Your Child’s General Anaesthetic

Produced by Joondalup Health Campus

 

Preparation
Studies have shown that children who are prepared before a hospital visit
tend to be less worried, cope more effectively with medical problems, need
less medication and adapt more quickly to being back home than children
who have not known what to expect.
There are many things you can do to prepare your child for coming into
hospital. In general the younger your child is, the less time you should leave
between talking about the visit and the event happening. It’s often better
to spread the information out over a few days than give it all at once. You
know your child best and will be able to tailor the information you give to
your child’s level of understanding.
Being positive, calm, open and honest and as matter-of-fact as possible will
help your child see that you feel confident about the procedure and this
will help allay their fears.
What is anaesthesia?
A general anaesthetic ensures that your child is unconscious and free
of pain during an operation.
• General anaesthesia is a state of controlled unconsciousness and
freedom of pain.
• Anaesthetics are the drugs (gases and injections) that are used to
start and maintain anaesthesia.
• Anaesthetists are specialist doctors who give the anaesthetic and
look after the health of your child during surgery. They will also be
involved with your child’s pain relief after surgery.
As a parent, you will be reassured to know that modern anaesthesia is
very safe and complications are extremely rare.

On the day of admission
Unless you have had prior contact an anaesthetist should come and visit
you on the ward before the procedure to discuss your child’s anaesthetic.
The anaesthetist needs to find out about your child’s general health,
previous experiences of anaesthesia, any medicines your child may be
taking and any allergies they might have. It is important that your child is
not suffering from any other illnesses that will make it harder for them to
recover from their surgery. A cold, cough, runny nose, or sore throat can
become much worse after an anaesthetic, or make it harder for your child
to breathe during or after the procedure. It is important for you to
also inform your anaesthetist if your child has any loose teeth.

Delaying the operation
Occasionally the anaesthetist may learn something about your child that
means that 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.

Fasting for general anaesthesia
The hospital should give you clear instructions about fasting. It is important
for your child to follow these.
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 damage their lungs.
These are the latest times that you should give your child anything to eat
or drink:
• 6 hours before your child can have a light meal, a glass of milk or a fizzy
drink. Bottle fed babies can have a formula feed.
• 4 hours before babies can have breast milk.
• 2 hours before all children and babies can have a small drink of water
but not a fizzy drink.
No lollies or chewing gum should be given at all on the day of surgery.

Premedication
Premedication (premed) is the name of drugs which are sometimes given
before an anaesthetic. Some premeds help your child to relax, and some
are given for their pain relieving properties (eg: paracetamol).
If your child does need a premed, this will usually be given as a liquid.
Occassionally an injection is essential.
Premeds are given some time before the anaesthetic.
The drugs used can be:
• Sedatives to ease your child’s anxiety.
• Local anaesthetic creams (numbing creams) can be applied to your
child’s hands. This makes insertion of an intravenous drip at the start of
the anaesthetic painless for most children.
• Pain relieving drugs such as paracetamol that can help at the end of
the procedure.
• Medicines to protect your child from the side effects of the anaesthetic
(eg: nausea).

Going to theatre
Most hospitals provide colourful gowns for your child to wear. Your child
will be able to keep their underwear/nappy on.
Most children stay relaxed if a parent goes with them to theatre. Your child
will travel to theatre on a hospital bed and in some cases you will be able to
travel on the bed with your child. The nurse from the ward will accompany
you and your child to theatre.
At the discretion of the anaesthetist you will be welcomed to stay with your
child until they are unconscious. Your child may have either an anaesthetic
gas to breathe or an injection through a small needle (cannula/drip).
If the anaesthetic is given by gas, it will take a little while for your child
to be anaesthetised and they may become restless as the gases take effect.
If an injection is used, your child will normally become unconscious very
quickly indeed.
Watching your child go to sleep may be upsetting or stressful. Some
children may roll their eyes, twitch, snore and go limp very quickly. This is all
perfectly normal. Once your child is asleep you will be asked to leave and a
member of staff will be with you as you leave.

What happens next?
Throughout the anaesthetic period, your anaesthetist remains with your
child and will monitor your child’s blood pressure, pulse, temperature and
breathing closely, ensuring that they are safe and fully unconscious.
Anaesthetic gases and/or drugs given into the vein will be used to keep
your child anaesthetised.

After Surgery
Most children will go to the recovery ward. Each child is cared for by a
specialist nurse until they have regained consciousness and are comfortable
enough to return to the ward. Pain relieving drugs are given during the
anaesthetic to ensure your child is as comfortable as possible after surgery.
The type and strength of pain relief given will depend on the procedure.
The right dose of pain medicine for a child is the dose that reduces the pain
with the fewest side effects. It may not be possible to eliminate all pain, but
there are strategies (medicines, as well as physical and psychological means)
that can reduce pain to acceptable levels.

Ways of giving pain relief
Syrups and tablets – just like home.
Melts – medicines that ‘melt in your mouth’ – these are especially suitable
for older children.
Suppositories – some pain relieving medicines like paracetamol can be
given rectally (into the bottom). These are often given whilst your child is
anaesthetised and last for several hours. Suppositories are very helpful
when children cannot take medicines by mouth.
Local anaesthetics – these are injected near the nerves around the
operation site to numb the area. The injections are given while your child is
anaesthetised and the pain relief lasts for several hours.
Caudal injections – Caudal anaesthesia is given with general anaesthesia
to block pain in the legs, low back, belly and lower trunk area. It is an
injection of local anaesthetic that is given in the part of the back where
your child sits. A caudal allows the anaesthetist to give a smaller amount of
general anaesthetic during the surgery, and also provides up to four hours
of pain relief in that area after the surgery.

Some common terms used with medicines:
IV – intravenous – when a drug is given into a vein through a cannula.
IM – intramuscular – when drugs are given by injection into the muscles
of the bottom or upper arm.
S/C – subcutaneous – when drugs are given just under the skin, either as a
one off or through a cannula.
Infusion – when drugs are given continuously, usually by a special pump.
PCA – Patient Controlled Analgesia – an infusion of pain relieving drugs
controlled by a pump with a button which your child can push when extra
doses are needed. This is usually restricted to older children who are able to
understand how to use the pump.
Epidural – local anaesthetic is injected through a thin tube placed close to
the spine – used after major surgery.
Caudal – an injection of local anaesthetic near the nerves as they leave the
spine, similar to an epidural.

Helping your child manage their pain at the hospital
Most children in hospital have pain. All children should know that pain
goes away and that many children have pain just as they do.

Signs your child is in pain
Sometimes children cannot use a scale to rate their pain. Crying can be an
obvious sign along with restlessness however there can be other indicators.
Here are some other signs that you can look for to tell if your child is in pain:
• not playing
• being more quiet than usual
• going back to using younger behaviours such as thumb-sucking or
wetting the bed.

Coping with pain
After you find out how much pain your child is feeling, you can work at
finding different strategies to manage that pain. There are many ways to
help a child cope with pain other than just pain medication.

Breathing
Deep breathing helps manage pain by relaxing your body. A handy tool to
help with deep breathing is to have your child blow bubbles.

Imagination
Using your imagination reduces anxiety and pain and will make your child
feel more calm and relaxed.

Tools
Distraction tools are known to help children manage their pain. These are
items that can be used during potentially painful or stressful situations or to
manage ongoing pain. You may like to try:
• magic wands
• bubbles
• light-up toys
• singing
• music
• a favourite object,
such as a stuffed animal
• picture books
• videos
• joke books
• squishy balls

Side effects and complications
Minor side effects from anaesthesia are common and some are
listed below:

Pain
Pain after surgery varies greatly from child to child and techniques to help
with pain are mentioned in earlier pages.

Nausea and vomiting
This can occur in about one in ten children but generally stops within the
day. The risk is much greater if the child has a history of vomiting with
anaesthesia or motion sickness, or if there is a strong family history of
vomiting with anaesthesia. You should tell the anaesthetist about any of
these prior to them going to surgery.

Allergic reactions
Allergic reactions to anaesthetic drugs are extremely rare in children and
mostly fully reversible.

Sore throat
This can occur after anaesthesia, most commonly due to a tube placed in
the throat to allow breathing during surgery. This settles quickly after 24
hours.

Local anaesthetic block effects
Side effects from local anaesthetic blocks are uncommon. Some children
dislike the numbness or weakness that happens with the block. If the block
is unsuccessful another method of pain relief may be needed.

Epidural/Spinal/Caudal blocks
Major complications are extremely rare but include permanent nerve
damage, epidural infection and convulsions due to local anaesthetic.
In modern anaesthesia, serious problems are uncommon. Risks cannot be
removed completely, but modern equipment, training and drugs have
made it a much safer procedure in recent years. About one in twenty
children in Australia are anaesthetised each year. Reliable figures show that
Australia is one of the safest countries in the world for children’s anaesthesia.

References:
1. Phillips, S., Daborn AK, Hatch DJ. Preoperative fasting for paediatric anaesthesia. Br J Anaesth 1994;
73:529–536.
2. Thompson, N. et al. Pre-operative parental anxiety. Anaesthesia 1996; 51:1008–1012.
3. Royal College of Anaesthetists – Raising the Standard: Information for patients- principles, samples of
current practice RCoA, London 2006
4. Tait, A.R. et al. Parents’ preferences for participation made in decisions regarding their child’s anaesthetic
care. Paed Anaes 2001; 11:283–290.
5. Setting standards for children undergoing surgery. Action for Sick Children, London 1994.
6. Schechter, N.L., Berde, C.B., Yaster, M. Pain in infants, children and adolescents. Lippincott Williams and
Wilkins, Philadelphia 2003.
Acknowledgements: Dr Merlin Nicholas and Fiona Crawford, Joondalup Health Campus.
Disclaimer: The advice and information contained herein is provided in good faith as a public service.
However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to
make their own enquiries as to the accuracy and appropriateness of any information or advice provided.
Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury
occurring as a consequence of such act or omission is expressly disclaimed.

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