Anesthesia - What to Expect

When your child is having any kind of procedure or surgery that requires anesthesia, it's understandable to be a little uneasy. You probably have plenty of questions about everything — from how the anesthesia is given, to what your child will experience, to where you're allowed to be.

What happens will, of course, depend on the type of procedure your child is having and the kind of anesthesia that will be used, either:

• general — in which your child would be "asleep"
• regional — when one large area of the body is numbed
• local — when one small part of the body is numbed

To ease your mind and feel better informed, here's a quick look at what may happen before, during, and after on the day of your child's procedure at a hospital or surgery center.

Before Surgery

Although you might be able to talk to the anesthesiologist a day or two before the operation, you may not meet until that day. Either way, the anesthesiologist will go over your child's medical history and information thoroughly, so that he or she can make the right choice of anesthetic medicines to meet your child's individual needs.

The anesthesiologist also may order some tests (such as X-rays or blood or laboratory tests) to help figure out the best possible personalized anesthetic plan for your child.

Besides doing a physical examination of your child's airways, heart, and lungs, the anesthesiologist will also want to get your child's medical history, which will include asking about:

• your child's current and past health
• your family's health
• any medicines, supplements, or herbal remedies your child takes (consider bringing a list of exactly what your child takes, detailing how much and how often)
• any previous reactions your child or any blood relative has had to anesthesia
• any allergies (especially to foods, medicines, or latex) your child may have
• whether your child smokes, drinks alcohol, or takes recreational drugs (this usually applies to older teenagers)

The anesthesiologist, surgeon, or someone on the nursing staff will let you know whether your child can eat or drink before surgery. It's important to make sure that your child doesn't eat anything before surgery (usually nothing after midnight the day before the operation). You'll get specific instructions based on your child's age, medical condition, and the time of day of the procedure.

Why is eating before surgery an issue? Because the body normally has reflexes that prevent food from being aspirated (or inhaled) into the lungs when it's swallowed or regurgitated (thrown up). But anesthetic medicines can suspend these reflexes, which could cause food to become inhaled into the lungs if there is vomiting or regurgitation under anesthesia. Sometimes, though, the anesthesiologist will say it's OK to drink clear liquids or take specific medicines a few hours before surgery.

To ensure your child's safety during the surgery, it's extremely important to answer all of the anesthesiologist's questions as honestly and thoroughly as possible. Things that may seem harmless could interact with or affect the anesthesia and how your child reacts to it.

Questions to Ask

You can also ask plenty of your own questions. If you don't meet the anesthesiologist before the day of the operation, you may want to ask your doctor or surgeon these questions days, or even weeks, beforehand so you and your child can have all the answers you need:

• Am I allowed to be with my child before surgery? If so, for how long?
• Am I allowed to be with my child while the anesthesia is being given?
• What kind of anesthesia will my child be given?
• How will the anesthesia be administered — with an injection, through an IV, or with a breathing mask or tube in the throat?
• Will my child be sedated before the anesthesia is given?
• Approximately how long will the surgery take?
• Will my child still have an IV in or be hooked up to any monitors or equipment after the surgery is over?
• How long will it take my child to fully wake up from general anesthesia or feel the area if local or regional anesthesia was used?
• Will my child feel pain and/or discomfort (such as nausea or vomiting) after surgery? If so, how long will it last and what can be done about it?
• How soon after the surgery can I see my child?
• How soon after the surgery can my child eat, drink, go to school, or drive [if you have a teen]?
• How soon after the surgery can my child come home?

When you meet with the anesthesiologist, you'll also be asked to sign an informed consent form, which authorizes the use of anesthesia. It's important to make sure to have all of your questions answered before signing the form.

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.

Just before going into the operating room and drifting off to sleep, young children may be given a special, sweet-tasting drink (that kids may call "silly medicine"). Depending on a child's age or ability to cooperate, this "silly medicine" might be given by spraying it into the nose. The medicine is absorbed well through the stomach or nose and lets a child be sedated before going into the operating room.

For minor procedures, a sedative may not be needed. In fact, some children may prefer not to be sedated. Depending on what's best for your child, the decision of whether or not to use sedation beforehand is made by the anesthesiologist, using your input.

In the Operating Room

If general anesthesia is used, the anesthesiologist will start transitioning your child from the normal awake state to the sleepy state of anesthesia. This is referred to as induction, which is usually done by either injecting medicine through an IV or by inhaling gases through a mask.

If, like many kids, your child is afraid of needles, the good news is that he or she may not have to get one while awake. Pediatric anesthesiologists often will begin the induction process by giving inhaled medicine. This is helpful because kids can have a hard time staying still and calm. The mask delivers medicine to make kids sleepy and help them relax before and during the surgery. That way, they'll already be asleep when the IV is inserted for general anesthesia or when a shot is given to numb a certain part or area of the body for local or regional anesthesia.

When using general anesthesia, the anesthesiologist will monitor your child's heart rate, blood pressure, breathing rate, and oxygen level; continue to deliver anesthesia; and keep your child as comfortable as possible throughout the operation.

To help your child breathe and/or to help deliver general anesthesia during the operation, the anesthesiologist may use an endotracheal tube (a plastic tube that's placed into the windpipe through the mouth or nose) or laryngeal mask airway (LMA — a mask with a tube that fits into the back of the mouth).

After Surgery

Once the operation or procedure is over, the anesthesiologist will reverse the anesthesia process and help your child "wake up" (if your child received general anesthesia).

Your child will then be taken to the recovery room or PACU (post-anesthesia care unit). In the PACU, nurses and the anesthesiologist will monitor your child's condition very closely to make sure he or she is making a smooth and comfortable transition from an anesthetized state to an awakened state.

When your child's medical condition is stable, you'll be asked to come to the PACU to be with him or her during the recovery period. If general anesthesia or sedation were used, don't expect your child to be fully awake right away — it may take a while and he or she may doze off for a bit. It usually takes about 45 minutes to an hour for kids to recover completely from general anesthesia. In some cases, it may be a bit longer depending on medicines given during or after surgery.

Your child may feel groggy, confused, chilly, nauseated, scared, alarmed, or even sad while waking up. Depending on the procedure or surgery, your child may also have some pain and discomfort, which the anesthesiologist can relieve with medicines. After recovering from the anesthetic, your child will be evaluated to make sure he or she is ready for discharge from the recovery room.

For many outpatient procedures, kids are allowed to come home soon after the surgery. In cases where hospitalization is required, most hospitals allow at least one parent to stay with their child day and night.

Before you leave the hospital, you'll get instructions for further care and recovery at home and for a follow-up visit with the surgeon. Talk to the surgeon and/or the anesthesiologist about what to expect after the surgery and how you can help your child be as comfortable as possible.

After discharge, call the hospital or surgeon's office if you have any concerns at all about your child's medical condition or if your child:

• has unusual bleeding from the surgical site
• has a fever higher than 101°F (38.3°C)
• has unusual redness on or discharge from the surgical site
• has unusual pain
• can't keep anything down
• can't take fluids by mouth

As you prepare for the surgery or procedure, it may help to remember that anesthesia is very safe. In today's hospitals and surgery centers, highly trained professionals use a wide variety of modern medicines and monitoring technology to make sure that kids are stable and as comfortable as possible before, during, and after their procedure.