Anesthesia Basics

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. 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.

About Anesthesia

Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). 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 surgical 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 medicines that numb an area of the body or help a person fall asleep and stay asleep. A pediatric anesthesiologist has additional specialized training that certifies him or her to care for children.

In addition to giving anesthesia medicines in preparation for the surgery, the anesthesiologist will:

• monitor your child's major body functions (such as breathing, heart rate and rhythm, body temperature, blood pressure, and blood oxygen levels) during surgery
• address any problems that might arise during surgery
• manage any pain your child may have after surgery
• keep your child as comfortable as possible before, during, and after surgery

Others who work with the anesthesiologist and surgeon — such as a specially trained certified registered nurse anesthetist (CRNA), fellow or resident physician, or student nurse anesthetist — may assist with giving your child anesthesia. CRNAs may work under the supervision of an anesthesiologist or on their own — it all depends on the state or hospital.

Types of Anesthesia

Anesthesia is broken down into three main categories: general, regional, and local. All of these can be given through various ways using medicines that affect the nervous system.

Think of the brain as a central computer that controls all the body's functions and the nervous system as a network that relays messages back and forth from the brain to different parts of the body. It does this via the spinal cord, which runs from the brain down through the backbone and contains threadlike nerves that branch out to every organ and body part.

General anesthesia. The goal is to make and keep the patient 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). Most children who receive regional anesthesia are deeply sedated or asleep for the procedure. Rarely, older kids or those who might be at risk by being asleep may be awake or lightly sedated for this type of anesthesia.

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. 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. Other common side effects, which should go away fairly quickly, include:

• nausea or vomiting, which usually can be eased with anti-nausea medication
• chills or shakiness
• sore throat (if a tube was used to help with breathing)

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.

If your child is younger than 3 years old and is scheduled to receive general anesthesia or be under sedation for 3 hours or more, talk with the doctor or surgeon about possible risks related to brain development.

Most complications can be prevented by giving the anesthesiologist complete information before the surgery, such as:

• your child's current and past health (including diseases or conditions such as recent or current colds, or other issues such as snoring or depression)
• any medicines (prescription and over-the-counter), supplements, or herbal remedies your child is taking
• any allergies (especially to foods, medications, or latex) your child has
• whether your child smokes, drinks alcohol, or takes any recreational drugs (this usually applies to older teenagers)
• any previous reactions your child or any family member has had to anesthesia

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 medicines for a certain period of time before surgery.

The thought of surgery and anesthesia can be scary for parents and kids alike. But you can rest assured that the safety of anesthetic procedures has improved a lot over the 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 be for both you and your child.