"For many adults needing surgical intervention, surgery is anxiety-provoking. Whether or not you are anxious about having surgery, almost everyone is anxious about having anesthesia. So, the idea of having your child under anesthesia is understandably stressful to most parents. There are a few things that I have told my friends prior to their child having anesthesia for these common procedures that they found helpful in decreasing their stress. Hopefully, this information can help decrease your own stress and better prepare you for what will happen.
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Editor’s Note: This article is written from the perspective of a medical provider and does not encompass all possible scenarios and outcomes. All providers have their own methods, and you should always ask your own doctor or anesthesia provider for specific information on how medical procedures and anesthesia will be approached for your child’s surgery.
Before Surgery
Before any surgical procedure, whether you are an adult or child, an anesthesia provider will do a preoperative evaluation interview. Since most children are unaware of their own medical conditions, most of the interview is between the provider and the parents or legal guardians. If the child is a little older and can answer some questions, I always try to engage them during this time. It’s pretty easy to tell within seconds of meeting children how they are going to respond to medical professionals and to being taken back into the surgical suite.
A sample preoperative interview consists of:
- Medical history (asthma, sleep apnea, heart murmur or defects, prematurity, diabetes, etc.)
- Allergies
- Previous anesthetics/reactions/family history of malignant hyperthermia
- Airway exam (loose teeth are important to point out)
- The last time the child ate or drank anything
- Recent or current fevers, coughs, colds, or infections
I cannot stress enough the importance of following the “NPO Guidelines” for withholding food, milk, or any liquid from your child prior to surgery, as per your doctor’s instructions. Of course, I understand and empathize with the idea that withholding food or a bottle from your child seems like torture for both the parent and the child. (For this reason, most pediatric ENT cases are scheduled first thing in the morning. However, it is crucial to follow these guidelines. This goes for any adults about to have surgery as well). It’s for the health and safety of your own child that these restrictions are in place, so being very strict about the timeframe is important.
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The reason for this is that children (and adults) that have food or non-clear liquid in their stomach during anesthesia significantly increase their risk of complications. The risk of aspirating the remaining food or liquid into the lungs is high and can cause significant damage. So, please do not lie to the anesthesia provider when asked about the last time your child ate or drank anything. And, please, always confirm with your own providers what they would like your child to do for preoperative fasting prior to surgery, and write it down. It’s that important!
Another part of the preoperative interview that is important to be honest about is whether or not your child has recently had or currently has a cold, infection, or a fever. Again, this is another scenario that puts your child at an increased risk for complications during anesthesia and after surgery. As inconvenient as it is to cancel and reschedule a surgery (we know people take off work and rearrange schedules), it’s far more dangerous to be under anesthesia with an active respiratory infection.
Besides the preoperative interview, something we evaluate is whether or not the child may benefit from a mild sedative prior to going into the OR suite. Some places give most children a sedative and others only on occasions when the child is visibly anxious or unable to separate from parents or cooperate with the staff. One of two reactions usually happens when children get preoperative sedatives: they either get goofy and slap-happy or they get sleepy and relaxed. Sometimes both! Either way, for the children that need some help going back to the OR suite, this usually makes the separation a little easier.
During Surgery
When it is time for surgery, the nurse and/or anesthesia provider will take your child back to the OR suite. If your child is young enough, we usually carry him or her back. We sing songs, play music, ask distracting questions about things they like to do or learn. Everyone taking care of children in the OR is not only functioning at the highest level of vigilance but with the utmost empathy for these kids during this time. We know these sorts of situations can be very scary for young children.
Both ear tubes, tonsils, and adenoids surgery is done under general anesthesia. We know that as calm as a child is prior to surgery, once they get in the room, they may be very anxious. Nurses and anesthesia providers work expediently to put on monitors and put the child to sleep. For ear tubes, most cases are done with anesthesia delivered through a mask for the duration of the procedure. For tonsils and adenoids, a breathing tube is placed once the child is asleep. Any time a breathing device is placed in the mouth, there is always a risk of damage to lips, gums, teeth, or tongue. It is rare, but it happens. That is why we ask about loose or chipped teeth prior to surgery.
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During surgery, every provider approaches certain aspects of pediatric anesthesia differently, but the one thing that is constant among all providers is the vigilance for your child’s safety under anesthesia. Our machines and monitors are looking at the child’s every breath, heartbeat, blood pressure, and oxygen level continuously throughout the case and during wake up. The entire surgical team is there caring for your child from beginning to end. Even after the surgery, the ENT surgeon stays in the room until the child is safely awake and ready to be brought to the recovery room. You are trusting us with your child, and that trust is taken very seriously.
The entire surgical team is there caring for your child from beginning to end … You are trusting us with your child, and that trust is taken very seriously.
After Surgery
Both tonsils and ear tube surgeries are relatively quick. After surgery, your child is brought to the recovery room. They are either carried or brought in a bed or crib. The recovery nurse and the anesthesia provider make sure your child is stable before bringing parents or guardians back to recovery. At my hospital, as soon as the child looks stable, the parents are called to the recovery room for snuggles and comfort.
After surgery, your child may be crying – like really crying, thrashing around, and seemingly inconsolable. Not all children wake up this way, but if yours does, it is totally normal. Most children wake up still a little foggy and disoriented, but not in much pain. They wake up surrounded by people they don’t know and in a strange place with lots of unfamiliar noises, so any sort of emotional outburst is understandable.
After a little time and some great snuggles, typically your child will get to go home. Some children may still be upset at this point, but most will take a crashing car nap on the way home. Be aware that their sleep patterns can change for up to a few days after surgery. Also, they may seem like they are awake but may be more likely to bump into things. Be extra cautious around stairs the first day or longer if they are taking liquid codeine. The child can throw up one time at home, and it doesn’t mean anything. He or she can still eat if hungry.
Always ask questions if you have any concerns or are uncertain about pre or post-operative instructions. It is always better to ask than to assume. Make sure you follow all instructions given to you about your child’s pre-operative fasting guidelines. And remember: the best thing you can do to help your child through surgery is to reassure them they are in good hands, and of course, give them plenty of snuggles.
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