What do you need to know about Anaesthesia for Paediatric Surgery?
Your child's surgery
All of our anaesthetists who provide anaesthesia for children in Private Practice also work with children at Southampton Children's Hospital within University Hospital Southampton. We are the teaching centre specialists for the Wessex region and are skilled in dealing with the concerns and worries of children and their carers. We can provide a range of local anaesthetic blocks during anaesthesia that greatly help with pain relief post operatively. Some children will have their operation done by their surgeon on an operating list which also contains adults but we also offer a monthly operating list on a Saturday when any surgeon can book children for operations with a specialist paediatric anaesthetist and post operative children's nurses.
The operation process
Sometimes sedative medicines (pre-meds) are given on the ward to help your child to relax and make the process of starting anaesthesia more acceptable to the child. Nearly all children will have 'magic cream' put on the back of their hands. This is also called 'Ametop' or 'EMLA'. It takes 30-60 minutes to work and reduces the pain of the injection if a cannula is placed in your child’s hand or arm.
Your child may be able to wear his or her own clothes to the operating theatre or the hospital will provide a colourful gowns to wear. Your child may be able to keep their underwear on. Your child may walk to the anaesthetic room, travel on a hospital trolley or be carried. A nurse from the ward will accompany you and your child to the anaesthetic room and your child will be able to take a toy or comforter.
If you wish, one parent or carer will usually be welcome to stay with your child until he or she is unconscious. The anaesthetic may be started while your child is lying on a trolley. Smaller children may be anaesthetised sitting on your lap. Staff would then help you lift him/her on to the trolley.
The anaesthetist will use either gas or an injection through a cannula to start the anaesthetic. This will have been discussed with you beforehand. If a cannula is used, your child will normally become unconscious very quickly indeed. The anaesthetist will then use a mask to continue the anaesthetic.
If the anaesthetic is started with gas, the anaesthetist generally uses a mask to give the gas. Anaesthetic gases smell similar to felt-tip pens. It normally takes up to a minute for the anaesthetic to take effect and it is normal for the child to become restless during this time. Staff will help you hold your child gently but firmly.
As your child becomes more sleepy you will then be asked to leave the anaesthetic room and a member of staff will be with you as you leave. The anaesthetist stays with your child throughout the operation/procedure. She/he will monitor your child’s blood pressure, pulse and breathing closely throughout the procedure, ensuring that he or she is safe and fully anaesthetised. Pain relieving drugs are given during the anaesthetic to ensure that your child wakes up as comfortable as possible. The type of pain relief will depend on the procedure. If a local anaesthetic nerve block is to be used to reduce post-operative pain, the anaesthetist will insert this once your child is fully anaesthetised.
After the operation
Children wake up in a recovery room after the procedure is over. Each child is cared for by a specialist nurse who makes sure your child is comfortable. She/he will give extra pain relief and anti-sickness medicines as needed. You will be called to be with your child during the waking up process. The anaesthetist is close by and can help if needed. Many children show some signs of confusion, agitation or distress when they wake up. This is more likely in younger children. They may cry and roll about or wave their arms and legs. This behaviour may last up to 30 minutes. The recovery room nurses are experienced at looking after children at this time. They will consider whether more pain relief will help and they will advise you on how best to comfort and reassure your child.
Once you and your child have returned to the ward they will often sleep for a while. Once they are fully awake they will usually be able to eat and drink immediately unless their surgery prevents this. Many operations on children are done as day cases and they can go home once they have eaten and have remained comfortable for a short time. You will be given advice about what pain control medicines to give your child at home but it is a good idea to ensure that you have a stock of both paracetamol and ibuprofen available in liquid form before the day of surgery so that it is available on your return. You can talk to your local pharmacist about what is the best formulation of these simple pain killers for your age of child.