As an anesthesiologist, I receive a lot of questions from parents regarding anesthesia. At Monroe Carell Jr Children’s Hospital at Vanderbilt, our goal is to make what can be a frightening time for children and parents as easy as possible. Here are the five most common questions I am asked by parents and patients. If you have a concern not addressed here, please ask your child’s anesthesiologist on the day of surgery.
Why can’t my child eat or drink before anesthesia?
We ask children to stop eating or drinking before surgery to reduce the risk of food or fluid coming up from the stomach and getting into the lungs. When we are awake, our natural airway reflexes actively protect us from having food or drink go into our airways. Anesthesia is intended to keep patients from feeling or remembering pain or discomfort from a surgical procedure. But anesthetics not only take out the bad responses (pain, anxiety), they also deactivate the good responses, such as your natural airway protection. The primary job of your child’s anesthesiologist is not to put your child to sleep (though this is important). The anesthesiologist’s primary responsibility is to keep a close eye on your child and protect him or her while the natural defenses are sleeping. Keeping food and drink out of the stomach helps me to keep your child safe.
Does my child need to have an intravenous line (IV) before they go to sleep?
We can use sleepy gas or intravenous (IV) medicine to have your child go to sleep. Using the sleepy gas lets us put in the IV after your child is asleep, and most younger children prefer this. It is possible for older children (older than 12) to go to sleep this way but it takes them longer and can make them feel disoriented or be unpleasant. So we prefer to get older children off to sleep with IV medicine. Some medical conditions make it safer for your child to have an IV first, but your anesthesiologist will discuss this with you.
Can I be in the operating room (OR) when my child goes to sleep?
Some hospitals allow parents to be present in the OR while their children go to sleep. This often sounds like a great idea, but can end up being more emotionally trying for all involved and can result in the medical team’s attention being diverted from your child to you. At Children’s Hospital, we want to give your child our total focus.
How will you make sure my child will be as comfortable as possible after he or she wakes up?
Anesthesiologists are specialists at controlling pain, and our goal is to make sure your child is as comfortable as possible. We watch vital signs such as blood pressure, heart rate and breathing rate and adjust the amount of pain medicine we need to give while your child is sleeping. Once the surgery is complete and your child is waking up, we give more medicine if needed. Often this medicine is given through the IV, but we can also use nerve blocks to keep your child comfortable. Nerve blocks are being used much more commonly in children than even just a few years ago. These blocks are often placed while your child is sleeping and they allow us to focus our pain control on the surgical area. This may mean fewer side effects, including nausea, vomiting and disorientation.
Can my child have something to help him or her relax before the operation?
Children who are understandably anxious before surgery can be calmed with either behavioral methods or with medication. Our child life specialists will explain what will happen on the day of surgery in ways children can understand. This is often enough to reassure children. For children who are still anxious or frightened, we can use medications by mouth or IV. However, we try to avoid these medications when possible because they can delay awakening, prolong recovery, and result in turbulent wakening.
By Daniel Roke, MD, FAAP, Pediatric Anesthesiologist