room. On the day of surgery, a child life specialist, nurses and your child’s anesthesiologist will work to establish trust with your child and may reassure and distract your child from their concerns using similar techniques. In younger children, sedative medications are also often used. Bringing a familiar item from home such as a stuffed toy, blanket, PSP or Gameboy may be comforting, distracting, and also help the process.
Remember, parents can help their child be ready for surgery by being ready themselves. Become informed through research and asking questions. Allow your child the opportunity to ask questions. Do your best to be calm and confident. Give reassurance without going overboard. Being accepting, brave and matter-of-fact is often effective at decreasing frightening uncertainly. Most likely, everything is going to be fine. ”
Can I accompany my child into the operating room?
Hospitals and surgery centers recognize the importance of keeping parents and children together in an atmosphere that keeps everyone feeling calm. At times it can be comforting for a child and helpful for the anesthesiologist to have parents accompany their children into the OR. However, parental accompaniment is not always necessary or beneficial. Studies have shown that, in general, parental anxiety and stress is increased by accompanying their child into the operating room. Also, operating rooms are professional areas where doctors and nurses focus their attention and work on the patient. The period of anesthetic induction (when the patient falls asleep) is a critical part of this process. In many situations it may be best for the patient, your child, to be alone under the focused attention of the nurses and doctors. If for any reason a child needs special care after entering the OR, parents are unable to help, and the medical staff need to be able to focus their attention on the patient even more. Therefore, hospitals and surgery centers have different policies about parents in the operating areas. Anesthesiologists and surgeons also have different rules for this practice. Ultimately, at the time of your child’s procedure, the anesthesiologist will discuss your options and decide what is needed and most beneficial for the child. Please be understanding and cooperative. Many of the doctors and nurses you will meet are also parents and understand the feeling of taking a child to surgery.”
Does my child need an IV?
For most surgical procedures your child will need an IV. For a few cases, like the placement of ear tubes, it is usually not necessary. Importantly, for most children under age ten, IVs are placed after the child is asleep from inhaled anesthesia gases. In the operating room, the child is monitored and gently given anesthetic gases through a breathing mask. Once asleep, the IV is placed. Occasionally it may be necessary to have the IV in place prior to going to sleep. This necessity occurs when there is an acute injury or a medical condition that requires the anesthetic to be given IV. For instance, an IV is absolutely necessary for the patient’s safety if there is increased risk of pulmonary aspiration, the movement of stomach contents out of the stomach and into the lungs. Your anesthesiologist will make that determination when your child is assessed preoperatively. For children 10 years old and above, small IVs are often placed preoperatively just as they are for adults and are usually well tolerated.
My child has a cold. Should surgery be cancelled? What are the risks?
In the past, children with respiratory infections had their anesthesia and surgery cancelled based on concern over increased risk of complications. We now know more about anesthesia during colds and cancellation is much less common. We also know that children frequently get symptomatic viruses and delaying a procedure for every minor infection makes it difficult to reschedule potentially important surgeries.
Regardless, children with colds have slightly more risk of respiratory complications during and after anesthesia than children who are healthy. Studies of children with colds have shown that asthma, intubation, heavy secretions or congestion, airway surgery (e.g. tonsillectomy), tobacco smoke, snoring, and a history of prematurity further increase the likelihood of respiratory problems. The main risk is spasm of the airways that can cause coughing, wheezing and lowering of oxygen in the blood. Fortunately, these complications are usually mild, quickly recognized and easily treated. Studies also show that anesthesia does not prolong or worsen colds in most children. Although there are rare cases of children with colds who developed pneumonia after anesthesia, there has been no evidence to suggest that the anesthetic was the cause.
At the time of your child’s procedure, the surgeon and anesthesiologist will assess them and determine if they are well enough to proceed. If your child has a Cold, the primary concern will be whether or not the cold is likely to cause difficulty breathing during or after anesthesia. Typically, children whose colds are limited to the nose and upper parts of the throat, with clear secretions, no fever, and no lethargy can be safely anesthetized. Children who look sick, have a temperature over 100°F and have thick or heavy secretions, especially if coughing, may benefit from having their surgeries postponed. Other factors may be important, however, including the urgency of the surgery.
Regardless, children with colds have slightly more risk of respiratory complications during and after anesthesia than children who are healthy. Studies of children with colds have shown that asthma, intubation, heavy secretions or congestion, airway surgery (e.g. tonsillectomy), tobacco smoke, snoring, and a history of prematurity further increase the likelihood of respiratory problems. The main risk is spasm of the airways that can cause coughing, wheezing and lowering of oxygen in the blood. Fortunately, these complications are usually mild, quickly recognized and easily treated. Studies also show that anesthesia does not prolong or worsen colds in most children. Although there are rare cases of children with colds who developed pneumonia after anesthesia, there has been no evidence to suggest that the anesthetic was the cause.
At the time of your child’s procedure, the surgeon and anesthesiologist will assess them and determine if they are well enough to proceed. If your child has a Cold, the primary concern will be whether or not the cold is likely to cause difficulty breathing during or after anesthesia. Typically, children whose colds are limited to the nose and upper parts of the throat, with clear secretions, no fever, and no lethargy can be safely anesthetized. Children who look sick, have a temperature over 100°F and have thick or heavy secretions, especially if coughing, may benefit from having their surgeries postponed. Other factors may be important, however, including the urgency of the surgery.
My child's surgery was cancelled because of a cold. How long should I wait to reschedule surgery?
Research has shown that children with colds may have sensitive air passages for several weeks after the symptoms have gone. Because a child with sensitive air passages is more likely to have complications during surgery, it is sometimes recommended to wait until the airways have had a chance to fully recover. The length of time that you should wait before rescheduling surgery varies but should be decided in consultation with your surgeon, anesthesiologist and pediatrician. If your child’s surgery was canceled, his or her symptoms were probably severe enough to be worrisome. In these cases the recommended wait time is 4 or more weeks. This should allow the air passages sufficient time to recover. If your child was diagnosed with a bacterial infection of the lungs or airways, he/she should receive antibiotics and surgery postponed for at least 4 weeks.
Why is fasting necessary before surgery?
An empty stomach at the time of anesthesia drastically decreases the risk of aspiration pneumonia and associated problems that can be life threatening. Aspiration pneumonia occurs when stomach contents are breathed into the lungs. Stomach acids can directly damage lung tissue and initiate potentially serious inflammation. When patients receive anesthesia, there is relaxation of muscles that normally keep down food and fluids. Therefore, patients are asked not to eat or drink anything prior to anesthesia and surgery. If the stomach is empty, the risk of aspiration is extremely low.
How long does my child have to fast before surgery?
Food and milk empty from the stomach much more slowly than clear liquids (e.g. water, apple juice, Gatorade). Therefore, pediatric patients must fast longer from food or milk but may often continue with clear liquids until 2 hours prior to anesthesia and surgery.
Recommended fasting times for different types of food and liquids are as follows: Type of food or liquid Fasting time before surgery Fatty or fried food 8 hours Light meal, milk 6 hours Breast milk (infants) 4 hours Clear liquids 2 hours It is recommended that you also discuss your child’s fasting requirements with your pediatrician. If emergency surgery is necessary, oral intake of food and liquids is stopped as soon as possible. In general, fluids and nutrients are then given through an IV. If the patient’s stomach is not considered empty and surgery cannot wait, the anesthesiologist will take special precautions to reduce the risk of stomach contents entering the patients lungs. These precautions are effective in almost all situations.
Recommended fasting times for different types of food and liquids are as follows: Type of food or liquid Fasting time before surgery Fatty or fried food 8 hours Light meal, milk 6 hours Breast milk (infants) 4 hours Clear liquids 2 hours It is recommended that you also discuss your child’s fasting requirements with your pediatrician. If emergency surgery is necessary, oral intake of food and liquids is stopped as soon as possible. In general, fluids and nutrients are then given through an IV. If the patient’s stomach is not considered empty and surgery cannot wait, the anesthesiologist will take special precautions to reduce the risk of stomach contents entering the patients lungs. These precautions are effective in almost all situations.
Should my child take his or her medications before surgery?
Medications should be taken or withheld prior to surgery as directed by your pediatrician, surgeon and/or anesthesiologist. If you are unclear which medications to take or hold please discuss it with your child’s doctors as early as possible. In general, medications taken with a sip of water before surgery do not increase the risk of aspiration.