Pre-Surgery Guidelines
If your child needs surgery or a diagnostic test which will require anesthesia, preparing for anesthesia usually starts long before the anesthesiologist is involved. Your doctor's office will make all the necessary arrangements for you and will begin an assessment.
Watch the video on the right from Cleveland Clinic Children's on what to expect when a child comes in for surgery.
In some cases, you or your child (if old enough) may be asked to take a preoperative survey called Child Quest. In other cases, your surgical case manager will go over the same questions verbally. It is important that you answer the questions as truthfully as possible. This survey is designed to help us identify potential risks to your child during and after anesthesia. Certain prescription and non-prescription medicines may significantly affect anesthesia and certain symptoms or conditions may also increase risks, or cause delays, if not known in advance.
In most cases, your child will then be scheduled for surgery. In some cases, a pre-anesthesia review and assessment may be scheduled before the surgery to date to assess special situations.
Your doctor's office will also give you a set of instructions on how to prepare for surgery. Chief among these recommendations will be guidelines for your child's medications along with guidelines for eating and drinking in the hours before surgery. It is important to follow these instructions carefully and let the staff know if there was any divergence from the instructions before surgery starts.
The following are the general food guidelines. However, please refer to the specific instructions you were given by your doctor's office as they may differ significantly depending on your child's individual needs. If you have any questions, please call your doctor's office.
In general, the guidelines specify that a patient should not eat solid food for eight hours before surgery and nothing more than a light meal or snack (crackers, soft food, etc.) for six hours before surgery. If the child is being breast fed, he or she should not nurse beyond four hours before surgery. Because children get dehydrated more quickly than adults, the general guidelines allow for clear liquids such as water, apple juice or Gatorade up to two hours before surgery, a rule that differs from the adult guidelines.
It is very important that you follow the guidelines you are given before surgery. Failure to do so may result in a delay of surgery, or if not known by our staff, it could even add significant risk to the surgery or result in discomfort afterward. We understand that, occasionally, children will disobey and eat or drink during the restricted times. However, it is of utmost importance to notify your anesthesiologist —even if it will delay surgery— Failure to mention such behavior could put your child at unnecessary risk. It is also very important to follow whatever guidelines you have been given regarding any medications (prescription or nonprescription) your child may be taking.
Day of Procedure
When you arrive for your scheduled surgery or diagnostic test, a Child Life Expert and an Anesthesiologist or Nurse Anesthetist will meet with both the child and his or her parents. The procedure will be explained to the parents and to the child, depending on the age of the patient. The child may be introduced to the anesthesia mask and other often intimidating equipment in order to provide the patient with a level of comfort regarding the equipment come time for the surgery. The practitioner will also give the child an oral sedative to help keep them calm allowing the process of anesthesia to begin even before the child enters the operating area.
At this time, the staff will also discuss any planned recovery issues and post-surgical pain management with the family and child.
One parent will be allowed to accompany the child into the operating room while the child goes to sleep. The rest of the family may wait in the family lounges until the child enters the recovery room and begins to wake up. A parent will then be called back to the recovery room, ensuring the child will wake up with a familiar, smiling face at his or her side.
How Children and Adults Differ
Pediatric Anesthesiologists provide the same range of anesthesiology services available to adults, but the special needs of younger patients creates significant differences in the mix of services provided. Children receive anesthesia for many tests and procedures that adults would undergo without anesthesia or with only sedation. Because children cannot hold still long enough or would suffer from anxiety, they are often given anesthesia for diagnostic tests such as MRIs, CAT and PET scans and Angiography or procedures such as radiation therapy.
Similarly, many minimally invasive procedures that would be performed under local anesthesia or with pain blocks are performed under full anesthesia with many children both for the child's safety and to prevent emotional trauma. Anesthesia techniques may also be different in these cases. If the child is not too sick or too young, they may be given less anesthesia so they are asleep, but do not require breathing support and can wake up much quicker and with less problems than with the standard anesthesia provided to adults.
Physical differences between children and adults also often require different equipment, different dosages and different techniques. Pediatric Anesthesiologists must be well-versed in all of the different growth stages of children so they can choose the proper equipment, dosages and techniques appropriate for the child's age, development and size.
Surgical and post-surgical monitoring of children also requires special training and expertise. Normal heart rates, blood pressure and other values change as a child grows and are different from adult values. Pediatric anesthesiologists know how to properly interpret children's vital signs to provide optimal care for their age and development level.
Often in cardiac cases, especially congenital heart cases, the differences the anesthesiologist must take into account can be profound and can challenge the practitioner's skills with valve problems, weak hearts and abnormal connections, all of which must be taken into account for safe anesthesia and proper monitoring.
Reducing Anxiety
One of the biggest differences between children and adults facing surgery and anesthesia is the level of fear and anxiety. While an adult may be scared of surgery and anesthesia, young children can be terrified by both the expectation and the experience. Very young children may have limited or no understanding of what is about to happen to them and parents struggle with ways to ease their child's anxiety.
At Cleveland Clinic, our efforts to reduce this fear start long before the operating room. Our Anesthesiologists, Anesthetists and Child Life Specialists take the time to meet with the parents and the child before surgery to assess the anxiety levels and to explain the process and the plans for recovery and pain management. Sometimes the child is allowed to see and touch samples of equipment that will be used in the operating room so it will be less scary. In most cases, the child is given an oral sedative to start the anesthesia process before they enter the operating area so they will be calm and relaxed when they receive full anesthesia.
In general, children are put to sleep by mask rather than IV (as with adults) to ease their fears. While IV lines are used, they are usually put in after the child is asleep as are epidural and pain blocks for post-surgery pain control (as needed).
Parents are an important part of the team and help greatly in reducing their child's fear. One parent can stay with the child until sleep is induced and a parent is allowed to be in the recovery room when the child wakes up.
At Cleveland Clinic, children (and adults) are allowed to wake up at their own pace. We believe the patient is less stressed when they wake up on their own and are not rushed with medications or physical techniques. A pediatric anesthesiologist is always on call for immediate response during the entire recovery process.
Recovery & Going Home
In most cases, the parents will know before surgery whether the child will be spending the night or returning home that evening. This is dependent on how ill the child is, what surgery was performed, the duration of anesthesia, and whether there are any signs of the child being in discomfort or recovering slowly from the surgery or anesthesia. Even if the child is unexpectedly in need of an overnight stay for more observation, it shouldn't be seen as something to worry about. Our staff takes the child's comfort and safety very seriously, and may sometimes request the child stay for additional observation, just to be sure everything is as it should be.
If the child recovered well from the surgery and feels well enough to be returned home, the nurses and the anesthesiologist will give you full instructions on how to care for your child post-anesthesia along with a list of some things to watch out for. In general, it is best to contact your doctor or the clinic immediately if any of the following occur:
- Nausea.
- Unexpected pain.
- Trouble breathing.
- Red rash.
