Specialist paediatric anaesthetist and Head of Anaesthetics at Joburg’s Nelson Mandela Children’s Hospital, Dr Clover-Ann Lee answers some of the most common questions parents ask about anaesthetics and children.
What if your baby, toddler or child needs to go to hospital for surgery or a medical procedure that requires a general anaesthetic? You wouldn’t be human if you didn’t worry, and have a heap of questions.
Specialist paediatric anaesthetist and Head of Anaesthetics at Joburg’s Nelson Mandela Children’s Hospital, Dr Clover-Ann Lee answers some of the most common questions moms and dads ask about anaesthetics and children.
What is a general anaesthetic?
A general anaesthetic is medication given to your child so that they cannot see, hear or feel anything during a procedure or operation. It’s administered by an anaesthetist (sometimes called an anaesthesiologist), a specialist doctor who also takes care of your child throughout the procedure. Their role is to make sure your child stays comfortable and well throughout the procedure and that his pain is well managed and kept to a minimum.
What’s the role of the anaesthetist?
Every person in the operating theatre is fully invested in your child’s health and safety. The anaesthetist is the person who makes sure everything goes well. He ensures your child gets ample oxygen, his blood pressure stays stable, and that he does not awaken during the procedure. You will probably meet the doctor, surgeon or physician before he is admitted for an operation or procedure at the hospital or clinic. However, you may only meet your child’s anaesthetist on the day of his procedure. The surgeon is responsible for the outcome of the procedure. But the overall safety of the patient is the primary responsibility of the anaesthetist.
How can I prepare my child for receiving an anaesthetic?
It depends on how old your child is. Teens and tweens benefit from as much information as you can give them. All children (from babies to teens) need to know what to expect, and that you’ll be there to help them through the experience. Talk to your child in words and language he understands. For young children, it’s enough to say the doctor is going to give him a special medicine that will make him fall asleep. The medical team will be dressed in hospital scrubs when he’s taken into theatre. Prepare him for this, as he will be expecting to see the familiar face of his doctor. Tell him the doctors will be wearing pyjamas and will look silly. Tell him, too, the doctors’ clothes are to make sure there are no bad germs in the room. They’re there to keep him safe. Reassure him that you will be there at the time he goes to sleep, and also when he wakes up. Prepare him to feel uncomfortable when he wakes up, but that the doctor has medicine for that. Children who know what to expect tend to manage the experience of anaesthesia well.
What about food and liquid? What’s safe and what isn’t?
Ensure you follow your doctor’s instructions to the letter. The protective reflexes that prevent food in our stomachs from coming up and going into our lungs are relaxed under anaesthesia. This is why your child’s stomach must be empty before an anaesthetic. Generally, offer a light meal or formula feed no less than six hours before anaesthetic. Breastfeeding is fine no less than four hours before anaesthetic, and sips of clear, non-fizzy liquid are OK no less than two hours before anaesthetic. To make it easier on your child, don’t eat or drink in front of her when she’s not allowed food and drink.
What can we expect once we get to the hospital?
Your child’s anaesthetist will visit you and your child in the ward before the procedure. He or she will ask quite a few questions. It’s important to answer all these questions honestly. It’s especially important to tell the anaesthetist if your child has had the flu or a cold in the last few weeks. This is also a great opportunity to ask the anaesthetist any questions you may have and to tell the anaesthetist what’s worrying you. This will help you feel more relaxed, and a relaxed mom and dad makes for a calmer kid!
What happens in the operating theatre?
Rest assured the medical team will take good care of your child. General anaesthetic medicine is either injected into a vein or given as a gas that’s administered by a mask placed over your child’s nose and mouth. The anaesthetist will be with your child throughout the procedure, making sure he stays asleep, monitoring him continuously and giving whatever fluid, medication and pain-relieving medicine he requires.
Can I go into the operating theatre with my child?
Yes. In most cases, one parent is welcome to accompany their child into theatre. But it’s fine, too, if you’d rather not go into theatre with your child. Your child will drop off to sleep really quickly once the anaesthetic drugs kick in. You’ll then be asked to leave the theatre to let the doctors get on with their work. If you do go into theatre, you can bring a favourite toy or blanket along to reassure your child. Distracting games on an iPad or phone are great, too. You can also chat to your child as the anaesthetic takes effect. It’s a good idea to be there when she regains consciousness, so wait outside the recovery room so you can be called when he is fully conscious and needing your presence and support.
What should we expect afterwards?
He might seem disoriented and upset for a few moments. This is absolutely normal. Reassure him that everything’s OK, and offer him a toy, blanket or dummy (if he’s still a baby) to help reassure him. Disturbed sleep patterns for a few days after anaesthetic are quite normal. This should settle down soon.
When is it safe to give him something to eat and drink after anaesthesia?
This largely depends on the kind of operation your child has had, and your surgeon will guide you. After most minor procedures (hernia repairs, tonsillectomies and grommets, for example), he’ll be able to drink as soon as he’s awake enough. The key is to let him have whatever he feels like, but not to push it. Children know how they feel, and might get sick if they eat and drink too much too soon.
Are there any side effects and complications to look out for or worry about?
Most side effects of anaesthesia are mild and will sort themselves out in a matter of hours or (at worst) a day or two. These could include nausea, a sore throat and a headache. Depending on the surgery and the pain-management medication that’s been prescribed, your child may also feel a little out of sorts for a few days, and need more or longer daytime naps than usual. This, too, will settle down after a few days. Call your doctor if there’s anything you’re worried about, or if something doesn’t seem right to you.
What’s the risk of anaesthesia?
While there’s no guarantee that they’re risk free, anaesthetics are generally very safe. Modern anaesthetic techniques, medication, monitoring and training continue to make anaesthesia safer.
More about the expert:
Dr Clover-Ann Lee did her under- and post-graduate training at Wits, and her fellowship in paediatric anaesthesia at Great Ormond Street Children’s Hospital in London. She is a full time paediatric anaesthetist at Nelson Mandela Children’s Hospital in Johannesburg, and also volunteers with Operation Smile, which provides free surgical care to children around the world born with cleft lips and palates.
Find out more about Dr Colver-Ann Lee here.
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