INFORMATION FOR PARENTS & GUARDIANS
This explains what to expect when your child comes into the hospital for surgery or a procedure under anaesthesia.
1. Who is a pediatric anaesthetist?
Anaesthetists are specialist doctors who administer anaesthesia; they ensure that the patient is unconscious and free of pain during an operation or procedure. The anaesthetist looks after the patient throughout surgery, and continuously monitors the patients’ parameters e.g., blood pressure, heart rate, breathing, oxygen levels, and temperature, and maintains these within normal limits. A pediatric anaesthetist is an anaesthetist with specific training, experience, and expertise in managing anaesthesia for newborns, small infants, and children.
2. How is anaesthesia administered?
Some anaesthetics start with an injection of anaesthesia medications into a vein. Other anaesthetics start with breathing gas through a mask attached to the anaesthesia machine. An intravenous line is then inserted after the child sleeps.
3. What are the risks of anaesthesia and anaesthetic medications?
Modern anaesthesia is very safe, especially inexperienced hands. Most children who undergo anaesthesia will be quite comfortable and have no complications.
The child can have minor side effects like sore throat, shivering, dizziness, grogginess/crankiness on waking up, nausea or vomiting, pain, or bruising in the arm where the IV was placed. Although at times uncomfortable or distressing, most common side effects are not particularly dangerous. They will either wear off or can be treated easily.
In very rare cases, anaesthesia can cause complications in children (such as abnormal heart rhythms, breathing problems, allergic reactions to medications). The risks depend on the kind of procedure, the condition of the patient, and the type of anaesthesia used. Some surgeries or pre-existing diseases may put your child at a higher risk for anaesthesia complications. Before surgery, you will have a chance to discuss your concerns with your child’s anaesthesia team.
You can help to reduce risk by:
- Sharing all information about your child’s health, including all medications your child is taking with your anaesthetist prior to the procedure. This will allow the anaesthetist to make a decision as to which type of anaesthesia and drugs are safest for the patient
- Adhering to the guidelines, you are given regarding limiting eating and drinking before the operation
- Continuing usual medications unless the anaesthetist or surgeon recommends against it
- Ensuring that any other chronic illnesses are being optimally treated
- Having an anaesthetist who is experienced in the care of children
4. Why can’t my child eat or drink before the procedure?
If there is food or liquid in your child’s stomach while he/she is anaesthetized, it could come up into the back of their throat and then go into the lungs. This would cause choking or serious damage to the lungs.
4. A. How long does my child have to fast before surgery?
Food and milk empty from the stomach much slower than clear liquids. To make sure the stomach is as empty as possible by the time anaesthesia is started, children must be fasting longer from food or milk than from clear liquids. You should always check with your doctor to see what they recommend. Recommended fasting times for different types of food and liquids are as follows:
| Type of food or liquid | Fasting time before surgery |
| Fatty or fried food | 8 hours |
| Light meal, milk | 6 hours |
| Breast milk (infants) | 4 hours |
| Clear liquids | 2 hours |
4. B. What type of liquids are clear liquids?
Clear liquids are any type of liquids that, when poured into a clear glass, would allow you to see through them. Some examples are water, electrolyte solutions, apple juice, and carbonated soft drinks.
5. How long does the effect of anaesthesia last on the children? When will my child wake up after surgery?
Modern anaesthesia drugs are short-acting. The duration of anaesthetic is tailored to the length of surgery. Typically, a child wakes up completely within 30-45 minutes in the recovery area.
6. When can my child eat again?
Except for surgery on the abdomen, the child can usually start clear liquids after 2 hours of surgery. If the child does not vomit, you can give non-spicy, light food to begin with (e.g., milk and biscuits, khichdi, etc.). For children below 1 year, the baby is fed early when fully awake after clearance by the anaesthetist or ward doctor.
7. Will my child experience pain after surgery?
Pain-relieving medications are given during the surgery as part of the anaesthetic to lessen the post-operative pain. Sometimes, medications can be injected locally to manage pain. Few medicines like Syrup Ibugesic are given orally once the child starts to eat. The type of pain relief will depend on the procedure and will be discussed by the anaesthetist while taking your consent for anaesthesia.
8. Is anaesthesia safe for newborns?
Newborns are constitutionally different from children and adults. Since anaesthesia drugs are given according to weight and are usually short-acting, they are safe for newborns who require surgery or procedures like MRI. However, babies born prematurely can take longer to come out of anaesthesia. Almost always newborn babies are observed in the ICU after anaesthesia and surgery.
9. Can anaesthesia have any long-lasting effects on my child’s intelligence or memory?
Scientists have been investigating the effects of anaesthetics on the developing brain of animals for more than twenty years. While animals, who have very long or repeated anaesthesia, have problems with learning and behaviour later in life, a single carefully administered anaesthetic has not been found to be associated with these problems in children.
Since a child’s brain growth and development occurs rapidly to 5 years of age, surgeries are advised in this age group only when absolutely essential. Anaesthesia is a must for all children undergoing surgeries. Delaying necessary surgery may be harmful to the child’s growth and development. The risk and benefits have to be weighed before the decision of surgery and anaesthesia is taken.
10. How can I as a parent help?
A well-informed parent is a calm parent. A calm parent often has a calm child. Tell your child that he or she will take a nap after taking some medicine provided by a special doctor, and they won’t feel anything during the surgery. Tell your child that after surgery, he or she might hurt, have an upset stomach, or might even throw up, but the doctors will provide medicine to make it better. Assure your child that you will be nearby the entire time. Do not hide what is going to happen from children as they can be more distressed by the unexpected.
11. What do I do if my child has a cough/cold/fever one day before or on the day of surgery?
Please call up the hospital or the surgeon if your child develops a significant cough or cold, diarrhea, or vomiting a few days prior to the day of the operation. It may be best to delay the operation until they are better.
Department of Paediatric Anaesthesia | NH SRCC Children’s Hospital, Mumbai