An anesthesiologist is a physician who has had 4 years of a premedical undergraduate college degree, 4 years of medical school, a 4 year anesthesiology residency, and possibly a 1 year fellowship. Pediatric anesthesiologists at Children’s Health Dallas have had at least 1 year of pediatric anesthesiology fellowship training. Some have had additional training in pain management for chronic pain disorders and in cardiac anesthesia for open heart procedures. Everyone is committed to the best possible care for your child.
An anesthesia care team includes a physician anesthesiologist, as well as, a fellow, resident, or an advanced practice practitioner such as an anesthesiology assistant or a nurse anesthetist.
General anesthesia is a combination of medications that provide loss of consciousness, prevent memory formation, and eliminate pain. This allows a patient to have surgery without any memory of the event and to be completely pain free during the procedure.
Other than general anesthesia, there are regional, epidural/spinal, local anesthesia, and monitored anesthesia care. Choosing the type of anesthesia is a shared process with the anesthesiologist taking into consideration, the parents’ and the patient’s wishes. Ultimately, the anesthesiologist will choose the safest, most comfortable and best option for your child.
A preoperative visit with a nurse practitioner and/or anesthesiologist can occur days or even a week before the scheduled surgery. If your child is very healthy, this visit may be on the day of the surgery. During this visit, we will obtain a medical history, perform a physical exam and will determine if any further testing is needed such as laboratory blood draws, ECG, echocardiogram, chest x-ray, CAT scan or MRI. Your questions can be answered at this time. This will prevent delays in caring for your child on the day of the surgery.
Before anesthesia, there are certain protocols that allow for safe care of your child, including the timing of food/drinks, medications and also preparation of your child to tolerate the experience of undergoing surgery.
We have a guideline which includes the latest time that is okay to eat/drink before surgery to allow for the stomach to be empty. This significantly reduces the risk of having aspiration, which happens when food comes up from the stomach and into the lungs.
We recommend for your child to get certain types of medications on the day of surgery with a small sip of water, (preferably at least 2 hours prior to the time of their surgery). It’s important to continue respiratory medications, such as albuterol on the morning of the surgery. This reduces the risk of an asthma attack during anesthesia. Anti-reflux medications such as prevacid, or pepcid can also be taken prior to surgery. Your child can take their anti-hypertensive medication the night before surgery, but ask your anesthesiologist about taking it on the morning of the procedure, as each situation is different. If your child is on specialized medication, it’s important to speak to your anesthesiologist to find out if you should take it the morning of surgery.
Children of different ages process information differently, especially something as significant as undergoing surgery. It is important to make them aware of what they will be seeing and experiencing. It’s also important for your child to see a cheerful parent, if at all possible, as children will pick up on clues from their parents, which will then make them either calmer or more nervous depending on the mood of the parents. We at Children’s Health have a department of child life that can help you on the day of surgery with your child.
Your child will have received silly juice in the pre-operative area that will help them relax and tolerate separation from you. Once in the operating room, our experienced nurses and OR staff, as well as the anesthesiologist, will work very hard to keep your child calm with use of games and distraction techniques. Using a mask with anesthesia air, your child will fall asleep and then receive an intravenous line (IV) after they are asleep. For older children, and if it is safer for smaller children, an IV may be started in the preoperative area. Once your child is asleep and being monitored closely by your anesthesiologist, surgery starts. Appropriate medications will be administered to make sure your child remains asleep for the duration of the procedure and comfortable when they awaken. The amount of medications is based on your child's weight and other factors which your anesthesiologist will take into consideration to keep your child safely pain-free and asleep.
Our operating rooms are sterile rooms and for your child’s safety, we don’t have parents stay during the surgery. On occasion, we may ask you to accompany your child into the operating room until they fall asleep and then escort you back to the waiting area. We will provide you with a uniform to put on in that situation.
A consent form is a document that lists the type of anesthesia that your child is expected to receive and the potential complications associated with it. The complication list is comprehensive, but it does not mean that the risk of those complications happening is very high. Your anesthesiologist will go over those with you and allow you time to ask questions about them.
A breathing tube is a tube that is placed after your child is asleep that passes through the mouth and into the trachea. We have ultramodern equipment that uses the latest technology, including video laryngoscopes, fiberoptic scopes and laryngeal mask airways (including the Supreme), to secure your child’s airway and prevent damage to the lungs from aspiration.
Modern general anesthesia is very safe. The risk of having a fatal event is in the order of 1:200,000 surgeries. Risk is proportional to the severity of illness and other congenital disorders and the invasiveness of the surgery. A liver transplant surgery in a child with bad heart function is a much higher risk than fixing a broken arm in a healthy child. Regardless of the risks, be assured that your anesthesiologist will do everything possible to keep your child safe and comfortable even during the riskiest of surgeries.
We will administer a premedication (sometimes referred to as silly juice or giggle juice) while they are with you in the preoperative area. This will prevent them from remembering separating from you and also will calm your child.
No. It is extremely rare for someone to remember their surgery or feel pain during surgery. In the very rare situation where your child is having a life saving surgery after a catastrophic accident, it may be impossible to administer anesthesia without harming your child (due to lower blood pressure), but even in those situations, your anesthesiologist will do everything possible to keep your child pain-free.
We base the amount of anesthesia on your child’s age, weight, the amount of pain known to be associated with each surgery and your child’s heart rate, blood pressure, and respiratory rate. This is learned over years of training under close supervision. Your anesthesiologist is an expert in controlling pain and the level of anesthesia for different surgeries and different patient needs.
Most often, it is known based on the surgery if there is expected blood loss. In these situations, we often utilize special tools such as, arterial lines and/or central venous catheters, to very closely monitor your child. We ensure that we are able to administer blood and replace blood loss with well functioning intravenous lines. When blood loss is anticipated, blood that has been matched to your child will be readily available. In cases of unexpected blood loss and emergency situations, blood can quickly be obtained from the blood bank.
An intravenous line is a catheter (plastic straw) that sits in a vein in the hand, foot or arm that allows us to give fluids to your child. An arterial line is a catheter that sits in the artery of the hand or foot that allows us to measure your child’s blood pressure with every beat of the heart and draw special blood tests to help us monitor your child’s condition during a major surgery. In addition to an arterial line, a central line may also be placed for major surgery. A central line is a catheter that sits in one of the large central veins of the body in the neck, chest or groin. All these are placed after your child is asleep and your anesthesiologist will discuss these with you, if they plan to place them.
PCA or patient-controlled analgesia, is a pump that allows us to deliver pain medications through an intravenous line. Most often the patient will have a button to press that will deliver the medication from the pump into their vein through their IV. In smaller children, the parents can be educated to press the button when their child is complaining of pain in the post-operative period.
Once the surgery is finished, we will turn off the anesthesia gas and assure that your child is comfortable and breathing well prior to removing the breathing tube. Your child will not remember the breathing tube coming out and will likely remain drowsy for a while after leaving the operating room, as he or she continues to breathe off the anesthesia gas. In certain severe situations, it may be safer to keep the breathing tube in place and to recover in the intensive care unit. Your anesthesiologist will discuss this with you if they think that this may be a possibility.
If you are here for an outpatient procedure, once your child is fully awake and drinking liquids with stable vital signs, you will be discharged home. We have very experienced nurses in the recovery room (also known as the PACU) who will only discharge your child if it is safe to do so. If your child is here for more major surgery or they are found to need longer monitoring, they may be admitted to the floor or the intensive care unit as needed.
Soon after your child arrives in the recovery room, and as soon as the nurse feels your child is stable, they will call to have you be escorted to your child’s bedside. In certain cases, this may be immediately upon arrival and in other cases, it may take over an hour to stabilize a child who is more sick and needs more medical attention.
We recommend to have your child start with liquids first which will be provided to them by the recovery room nurse. Once they tolerate the clear liquids, breast milk or formula may be attempted. It is generally better to start regular food after arrival to home or to the hospital room if your child is being admitted.
For outpatient procedures, once your child is awake and able to drink liquids with his or her pain under control and vital signs stable, he or she will be discharged home. Your recovery nurse and anesthesia team will determine when discharge is appropriate. Discharge instructions will be provided and questions answered prior to your departure. For more involved procedures or in cases when there are specific health concerns, observation overnight or even admission for several days of recovery may be required prior to discharge.
If there is something that your child is at increased risk for after surgery, you will be informed. It is rare for a child who has met the discharge criteria to have a complication at home that requires return to the hospital. Occasionally, if your child is ill, for instance, with an upper respiratory infection, but the procedure is necessary, your anesthesiologist may tell you to see your pediatrician in case your child becomes sicker and develops a fever postoperatively. This should be a rare situation. Also, if your child refuses to drink prior to leaving the hospital, your anesthesiologist will recommend to you to come back to the hospital if your child doesn’t drink anything within a certain time frame. This is recommended to avoid possible dehydration of your child due to poor intake of liquids.
You will be given discharge instructions prior to leaving the hospital. Nausea and vomiting are common after anesthesia, but do not become a major issue unless your child is not keeping any food or drink down and he or she is becoming dehydrated. In that rare situation, you should bring your child back to the emergency department.