Preparing your child for anaesthesia

Coming to hospital for an operation can be a daunting experience for children and parents of all ages. A little preparation and understanding of what to expect can make all the difference.

Be assured that all the nurses, doctors and operating theatre staff are working as hard as possible to make things as easy as they can be for you and your child, but it can be facilitated immensely by the parents’ attitude and expectations. Your surgeon, anaesthetist and nursing staff work together as a team to provide the safest possible care for your child and everything that happens is directed towards this goal.

Preparing for the day of surgery

For an excellent general information brochure regarding the role of your anaesthetist please visit the website of the Australian Society of Anaesthetists and read the patient information brochure “Anaesthesia and You”.

As far as possible beforehand, please make contact with your anaesthetist if your child has any serious medical conditions e.g. poorly controlled asthma, a heavy head cold or chest infection, diabetes, epilepsy or bleeding disorders. This way any necessary tests or treatments can be done, medications can be prescribed, and we can make contact with any other specialists involved in his/her care. It is most important that any medical conditions are as well treated as they can be prior to an anaesthetic. Please also make contact with us if you have any other concerns or questions. The surgeon’s secretary will usually be able to tell you who the anaesthetist will be and how to reach us.

From experience even very young children find an operation a much easier process if they are completely prepared in their own minds and know roughly what to expect. Some parents try the “surprise” method, usually because they themselves are scared, and don’t tell their children until a day or two before, or even on the day of the operation, that they are coming to hospital. This inevitably ends in a difficult situation as the child has not had time to ask their own questions and come to terms with the fact that they need to have surgery.

Once a child is over the age of two it really is best to tell them at least a week or so before. You don’t need to make a big deal of it but we would suggest having a chat with them and telling them in a straightforward way that because they have a sore throat/ear (or whatever the reason), they are going to come to hospital and have an operation and the doctors and nurses are going to help them feel better even though it might be a little scary and sore at first. You will be surprised how maturely even pre-schoolers will approach things if they know it will help them feel better in the long run. There are several children’s books written about going to hospital which you could read together, and there are plenty of other children who have had ENT and general paediatric surgery that you could talk to. Don’t listen to the melodramatic stories at school or playgroup and stay away from Google! Avoid offering bribes or making untrue promises such as it won’t hurt at all, and please don’t threaten children to “behave or else the doctor will give you a needle” as this can make our job far more difficult.

What to expect on the day of surgery

An early start!

Fast your child according to the instructions given by the hospital. In general for a morning operation he/she should not have any food or milk after midnight the day before, and may drink water only until 6am on the day of surgery then nothing. Please do not ignore fasting guidelines, even the smallest amount of food or fluid snuck in beyond these guidelines puts your child at risk. For an afternoon operation you will probably be asked to give your child early breakfast, then water only until 11am. If your child is a breastfeeding baby please make contact with your anaesthetist for a specific fasting plan. Bottle-fed babies should fast for formula the same as for food.

Please give all regular medications with a little water, and puffers as usual. Teeth can be brushed with a little water to rinse. DO NOT GIVE any anti-inflammatory medications such as Nurofen or aspirin, or blood-thinning medications e.g. Warfarin in the days leading up to surgery. If he/she is diabetic please contact your anaesthetist for a fasting and insulin plan.

If your child has a heavy cold or cough, or an exacerbation of asthma, you will need to contact us a few days before surgery as the operation may need to be delayed a few weeks and some treatment started.

A lot of waiting is involved even for the shortest operation; bring toys/books/portable DVD player. Bring any dummies or blankets or comforters that he/she normally needs to go to sleep (within reason). Remove all snacks and drink bottles from your bag to reduce temptation, tantrums and pilfering while nil by mouth.

Your anaesthetist will visit on the ward pre-operatively or if it is a busy operating list and already underway you may meet later in the day outside the operating theatre. He/she will conduct a consultation with you and your child, including questions about general medical health and previous anaesthesia. Please come informed with current medications and medical history, Dads often need this in a written format as they get their children mixed up. Based upon this consultation the anaesthetist will decide on the best and safest anaesthetic, and will explain to you what is going to happen next. They will also give you advice on what to do at home afterwards in terms of pain management.

A few minutes before coming to theatre children less than 4-6 years old will often be prescribed a pre-medication (as a drink) called midazolam. This will make him/her relaxed and maybe a little drowsy.

In the operating theatre

If one parent wishes to accompany their child to the operating theatre until they are anaesthetised this is encouraged. Bring one favourite teddy, blankie or dummy to theatre if it will help. Your presence is purely to provide support and reassurance for your child. It is important that you adopt a calm, relaxed attitude regardless of how anxious or upset you are feeling. It is natural to feel protective as you entrust your most precious thing to the care of another, but if you are agitated and teary your child will sense this and react similarly. If you feel that you cannot do this it is best to not come into the theatre, as it will upset your child and distract the anaesthetist; he/she will be in safe, kind hands whether you are present or not. There is absolutely no medical evidence to suggest children do worse or have any kind of long term mental trauma if their parent says a cheerful goodbye at the door instead of coming in. Nothing dreadful is going to happen inside the operating room, we are all very nice, but we are also very experienced in how to anaesthetise children so be guided by us in how to act and when to leave.

Most of the time for children less than about 10 years old the anaesthetic is administered via a face mask and anaesthetic gas to breathe. An anaesthetic plan will be discussed with you during the pre-operative consultation and the anaesthetic prescription will be decided according to your child’s age, medical history and the surgery required. Routine monitoring is used for all children, including oxygen saturation monitoring, heart rate and rhythm monitoring, blood pressure and anaesthetic gas concentrations. Some or all of these monitors will be applied before he/she goes to sleep. Occasionally for medical reasons the anaesthetic will be given via an IV cannula in the hand or forearm, but usually this is inserted once he/she is asleep via the face mask. Older children may often prefer to go to sleep with an IV and if this method is chosen a local anaesthetic patch will be applied to numb the skin beforehand. Drugs that may be given during the anaesthetic could include morphine and other drugs for pain relief, paracetamol, antibiotics, anti-nausea drugs, steroids and IV fluids to make up for fasting time.

Going to sleep breathing the anaesthetic gas will take a couple of minutes at the most and you will be shown out of the operating theatre promptly so that the rest of the anaesthesia and surgery can commence. Once your child is in the recovery room, awake and resting comfortably you will be able to come back to them. After about half an hour you will both return to the ward or day surgery lounge.

It is not uncommon for children to be unsettled and cranky in recovery, especially after surgery for grommets or adenoids/tonsils, as they may be dizzy and disoriented. This is not usually pain-related but rather a response to the unfamiliar environment and anaesthetic. It will settle over fifteen to forty five minutes. Usually once they have had a cuddle and an iceblock everything gets better very quickly. He/she will have been given pain relief medication as part of the anaesthetic and this is often supplemented by local anaesthetic so it is very unlikely your child will wake up in severe pain. The recovery nurses will have been given a prescription for further pain relief by the anaesthetist and they will give this if they feel that pain is an issue.

After the operation

If there is any later post-operative pain this will be managed by the nurses while you are in hospital. Local anaesthetic is used in combination with a general anaesthetic to minimise the need for intravenous pain relief. While the IV is in place there is rarely a need for injections (“needles”) as most medications can be given orally or IV.

It is not unusual to have one or two vomits especially after tonsillectomy/adenoidectomy or turbinoplasty, and for there to be a little blood in the vomit coming from the site of the surgery. Prolonged nausea or vomiting can occur after an anaesthetic, this is rare in children however and if it does occur will be treated quickly. Don’t feed your child too much rich or fatty food in the first few hours as this can exacerbate vomiting, best to stick to toast, sandwiches, jelly and other light meals. Even after a tonsillectomy a normal, light diet is recommended. Unless they are “nil by mouth” they may drink water or diluted juice as soon as they like.

The anaesthetic medications used are all fairly short acting and he/she should be back to their usual self within a few hours.

Please refer to other information sheets specific to your child’s operation for advice about how to care for your child in the days following.