Pediatric Anesthesia: General Anesthesia for Children.
As anxiety-provoking as it is to undergo an operation, it is even more stressful to know that your child will have anesthesia and surgery. You may wonder if anesthesia is safe for your child. You will likely worry about their confusion about what is happening and why. You will definitely hope that everything goes smoothly and that your child does not have pain or any complications for surgery or anesthesia.
While there are differences between adults and children under anesthesia, your anesthesiologist has been specifically trained to know and address these differences. For more serious surgeries (such as heart or brain operations), it is likely that the anesthesiologist taking care of your child has done a fellowship (more advanced training beyond medical school and residency) in pediatric anesthesia.
Training of an Anesthesiologist in the United States
College 4 years
Medical School 4 years
Internship in Internal Medicine or Surgery 1 year
Anesthesia Residency Training 3 years
Fellowship* (not required) 1 or more years (Pediatric fellowship 1 year)
(There may be some variability, but this is a typical pathway.)
*Most anesthesiologists do not pursue a fellowship and take the test for board-certification in Anesthesiology after residency.
What is a Pediatric Anesthesiologist? and....Do We Need One?
Pediatric anesthesiologists are board-certified anesthesiologists who spent extra time training in the anesthesia care of children. Keep in mind, that for most procedures, in most places, pediatric anesthesiologists are not utilized. Usually, you will encounter specially-trained pediatric anesthesiologists at children's hospitals and large medical centers. If your child is having major surgery (brain, heart, other more serious operations), then you will want a pediatric anesthesiologist.
Most local and regional medical centers and hospitals have anesthesiologists who are M.D.s or nurse anesthetists providing anesthesia for your child. If your child has significant health issues or is undergoing major surgery, you should be referred to a center that matches that more specialized level of care.
Anesthesiologists who are not pediatric specialists still receive training in the care of healthy pediatric patients for routine procedures and are required to demonstrate competence prior to becoming board-certified. So, if your child is healthy and having a routine procedure (tonsils, hernia, appendix for example), you do not need to seek out a fellowship-trained pediatric anesthesiologist.
If Your Child Needs Anesthesia...
Speak to your surgeon about your child's needs. Make sure the level of care they will get matches their health status and surgery. Usually, your surgeon will already be aware of this.
- Talk to your child in age-appropriate terms about their surgery. Try to avoid scary words and phrases that may frighten them like "the surgeon will cut". When choosing the language you use, think about the visual image the child may have and choose your words accordingly. Use more friendly terms like "an opening". Do not tell your child that they will "be put to sleep". This scares them because if their pet or another child's pet has been "put to sleep", the child is aware that the pet did not come back. Instead say "special sleep" or "anesthesia sleep so you can't see, hear or feel anything", but will wake up as soon as (and only when) the operation is done. Reassure your child that someone will be with them all the time, even when they are in their special sleep.
- Remain calm! One of the biggest factors affecting your child's anxiety and overall experience is your stress level. Even if you are apprehensive and fearful, maintain a happy, positive outlook around your child. Be very matter of fact that the surgery is just something that has to be done. It will be fine and any bad feelings will be temporary. This isn't easy, but it does help them before and after surgery, according to the American Society of Anesthesiologists.
- Follow all preoperative instructions. This includes restrictions on eating and drinking. Also, use or skip medications as instructed. Call ahead of time if you have any questions.
Prepare Your Child for Anesthesia
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FREQUENTLY ASKED QUESTIONS
- Will my child get general anesthesia? While there are some procedures that can be done under sedation, usually general anesthesia is used for operations.
- Will I be with my child when he/she goes to sleep? It depends. Some centers are equipped to do 'parent inductions' and some are not. Community hospitals, however, are less likely to be able to let parents into the operating rooms. (Personal note: The places where I have worked have not had parent presence at the beginning of anesthesia. Likewise, when my child had surgery, I was not present for the induction of anesthesia. I was ok with this. Children can and may be given a sedative prior to being taken to the operating room which means they will not know or remember anyway if you were there or not. The presence of parents in an OR where they aren't usually allowed can be a distraction and interrupt the normal flow of the operating room. Personally, I think it's best to let the operating and anesthesia staff do things in the way they are used to doing them. Insisting on changing their routine is likely to cause more problems than it solves (my opinion from having been on both sides of a child receiving an anesthetic).)
- Will my son or daughter have to have an IV before they go to sleep? This is another that is answered with "It depends". The anesthesiologist will have to consider your child's age, size, surgical procedure and other health issues in order to make this decision. In general, healthy children of normal body habits, under age 6 or 7 who are not having certain abdominal operations, can usually go to sleep with anesthesia gas in a mask, then have the IV placed after they are sleeping.
- Is anesthesia safe for my child? The risks of anesthesia for healthy children undergoing routine procedures is very, very small. For more information, see the website of the Society for Pediatric Anesthesia.
- I've heard that anesthesia causes behavioral problems in children. How concerned should I be? In the past few years, some studies have shown a link between anesthesia and attention deficit disorder in children. This is an ongoing and active area of research and we just don't have all the answers yet. Most experts think that this link is usually related to frequent or repeated surgeries and not after one surgery or anesthetic. If your child needs surgery, talk to the anesthesiologist and surgeon beforehand if you have concerns. There is no way at this point to give definite answers or guarantees regarding this issue, but if your child is having one surgery, it is unlikely to produce lasting effects on their health or behavior.
- How do you know my child is asleep the whole time? The anesthesiologist is with your child the whole time. They will be monitoring their ability to respond. Increases in heart rate and blood pressure, changes in breathing and movement all happen BEFORE a child regains consciousness. These parameters are watched closely during the surgery by the anesthesia provider.
- How do you know how much medicine to give him/her? Initial drug doses are calculated based on age and weight. The maintenance anesthesia is usually an anesthesia gas. The levels usually needed are within a standard range. The actual level in this range is adjusted throughout surgery based on the child's needs.
- What are the risks of general anesthesia for my child? Side effects can be expected to occur in most children (and adults) undergoing surgery and anesthesia. You can expect your child to be sleepy or tired the rest of the day. They may complain of a sore throat (from the breathing tube and dry oxygen/gases used). Nausea or dizziness is another common side effect. Vomiting can occur, but may be prevented or treated by medications prescribed by your surgeon. Feeling "yucky" overall with muscle aches, tiredness, nausea, and sore throat may make you and your child think they are getting sick. This is a common feeling after anesthesia. Complications, whereby unexpected bad outcomes happen,are much, much more rare. If you suspect your child is experiencing something abnormal (from allergic reaction to high fevers or breathing problems and so on), call your doctor or if it seems more serious, take your child to the emergency room immediately. This is unlikely, but is the safest course of action.
- My child has a cold or sore throat. Do we need to delay the surgery? It depends. There are a lot of opinions on this in the anesthesia community. If your child is having elective surgery and has been sick with high fevers and a cough or a significant respiratory infection in the lungs, it will be best to wait a few weeks to minimize risk. This may also be true of a child with asthma and any respiratory infection. Sometimes, it may be ok to proceed with surgery, even if your child has a minor illness. Mostly, we encounter this with tonsillectomy. Children who need their tonsils out may have a sore throat most of the time. It may not be possible to wait for perfect health in this case.
Distractions can be very helpful on the morning of surgery and in the recovery period. Here are a few ideas for distractions for your child.
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