Anaesthesia

The word ‘anaesthesia’ means ‘loss of sensation’. A general anaesthetic ensures that your child is unconscious and free of pain during an operation or test (investigation).

Anaesthetics are the drugs (gases and injections) that are used to start and continue anaesthesia.

Anaesthetists are the specialist doctors who manage an anaesthetic. Those looking after your child at Queensland have had extra training and experience in giving babies and children anaesthetics and are some of the best trained anaesthetists in Australia.

The anaesthetist will be with your child and caring for them the whole time they are unconscious. They are assisted by highly specialised machines which help to watch your child’s breathing and circulation.

After the anaesthetic, the anaesthetist will be involved with other clinical staff in helping to provide your child with the best possible pain relief.

Choosing how your child’s anaesthetic is given

There are different ways to start an anaesthetic. For instance, we may use gas through a face mask or place a plastic tube or needle into a vein. There are also different ways to provide your child’s pain relief after an operation.

It is usually possible for you and your child to choose how the anaesthetic and other medicines are given but sometimes there are important medical reasons why things have to be done in a certain way.

Your wishes and those of your child are very important to us. We understand that you and your child are best placed to tell us what you need. We will not do anything without discussing it with you first.

It is very important that you understand and agree with how we are planning to give the anaesthetic as we want to provide the best possible care for your child.

Please ask your anaesthetist if there is anything you would like to know or don’t understand.

What your anaesthetist needs to know:

• Detailed information about your child’s medical and surgical history.
• What medicines your child is currently taking.
• Whether your child or members of your family have any allergies or unusual reactions to drugs or anaesthetics.
• If your child has had an anaesthetic before and has gone to sleep and woken up well.

The anaesthetist will examine your child and then talk to both you and your child about the anaesthetic and the choices available.

If your child has a more complex medical history, you may be contacted by a member of the anaesthetic team by telephone in the weeks leading up to your child’s surgery.

This will give you another opportunity to ask any questions.

Side effects and complications

Anaesthesia is very safe, and serious complications are very rare. We do our best to ensure this but there will always be a risk of unplanned things occurring during and after anaesthesia and surgery. Some children are more at risk than others because of their medical problems or the surgery they are having.

However, it is very important that you understand the risks. Your anaesthetist will discuss these possible risks for your child with you before the operation. Please ask if there is anything you do not understand.

You may want to ask the following questions:

• How likely is it that there might be a problem?
• How serious the problem could be and if the effects could be permanent?
• What we do to try to prevent it?
• What we do to treat it if it happens?

A common concern from families about anaesthesia is the risk of dying during the procedure. Please be assured that death as a result of an anaesthetic is an extremely rare outcome for healthy patients. In fact, the risk of dying in a road accident while driving to the hospital is much higher than when having the anaesthetic.

It is important to remember that your anaesthetist has had special training to prevent complications and treat them if they happen. We are not listing the following complications to alarm you. They are here so that you can look at them and ask your anaesthetist about any one of them that might particularly worry you.

General anaesthesia side effects

Common

• When a plastic needle (cannula) is put into a vein for the injection of drugs and fluids, skin bruising at this site is fairly common but usually gets better quickly.
• Most children have a breathing tube placed into their windpipe or mouth to help them breath. This may cause a sore throat and possibly a hoarse voice.
• Nausea and vomiting may be caused by many things including anxiety, the surgery and the pain-relieving and anaesthetic drugs (such as morphine) that we use.
• Both you and your child may feel some emotional distress at the start of the anaesthetic or while they are waking up afterwards.
• Your child may have some pain after surgery. They will receive pain relief to help with this.

Rare

• Damage to a tooth or teeth.
• An unexpected severe allergic reaction to a drug.
• Vomit entering the lungs causing serious problems – this is why it is important that your child’s stomach is empty at the time the anaesthetic is given.

Very rare

• Awareness – being awake during the operation.
• Serious and even permanent damage to the heart, lungs or brain which could possibly cause permanent disability or death.

Local anaesthetic side effects

Common

• The local anaesthetic not working properly and therefore your child will need other medicines to manage their pain.
• Numbness or muscle weakness that usually gets better within a few hours.

Very rare

• Nerve damage from an injection of local anaesthetic around a nerve.

What to tell your child

Parents have an important role in preparing their child to make the visit to hospital as positive as possible. We believe that your child should be told as much as possible about what will be happening to them. We therefore recommend that you are honest.

All children over 18 months should be told:

• that they are going to hospital
• that they are going to have an operation or test
• and about having an anaesthetic

Fasting (no eating or drinking before surgery)

We appreciate how hard it can be for a child to fast, but it is very important for you and your child to follow the fasting instructions you are given. If there is food or liquid in your child’s stomach during the anaesthetic, it could come back up and then enter their lungs as they go off to sleep and cause serious damage.

If the fasting instructions are not followed, the operation may be postponed or rescheduled to another day.

You will get separate instructions about fasting. If you don’t, please remember to ask about them.

Premedication

Your anaesthetist may decide to give your child some medication before the anaesthetic. This may be a drug to stop pain, make your child a little more relaxed or a special cream that is put on the skin to prevent any pain when the cannula or needle is inserted.

Staying with your child

It can be reassuring for a child if a parent or carer stays with them until they are asleep. However if you are showing signs of being anxious this may upset the child even more. Your child may bring a favourite toy or blanket.

Sometimes there are other reasons why staying with your child is not a good idea – for example if your baby is less than 9 months of age or for emergency procedures. Children aged 9 months to 6 years are more likely to be distressed when separating from their mum and dad. We are very aware of this.

Your anaesthetist will discuss this option with you. We hope you will respect our decision if we don’t think that you should be present for the start of the anaesthetic. Your child’s safety is very important to us.

If you stay with your child we don’t want you to be alarmed if you see your child behaving in an unusual way. Your child may briefly twitch or wriggle, roll their eyes, breath noisily or suddenly go limp. This is all normal but may be frightening for you.

In recovery

Your child will spend some time (at least 20 minutes) in the recovery room waking up after their anaesthetic. Aspecially trained recovery nurse will ensure your child:

• is recovering well after the anaesthetic;
• is comfortable and will give extra medicine to treat discomfort if needed;
• is not feeling queasy;
• that the surgical site is not bleeding.

One parent may be invited into recovery to be with your child as they wake. You will be contacted by mobile phone so please keep this switched on. As the effects of the anaesthetic are wearing off, your child may be disorientated, feel dizzy or have blurry vision. This is normal and every child may behave slightly differently. As there are a number of children all in different phases of waking up, we ask that you respect their privacy.

We aim to let your child have something to drink and then eat as soon as they are awake enough and the type of surgery permits this.

Pain relief

Your child is likely to feel some pain after an operation. Your child’s anaesthetist will be using a variety of medicines to control the pain and make your child comfortable. Some of the medicines we use to control the pain have side effects. This may limit how much we can give your child and we will work with you and your child to provide the best pain relief possible.

Depending on the nature of your child’s operation and what medicines your child may tolerate, we usually use a combination of medicines which may include: paracetamol, ibuprofen, oxycodone, morphine, and local anaesthetics. Suppositories may be used.

We would recommend using at least paracetamol regularly for the first 24 hours after surgery. Please refer to the recommended dosage on the packaging.

Talking to your child’s anaesthetist

This fact sheet is not a substitute for talking to your child’s anaesthetist. There are probably many other things that you will want to know but we hope that it will help you to think of the questions you would like answered.

If there is something that you are not sure about it is very important that you ask your child’s anaesthetist. We will not go ahead with the anaesthetic until you have had all your questions answered.

For more information

• Royal Children’s Hospital, Melbourne
• Association of Paediatric Anaesthetists of Great Britain & Ireland
• Children’s Hospital , Westmead Sydney

When to seek help

Please contact us if:

• Your child is sick – if your child is unwell, with fevers, active diarrhoea, wheezing, or vomiting. Please check with your local GP for an opinion regarding your child’s fitness for anaesthesia and surgery if you are concerned.
• You want to cancel a booking.
• Your contact details change.

In an emergency, call Triple Zero (000) and ask for an ambulance.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Developed by the Anaesthetics Department, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS105. Reviewed: February 2016.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.