The physicians of the Associated Anesthesiologists Medical Group fully appreciate that surgery on one’s child is a stressful event for any parent. Knowing this, we make every attempt to provide anesthetic care to children in the most calm, reassuring and non-threatening way possible. While the child’s safety is certainly our highest priority, we always strive to minimize discomfort and anxiety as well.

In our experience, one of the best ways to minimize parental anxiety is via a preoperative consultation, by telephone, the evening before surgery. We attempt to contact the parents of all pediatric patients during the evening before so that the events of the next morning can be discussed, and any questions answered. It is important that parental anxiety be addressed before the day of surgery, as it may be sensed by the child, with a resultant increase in the child's own level of anxiety. Although the details specific to each child’s surgery will be discussed during the preoperative consultation, what follows below is a general overview of our approach to the anesthetic care of the pediatric patient.

Children must refrain from eating or drinking for a certain period of time prior to surgery. This is done for safety reasons, so as to minimize the chance of pneumonia should a patient vomit just as they are receiving the anesthetic. This problem is fortunately quite rare nowadays, in large part because of these fasting guidelines. Children tolerate these restrictions on eating and drinking better than one might imagine.

Solid food is not allowed anytime on the day of surgery, although certain exceptions may be made for children who will not be having their surgery until late in the afternoon. Clear liquids may be taken up until two to four hours before surgery, depending on the age of the child. Clear liquids include any liquid which is clear enough to see through, such as water, apple juice, Gatorade, water, tea, bullion, popsicles, or jello; the latter two are obviously solid when eaten but melt to clear liquids rapidly in the stomach. Please note that milk is NOT a clear liquid.

Because the separation of a young child from his or her parents can be one of the most distressing aspects of the perioperative experience, many children benefit significantly from oral preoperative sedation with
midazolam. This relatively pleasant-tasting liquid is given by mouth about twenty minutes prior to the start of the anesthetic. Although the midazolam rarely causes children to fall asleep, it does reduce anxiety dramatically, allowing for a much smoother separation from parents. It also tends to cause a wonderful short term amnesia, so that the children often have no recollection of separating from their parents, or even of going to the operating room.

Although the initial anesthetic is usually administered via an intravenous infusion in adult patients, this approach requires starting an IV while the patient is still awake. This technique would be quite unpopular with younger children. Most children prefer to go asleep by breathing gas, a technique known as an inhalation induction. This technique is used for almost all routine surgeries, but cannot safely be employed in certain rare situations, such as emergencies.

An inhalation induction consists of the child breathing a relatively pleasant smelling anesthetic vapor - usually
sevoflurane - via a facemask for approximately 30 to 60 seconds. The child loses consciousness while breathing the gas, and the IV can then be started painlessly. Generally, the child continues to breath the gas throughout the duration of the surgery, either via the facemask or an endotracheal tube, depending on the duration and type of surgery. It is this breathing of the gas which keeps the child anesthetized. At the end of the surgery, the gas is discontinued, and the child begins to awaken.

Prior to awakening, children may be given either analgesics (pain medicines) or anti-emetics (drugs which reduce the likelihood of nausea and vomiting). The type of surgery will determine which of the many possible medications will be used for these purposes.The purpose of these medications is to make the child’s awakening as calm and pleasant as possible. Equally important in this regard is reuniting the child with his or her parents as quickly as possible. We therefore encourage one parent to join their child in the recovery room as soon as the child is awake.

Despite our best attempts, it is important for parents to realize that children, especially those less than five years of age, often are somewhat cranky and irritable following anesthesia and surgery. We do our best to minimize this, but we cannot prevent it in all cases. Similarly, some children will experience postoperative nausea and vomiting despite receiving medications which are intended to prevent it.

We understand that parents need to be assured that the anesthesiologist caring for their child is appropriately qualified to do so. All members of the Associated Anesthesiologists Medical Group are board certified by the American Board of Anesthesiology and have been trained in pediatric anesthesia. Further, be assured that those physicians whose continued expertise does not include the extremes of age are not assigned to these cases.

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