Most children having surgery will need a general anaesthetic, where they are deeply unconscious. Sedation and regional anaesthesia alone (local anaesthetic blocks) are not commonly used, as children can be anxious and they won't stay still.
Depending on on the age of your child, their cooperation, their general health, and the type of operation they are having, they will either receive a gas induction or an intravenous (IV) induction.
Gas Induction
A plastic mask attached to the anaesthetic machine is placed on the nose and mouth. The anaesthetic gas is breathed in, and your child slowly becomes unconscious. Gas induction is slower than IV induction so your child goes through the 'excitement' stage of anaesthesia. This means that the eyes will roll around a lot and become crossed. The breathing becomes very heavy and your child will snore. Sometimes your child will cough. About half of children will become quite agitated and may need restraint by theatre staff. Your child is not in distress, but it can look like it. By this time your child will be unaware of what is going on, as they are almost unconscious. Once your child is unaware, you will be shown out by a member of the operating theatre staff. Even though it can be difficult, it is important to leave so that I can concentrate on the anaesthetic and look after your child. After this I will put an IV cannula into a vein, and do what's necessary for that particular operation, such as insert a breathing tube and perform a local anaesthetic block.
Intravenous Induction (IV)
IV induction needs a cannula inserted first so that the anaesthetic agent can be injected into a vein. The cannula is very small, and does not usually cause much pain. However, children are often worried about this, so to reduce the pain they will have local anaesthetic cream applied, have the skin numbed with cold (CoolSense), or be given nitrous oxide gas first. Once the cannula is in and taped securely, oxygen will be given by a mask, and the anaesthetic will be injected. Children loose consciousness within a few seconds. Sometimes they will yawn and cough, and then they will stop breathing. I will take over their breathing with the face mask. The IV anaesthetic sometimes aches as it goes up the arm, but it stops within a few seconds. Occasionally their body goes a little stiff, and then becomes floppy. All of this is completely normal, and hopefully you will not be alarmed, now that you have been forewarned. Once your child is unaware, you will be shown out by a member of the operating theatre staff. Even though it can be difficult, it is important to leave so that I can concentrate on the anaesthetic and look after your child. After this I will do what's necessary for that particular operation, such as insert a breathing tube and perform a local anaesthetic block.
How to to support your child
You play an essential part in looking after your child on the day of surgery. It is important that you prepare your child for the operation once it has been decided to perform surgery. Children tolerate anaesthetics and surgery better when they are prepared.
Children can be naturally fearful of the unknown. Tell your child what will happen in simple terms. Be honest. Tell them that they will have an operation at the hospital, which might be a little sore afterwards, but that you and the doctors and nurses will look after them.
Nothing calms a child more than calm parents. Being present when your child is anaesthetised is often helpful and it is common for one parent to be present as your child goes off to sleep. However, please do not feel you have to come in if you think it will upset you. It is perfectly acceptable for you to choose not to be present at the start of the anaesthetic.
Children often like to bring in their favourite teddy, or their sleeping blanket. Books and iPads can be useful too. Many children feel more relaxed when their parents sing to them. Most children love to hear that they will be able to have an icy pole when they wake up in the recovery room!
Trust the anaesthetist and the theatre team. We are all there to look after you child from the beginning to the end of the operation.
Anaesthetic Blocks (Regional Anaesthesia)
For many operations an anaesthetic block is very useful to control pain both during surgery and afterwards. Such operations include those on the legs (orthopaedic or plastics), those on the genetalia (urology), and those in the abdomen or pelvis (general surgery, urology and orthopaedics)
A caudal block: After the child is anaesthetised, local anaesthetic is injected into the epidural area at the base of the spine. It is similar to a labour epidural, but it is a single injection only. No catheter is left in place. A caudal makes the body numb from the belly button to the feet. Sometimes the legs can be a little weak for a few hours afterwards, but they will become stronger as the block wears off. Leg weakness is often desired for a short time, as it reduces the amount the child moves after the operation, and can reduce the risk of bleeding. The caudal lasts between 6 and 12 hours.
The advantages of a caudal include:
Perfect pain relief for a number of hours when successful.
Less nausea and vomiting.
Less muscle spasm.
Less bleeding during surgery and after.
Less need for strong intravenous pain relieving drugs such as morphine and ketamine.
Less difficulty breathing after the operation.
Less constipation.
The risks of a caudal include:
About 1% of caudals don't work properly and so other methods of pain relief like morphine and ketamine, need to be used as well. It's obvious that the caudal doesn't work during the operation, so this can be fixed before the child recovers consciousness.
Bruising at the injection site at the base of the spine.
There is a very small risk of damage to nerves in the spine, which can be temporary or permanent. In the worst case scenario this could lead to permanent paralysis, however this is extremely rare. The risk of ongoing problems from a caudal is about 1 in 10,000 to 1 in 100,000, which means most anaesthetists will never encounter it in their entire career. As a comparison to common daily events, the risk of dying in a car crash in Australia is 1 in 10,000 for every 40,000 km driven.
Depending on on the age of your child, their cooperation, their general health, and the type of operation they are having, they will either receive a gas induction or an intravenous (IV) induction.
Gas Induction
A plastic mask attached to the anaesthetic machine is placed on the nose and mouth. The anaesthetic gas is breathed in, and your child slowly becomes unconscious. Gas induction is slower than IV induction so your child goes through the 'excitement' stage of anaesthesia. This means that the eyes will roll around a lot and become crossed. The breathing becomes very heavy and your child will snore. Sometimes your child will cough. About half of children will become quite agitated and may need restraint by theatre staff. Your child is not in distress, but it can look like it. By this time your child will be unaware of what is going on, as they are almost unconscious. Once your child is unaware, you will be shown out by a member of the operating theatre staff. Even though it can be difficult, it is important to leave so that I can concentrate on the anaesthetic and look after your child. After this I will put an IV cannula into a vein, and do what's necessary for that particular operation, such as insert a breathing tube and perform a local anaesthetic block.
Intravenous Induction (IV)
IV induction needs a cannula inserted first so that the anaesthetic agent can be injected into a vein. The cannula is very small, and does not usually cause much pain. However, children are often worried about this, so to reduce the pain they will have local anaesthetic cream applied, have the skin numbed with cold (CoolSense), or be given nitrous oxide gas first. Once the cannula is in and taped securely, oxygen will be given by a mask, and the anaesthetic will be injected. Children loose consciousness within a few seconds. Sometimes they will yawn and cough, and then they will stop breathing. I will take over their breathing with the face mask. The IV anaesthetic sometimes aches as it goes up the arm, but it stops within a few seconds. Occasionally their body goes a little stiff, and then becomes floppy. All of this is completely normal, and hopefully you will not be alarmed, now that you have been forewarned. Once your child is unaware, you will be shown out by a member of the operating theatre staff. Even though it can be difficult, it is important to leave so that I can concentrate on the anaesthetic and look after your child. After this I will do what's necessary for that particular operation, such as insert a breathing tube and perform a local anaesthetic block.
How to to support your child
You play an essential part in looking after your child on the day of surgery. It is important that you prepare your child for the operation once it has been decided to perform surgery. Children tolerate anaesthetics and surgery better when they are prepared.
Children can be naturally fearful of the unknown. Tell your child what will happen in simple terms. Be honest. Tell them that they will have an operation at the hospital, which might be a little sore afterwards, but that you and the doctors and nurses will look after them.
Nothing calms a child more than calm parents. Being present when your child is anaesthetised is often helpful and it is common for one parent to be present as your child goes off to sleep. However, please do not feel you have to come in if you think it will upset you. It is perfectly acceptable for you to choose not to be present at the start of the anaesthetic.
Children often like to bring in their favourite teddy, or their sleeping blanket. Books and iPads can be useful too. Many children feel more relaxed when their parents sing to them. Most children love to hear that they will be able to have an icy pole when they wake up in the recovery room!
Trust the anaesthetist and the theatre team. We are all there to look after you child from the beginning to the end of the operation.
Anaesthetic Blocks (Regional Anaesthesia)
For many operations an anaesthetic block is very useful to control pain both during surgery and afterwards. Such operations include those on the legs (orthopaedic or plastics), those on the genetalia (urology), and those in the abdomen or pelvis (general surgery, urology and orthopaedics)
A caudal block: After the child is anaesthetised, local anaesthetic is injected into the epidural area at the base of the spine. It is similar to a labour epidural, but it is a single injection only. No catheter is left in place. A caudal makes the body numb from the belly button to the feet. Sometimes the legs can be a little weak for a few hours afterwards, but they will become stronger as the block wears off. Leg weakness is often desired for a short time, as it reduces the amount the child moves after the operation, and can reduce the risk of bleeding. The caudal lasts between 6 and 12 hours.
The advantages of a caudal include:
Perfect pain relief for a number of hours when successful.
Less nausea and vomiting.
Less muscle spasm.
Less bleeding during surgery and after.
Less need for strong intravenous pain relieving drugs such as morphine and ketamine.
Less difficulty breathing after the operation.
Less constipation.
The risks of a caudal include:
About 1% of caudals don't work properly and so other methods of pain relief like morphine and ketamine, need to be used as well. It's obvious that the caudal doesn't work during the operation, so this can be fixed before the child recovers consciousness.
Bruising at the injection site at the base of the spine.
There is a very small risk of damage to nerves in the spine, which can be temporary or permanent. In the worst case scenario this could lead to permanent paralysis, however this is extremely rare. The risk of ongoing problems from a caudal is about 1 in 10,000 to 1 in 100,000, which means most anaesthetists will never encounter it in their entire career. As a comparison to common daily events, the risk of dying in a car crash in Australia is 1 in 10,000 for every 40,000 km driven.