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Paediatric Anaesthetic Information

The peri operative (time around surgery and being admitted to hospital) period of a child’s surgery can be very stressful for the whole family. Your anaesthesiologist recognizes that it poses a number of concerns for both young patients, as well as parents. (She is a mom of 2 children herself and so she understands how difficult it can be to go through this!)

Please read this information carefully as it aims to reassure and better inform you of what can be expected peri operatively, as well as how best to prepare for your child’s Anaesthesia.

History

Please ensure you are available to provide a comprehensive background history of your child or baby regarding the following:

  • Any complications during pregnancy or their delivery, their developmental milestones, vaccinations, any difficulties in feeding or growth, hospital admissions, complications or necessary interventions. Please bring the clinic card from their delivery to the hospital, if you still have it.
  • Family history and sibling’s history of medical conditions, allergies, reactions to Anaesthesia or medications, or traumatic experiences associated with previous surgery/Anaesthesia. Also, if your child or baby is adopted, or a Jehova’s Witness, please inform your anaesthesiologist.
  • Basic medical and surgical history of the child, especially acute or chronic medications, and recent infections. Please inform your Anaesthesiologist if your child is unable to swallow syrups or if you do not want them to receive suppository medication. It is also important to share if your child has previously received codeine or any codeine combination medications, or if your family has an adverse reaction.

History

Please ensure you are available to provide a comprehensive background history of your child or baby regarding the following:

  • Any complications during pregnancy or their delivery, their developmental milestones, vaccinations, any difficulties in feeding or growth, hospital admissions, complications or necessary interventions. Please bring the clinic card from their delivery to the hospital, if you still have it.
  • Family history and sibling’s history of medical conditions, allergies, reactions to Anaesthesia or medications, or traumatic experiences associated with previous surgery/Anaesthesia. Also, if your child or baby is adopted, or a Jehova’s Witness, please inform your anaesthesiologist.
  • Basic medical and surgical history of the child, especially acute or chronic medications, and recent infections. Please inform your Anaesthesiologist if your child is unable to swallow syrups or if you do not want them to receive suppository medication. It is also important to share if your child has previously received codeine or any codeine combination medications, or if your family has an adverse reaction.

Starvation Guidelines

It is very important that your child or baby has an empty stomach at the time of an elective Anaesthetic, as any food or liquids that have been consumed outside of the starvation guidelines below may regurgitate into your child’s mouth and leak into their lungs under anaesthesia. This is a life-threatening complication and so very rigid starvation guidelines need to be followed for your child’s safety:

  • Solid food, fizzy drinks, milk and non-dairy milk – stop taking 6hrs before surgery
  • Formula milk – stop feeding 6hrs before surgery.
  • Breast milk – stop feeding 4hrs before surgery.
  • Clear fluids (with no sediment, milk or fizz), water, Energade/Powerade, clear apple juice – stop drinking 2hrs before surgery.

Please ensure though that your child or baby DOES continue to drink clear fluids UNTIL 2hrs before their surgery as this definitely eases the waiting period and shows health benefits peri operatively. It is not advisable to leave any food or drinks with the child, or within their reach, preoperatively as they are not always able to exercise restraint.

Consent

In children under 12yrs, only a legal guardian or a parent may give consent for elective Anaesthesia or surgery. However, our laws state that children over 12yrs may now consent for themselves, provided they are mature enough to do so. Parental guidance or assent is required in this case, but you are encouraged to discuss the implications of consent with your teenager in the event that they are requested to sign their own consent with you.

In children under 12yrs, only a legal guardian or a parent may give consent for elective Anaesthesia or surgery. However, our laws state that children over 12yrs may now consent for themselves, provided they are mature enough to do so. Parental guidance or assent is required in this case, but you are encouraged to discuss the implications of consent with your teenager in the event that they are requested to sign their own consent with you.

Post Operatively

Your child or baby may be very disorientated and distressed when they wake up. This is referred to, in extreme cases, as emergence delirium and is a known potential side effect of general anaesthesia in children, but not a serious one. If they are crying, it does not necessarily mean that they are experiencing pain, but rather that they are often just in a very unfamiliar environment and not quite awake enough yet to understand or fully process it. Your child will be carefully assessed before they are discharged  to the ward and it will be ensured that they are safe and pain free. Should it be required, additional sedation will be prescribed. Please bring their milk/juice bottle to theatre as, usually, once they are fed and comfortably back with their parents, they settle down quickly. Please also bring a change of clothes for your little one as they do occasionally require it.

Your child or baby may be very disorientated and distressed when they wake up. This is referred to, in extreme cases, as emergence delirium and is a known potential side effect of general anaesthesia in children, but not a serious one. If they are crying, it does not necessarily mean that they are experiencing pain, but rather that they are often just in a very unfamiliar environment and not quite awake enough yet to understand or fully process it. Your child will be carefully assessed before they are discharged  to the ward and it will be ensured that they are safe and pain free. Should it be required, additional sedation will be prescribed. Please bring their milk/juice bottle to theatre as, usually, once they are fed and comfortably back with their parents, they settle down quickly. Please also bring a change of clothes for your little one as they do occasionally require it.

 

The Parent’s Role

You are encouraged to contact your anaesthesiologist prior to the surgery, should you have any further questions or concerns. Children usually take their cue from their parents and so the better informed you are, usually the more comfortable your child will be in an otherwise very foreign environment.

Please bring any of their favourite toys, books or digital media with them on the day of admission. This will keep them busy during what may be a long wait before surgery, as well as help to distract them from the starvation period. Your anaesthesiologist will allow these favourite things to come into the operating room for them to play with whilst they are being put to sleep, wherever possible. The aim is to try to empower them, enable healthy coping mechanisms and help them to feel safe and comfortable on their time in hospital.

A parent, guardian or familiar adult should always accompany your child to theatre for moral support. Please reassure them of this, that they will not be alone, and talk to them about the process if they need to ask questions. Once they are comfortably under Anaesthesia, you will be able to wait in their ward or just outside theatre, where they will then be safely returned to you post operatively.

Post operatively and once you get home, chat again to your child about their experience. It would still have potentially been quite a stressful time for them and just talking it through, and reminding them how brave they were and well they did to cope, is very important in their processing of the event as a more empowering experience.

The entire medical team is dedicated and committed to ensuring that you and your child have the best peri operative journey!

Remember to please contact your anaesthesiologist if you have any questions or concerns!

You are encouraged to contact your anaesthesiologist prior to the surgery, should you have any further questions or concerns. Children usually take their cue from their parents and so the better informed you are, usually the more comfortable your child will be in an otherwise very foreign environment.

Please bring any of their favourite toys, books or digital media with them on the day of admission. This will keep them busy during what may be a long wait before surgery, as well as help to distract them from the starvation period. Your anaesthesiologist will allow these favourite things to come into the operating room for them to play with whilst they are being put to sleep, wherever possible. The aim is to try to empower them, enable healthy coping mechanisms and help them to feel safe and comfortable on their time in hospital.

A parent, guardian or familiar adult should always accompany your child to theatre for moral support. Please reassure them of this, that they will not be alone, and talk to them about the process if they need to ask questions. Once they are comfortably under Anaesthesia, you will be able to wait in their ward or just outside theatre, where they will then be safely returned to you post operatively.

Post operatively and once you get home, chat again to your child about their experience. It would still have potentially been quite a stressful time for them and just talking it through, and reminding them how brave they were and well they did to cope, is very important in their processing of the event as a more empowering experience.

The entire medical team is dedicated and committed to ensuring that you and your child have the best peri operative journey!

Remember to please contact your anaesthesiologist if you have any questions or concerns!

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PHONE Dr Caroline Corbett