General Anesthesia in Children

General Anesthesia in Children

General anesthesia is the use of medicines to make a person “go to sleep” (unconscious) for a medical procedure. General anesthesia must be used for certain procedures, and is often recommended for procedures that:

• Last a long time.
• Require your child to be still or in an unusual position.
• Are major and can cause blood loss.
• Will cause pain or discomfort.
• Might be scary to experience.
• Affect breathing.

The medicines used for general anesthesia are called general anesthetics. As well as making your child unconscious for a certain amount of time, these medicines:

• Prevent pain.
• Control blood pressure.
• Relax the muscles.

Tell a health care provider about:

• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or family members have had with anesthetic medicines.
• Types of anesthetics your child has had in the past.
• Any surgeries your child has had.
• Any medical conditions your child has, including blood disorders and allergies.
• Any history of:
  • Heart or lung conditions, such as heart failure, sleep apnea, asthma, or Bronchopulmonary dysplasia (BPD).
  • Motion sickness, either in your child’s personal history or family medical history.
  • Depression or anxiety.
  • Tobacco or drug use, if applicable. This includes marijuana and alcohol use.
• Any recent upper respiratory, chest, or ear infections.
• Any problems the mother had during pregnancy.
• Your child’s newborn (neonatal) history, especially if your child was born early (prematurely).
• Any problems your child had during infancy.
• Any loose teeth, braces, bands, or retainers your child has.
• Any noisy breathing or daytime sleepiness.
• Whether your child is pregnant or may be pregnant (if applicable).

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Allergic reaction.
• Lung and heart problems.
• Inhaling food or liquid from the stomach into the lungs (aspiration).
• Nerve injury.
• Air in the bloodstream, which can lead to stroke.
• Extreme agitation or confusion (delirium) when your child wakes up from the anesthetic.
• Waking up during the procedure and being unable to move. This is rare.

These problems are more likely to develop in children who are having a major surgery, or who have an advanced or serious medical condition such as heart or breathing diseases. You can prevent some of these complications by answering all of the health care provider’s questions thoroughly and by following all instructions before your child’s procedure.

General anesthesia can cause side effects, including:

• Nausea or vomiting.
• A sore throat from the breathing tube.
• Hoarseness.
• Wheezing or coughing.
• Shaking chills.
• Tiredness.
• Body aches.
• Anxiety.
• Sleepiness or drowsiness
• Confusion or agitation.

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

Ask your child’s health care provider about:

• Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
• Giving medicines such as ibuprofen. These medicines can thin your child’s blood. Do not give these medicines unless your child’s health care provider tells you to give them.
• Giving over-the-counter medicines, vitamins, herbs, and supplements. Do notgive these during the week before your child’s procedure unless your child’s health care provider approves them.

General instructions

• Ask your child’s health care provider if your child will be going home the same day, the following day, or after a longer hospital stay.
• If your child uses a car seat and you will be driving your child home within 24 hours of the procedure, plan to have another adult sit with your child in the back seat to:
  • Watch your child for breathing problems and nausea.
  • Make sure your child’s head stays up if he or she falls asleep.
• If your child brushes his or her teeth on the morning of the procedure, make sure he or she spits out all of the toothpaste.
• Tell your child’s health care provider if your child becomes ill or develops a cold, cough, or fever.
• If instructed by your child’s health care provider, bring your child’s sleep apnea device along on the day of the surgery (if applicable).

What happens during the procedure?

• Your child may be given a medicine to help him or her relax (sedative). The medicine may be given:
  • By mouth (orally).
  • As an injection.
  • As a nose spray.
  • Through an IV.
• Your child will be given anesthetics through one or both of the following:
  • A mask placed over the nose and mouth.
  • An IV in one of your child’s veins.
• After your child is unconscious, a breathing tube may be inserted down his or her throat to help with breathing. This will be removed before your child wakes up.
• An anesthesia specialist will stay with your child throughout the procedure. He or she will:
  • Keep your child comfortable and safe by continuing to give medicines and adjusting the amount of medicine that your child gets.
  • Monitor your child’s blood pressure, pulse, and oxygen levels to make sure that the anesthetics do not cause any problems.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s blood pressure, temperature, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines have worn off.
• Your child will wake up in the room where the procedure was performed or in a recovery area.
• If your child feels anxious or agitated, he or she may be given medicine to help him or her calm down.
• If your child will be going home the same day, the health care provider may check to make sure that your child can walk, drink, and urinate.
• Your child’s health care provider will treat any pain or side effects before your child goes home.
• If applicable, do not allow your child to drive for 24 hours if he or she was given a sedative.

Summary

• General anesthesia is used during painful or long procedures to keep your child still and comfortable.
• It is important to tell your child’s healthcare provider about your child’s medical history and any surgeries your child has had, and the child’s previous experience with anesthesia.
• Make sure you know when to stop offering food and fluids to your child, and which medicines should be given prior to the procedure. This is important.
• Some common side effects of general anesthesia are nausea, vomiting, tiredness, and a sore throat.

Care After General Anesthesia in Children

This sheet gives you information about how to care for your child after your procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the procedure?

For the first 24 hours after the procedure, your child may have:

• Pain or discomfort at the IV site.
• Nausea.
• Vomiting.
• A sore throat.
• A hoarse voice.
• Trouble sleeping.

Your child may also feel:

• Dizzy.
• Weak or tired.
• Sleepy.
• Irritable.
• Cold.

Young babies may temporarily have trouble nursing or taking a bottle. Older children who are potty-trained may temporarily wet the bed at night.

Follow these instructions at home:

For at least 24 hours after the procedure:

• Observe your child closely until he or she is awake and alert. This is important.
• If your child uses a car seat, have another adult sit with your child in the back seat to:
  • Watch your child for breathing problems and nausea.
  • Make sure your child’s head stays up if he or she falls asleep.
• Have your child rest.
• Supervise any play or activity.
• Help your child with standing, walking, and going to the bathroom.
• Do not let your child:
  • Participate in activities in which he or she could fall or become injured.
  • Drive, if applicable.
  • Use heavy machinery.
  • Take sleeping pills or medicines that cause drowsiness.
  • Take care of younger children.

Eating and drinking

• Resume your child’s diet and feedings as told by your child’s health care provider and as tolerated by your child. In general, it is best to:
  • Start by giving your child only clear liquids.
  • Give your child frequent small meals when he or she starts to feel hungry. Have your child eat foods that are soft and easy to digest (bland), such as toast. Gradually have your child return to his or her regular diet.
  • Breastfeed or bottle-feed your infant or young child. Do this in small amounts. Gradually increase the amount.
• Give your child enough fluid to keep his or her urine pale yellow.
• If your child vomits, rehydrate by giving water or clear juice.

General instructions

• Allow your child to return to normal activities as told by your child’s health care provider. Ask your child’s health care provider what activities are safe for your child.
• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not give your child aspirin because of the association with Reye syndrome.
• If your child has sleep apnea, surgery and certain medicines can increase the risk for breathing problems. If applicable, follow instructions from your child’s health care provider about using a sleep device:
  • Anytime your child is sleeping, including during daytime naps.
  • While taking prescription pain medicines or medicines that make your child drowsy.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has ongoing problems or side effects, such as nausea or vomiting.
• Your child has unexpected pain or soreness.

Get help right away if:

• Your child is not able to drink fluids.
• Your child is not able to pass urine.
• Your child cannot stop vomiting.
• Your child has:
  • Trouble breathing or speaking.
  • Noisy breathing.
  • A fever.
  • Redness or swelling around the IV site.
  • Pain that does not get better with medicine.
  • Blood in the urine or stool, or if he or she vomits blood.
• Your child is a baby or young toddler and you cannot make him or her feel better.
• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.

Summary

• After the procedure, it is common for a child to have nausea or a sore throat. It is also common for a child to feel tired.
• Observe your child closely until he or she is awake and alert. This is important.
• Resume your child’s diet and feedings as told by your child’s health care provider and as tolerated by your child.
• Give your child enough fluid to keep his or her urine pale yellow.
• Allow your child to return to normal activities as told by your child’s health care provider. Ask your child’s health care provider what activities are safe for your child.