We use anesthesia to protect your child from feeling pain during surgery and certain procedures. An anesthesiologist administers the anesthesia. We may also give your child a sedative before the anesthesia, while you are still in the room, to help them relax.
Types of Anesthesia
We use three types of anesthesia. The major types of anesthesia are:
- General anesthesia: This is usually the most appropriate for young patients. We start general anesthesia by having a child breathe through a face mask or by using an intravenous (IV) injection. We usually use a face mask because IVs involve inserting a catheter in the vein, which can be painful.
- Regional anesthesia: This approach numbs just the area that will be operated on. Regional anesthesia involves injecting medication near the nerves that serve the part of the body that is operated on. This approach is often used together with general anesthesia. The combination of general and regional anesthesia means less general anesthesia will be needed. It also helps with pain after the procedure.
- Sedation: This relieves pain and makes the patient sleepy, but not unconscious. Sometimes patients fall asleep with sedation.
Your anesthesiologist will pick the best type of anesthesia to use based on several factors:
- Age of patient
- Medical condition of the patient
- Patient preference
- Type of surgery
What to Expect
The first step is to put monitors on the young patient. We do this so we can track their heart rate, blood pressure, and other physiological factors. Monitors may include:
- Electrocardiogram: Tracks the heart rate and rhythm
- Blood pressure cuff: Checks the blood pressure
- Pulse oximeter: Monitors the level of oxygen in the blood
- Temperature probe: Keeps track of the child’s temperature
If we have difficulty placing these monitors on your child, we may attach them once the child is asleep.
To start the anesthesia, we place a clear face mask over the child’s nose and mouth. Our face masks have been pretreated with a pleasant smell, usually bubble gum. We deliver oxygen and anesthetic gases through the face mask. After a few breaths, the gas will begin to take effect and your child will fall asleep. If we haven’t already done so, we can place the monitors on the child at this point.
Sometimes we may choose to administer anesthesia through a catheter that we insert into a vein. We may also need to insert a breathing tube (endotracheal tube) in the child’s windpipe (trachea) to help us control the child’s airway and breathing.
Generally, we use an IV if the child already has an intravenous catheter or if they prefer it. IVs mean the anesthesia takes effect quickly and the child does not have to breathe the smell of anesthetic gasses, which can be unpleasant. The disadvantage is that this approach requires a needle stick. When possible, we can use an ointment to numb the skin before inserting the IV. It takes at least 45 minutes for the ointment to take effect.
Postanesthesia Care Unit
After the procedure, your child will wake up in the operating room. We will move them to the postanesthesia care unit (PACU). In the PACU, we will check the child’s vital signs, then permit one parent at a time to visit the child. If the PACU is not very busy, the nurse in charge may allow both parents in at the same time.
Your child may be quiet or crying when they arrive in the PACU. Both are normal behaviors after anesthesia. Children usually calm down soon after arriving to the PACU and are fully awake and with their parent or parents. Sometimes they need additional pain medication, which the PACU nurse can give. Some children may feel restless, disoriented, combative, or have difficulty communicating when they wake up from the anesthesia. They may cry. This can be upsetting to the parent, but it is not unusual, and the child often feels better quickly. During this time, it is important to comfort and reassure your child while making sure that the child does not hurt themselves.
If your child is going home the same day, they will usually stay in the PACU for an hour or two. During this time, we monitor the child to make sure no problems arise. Your child received intravenous fluids in the operating room, so they may not be thirsty in the PACU. Drinking prior to discharge from the PACU is not required unless your child had a tonsillectomy. It is not unusual for patients to get carsick after anesthesia.