Anaesthesia for Children

Your child is to have a procedure under general anaesthesia. The information here is to explain what to expect when your child comes into hospital to have an operation under general anaesthesia, and how you can help prepare your child.

Preparation

There are many things you can do to prepare your child. All children (except infants too young to understand) should be told that they are going into hospital to have an operation and some basic information about what will happen to them.

Everything should be explained to your child in a way that he or she can understand. Explain that the procedure will help them get better, and encourage your child to talk about the operation and ask questions.

Tell your child when he or she will have the operation, and whether they will be staying in hospital overnight. Your child can help pack his or her own bag and decide which toys and clothes to bring.

The links below will give you some resources to help you explain the anaesthetic to your child.

Before the procedure

Your anaesthetist will talk to you prior to your child’s procedure. If possible they may contact you the day before the operation by telephone.

On the day of surgery, your anaesthetist will meet with you and your child and perform a pre-anaesthetic assessment. The anaesthetist will ask you about your child’s general health including asthma or heart problems, their previous experiences of anaesthesia, any medicines your child is taking, and about any allergies he or she may have.

A plan for the anaesthetic and post-operative pain management will be made at this time. Your anaesthetist will discuss the risks of general anaesthesia with you, and you will have the opportunity to ask questions and address any concerns you may have about the anaesthetic. You may find it helpful to make a list of questions you want to ask.

For your child’s safety, it is important that the fasting instructions are followed. If there is food or liquid in your child’s stomach during the anaesthetic it could come up into the back of the throat and enter his or her lungs and cause serious damage.

Fasting times
  • No milk drinks, food, lollies or chewing gum for 6 hours before anaesthesia
  • Clear fluids* are allowed up to 2 hours before anaesthesia

Children <6 months of age

  • Last breastfeed to finish no later than 3 hours before anaesthesia
  • Formula of cow’s milk feed to finish no later than 4 hours before anaesthesia

* Clear fluids are water, dilute cordial and clear apple juice. Juices that are cloudy or have bits in are considered the same as food and should not be given for 6 hours before anaesthesia.

Oral medication

Continue regular oral medication with a sip of clear fluid unless otherwise requested by anaesthetist

Examples:

Morning Operation

  • Fast from 0200 for food and milk
  • Continue clear fluids until 0600

Afternoon Operation

  • Fast from 0700 for food and milk
  • Continue clear fluids until 1100

Occasionally your anaesthetist may learn something about your child that means it would be safer not to do the procedure on that day. This could happen if your child has a bad cold, has a rash or has eaten food too recently. If your child is unwell please contact us prior to the day of surgery so we can minimize any chance of this happening.

Premedication

Sometimes your anaesthetist may suggest that your child has a “premed” (premedication). This is medication that is sometimes given before an anaesthetic, and can be given for several reasons. It may be a sedative to help ease your child’s anxiety, or pain relieving drugs such as paracetamol, usually given in liquid form. It can also be a topical local anaesthetic cream that is applied to numb the skin so that a cannula can be inserted without your child feeling pain from the needle.

Not every child needs a premed, and depending on the type of surgery and your child’s condition you will be able to help your anaesthetist decide if your child needs a premed.

Going to theatre

If you would like, you are usually welcome to stay with your child for the induction of anaesthesia (until he or she ‘goes to sleep’). However, there are some circumstances when this may not be possible, and your anaesthetist will clarify on the day if you may accompany your child into the anaesthetic room or operating theatre. If you are very nervous or upset it is best not to come into the anaesthetic room as your anxiety is conveyed to your child and makes the induction of anaesthesia more difficult.

There are two ways to give a general anaesthetic, and your anaesthetist will decide which method will work best for your child. Your child may have either an anaesthetic gas to breathe, or an injection through a cannula. Some children prefer one method to the other, and if both are safe for your child, you may be able to choose which is used.

If the anaesthetic is given by gas, the anaesthetist generally cups a hand over your child’s nose and mouth, or uses a facemask to administer the anaesthetic gas. Anaesthetic gases smell similar to ‘texters’, and sometimes your anaesthetist may offer a different flavour smell (such as strawberry or chocolate) to mask the smell of the anaesthetic gases. It will take a little while for your child to be anaesthetised with this method, and he or she may become restless as the gases take effect.

Alternatively, your child may have a small cannula placed in the back of his or her hand or arm, if they have had local anaesthetic cream applied beforehand. A cannula is a thin plastic tube that is placed under the skin. A needle is used to put the cannula in, but the needle is removed immediately leaving only the soft cannula in place. The local anaesthetic cream numbs the skin, so that while your child may feel touch, he or she will not feel pain from the needle. The cream needs to have been applied for at least an hour prior to the procedure to be effective. With this method, your child will usually become unconscious very quickly, and some parents may find this unsettling.

Once your child is unconscious, you will be asked to leave the anaesthetic room or operating theatre promptly so we can concentrate our care on your child. Your anaesthetist will monitor your child closely throughout the procedure ensuring that he or she is safe and fully unconscious. Anaesthetic gases and/or drugs given into the vein are used to keep your child anaesthetised for the duration of their procedure. Pain relieving drugs are also given during the anaesthetic to ensure that your child is as comfortable as possible after surgery. The type and strength of pain relief will depend on the procedure, and you will have a chance to discuss the available options during the pre-anaesthetic assessment.

After surgery

Following their operation, your child will go into a recovery room, where a specialist nurse cares for him or her until he or she has fully regained consciousness and is comfortable. You will be able to return to your child as soon as they start to wake up in the recovery area.

Some children may have nausea, and sometimes vomiting after an anaesthetic. If your child is at high risk for nausea and vomiting, your anaesthetist will often give drugs during the procedure to decrease vomiting. Some children may wake up confused and may be distressed for some time until they are fully awake. Time and comfort from you usually settles this down. Some children may also experience sore throat, hoarse voice, headache and blurry vision. These problems are usually short-lived and are easily managed in the recovery room.

Serious problems such as a serious allergic reaction to the anaesthetic are uncommon, but no procedure or anaesthetic is entirely without risk. The exact likelihood of complications depends on your child’s medical condition, and the nature of the surgery and anaesthesia that your child needs. Your anaesthetist will discuss this with you in more detail during the pre-operative assessment.

The following links give more information on anaesthesia for children, and your anaesthetist will be able to address any specific concerns you may have prior to your child’s procedure.