What to Expect When Your Child Needs Anesthesia

Podcast Transcript

Dr. Richard So:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time.

In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, here's today's host.

Dr. Lynn Woo:

Welcome back to Little Health, the Cleveland Clinic Children's podcast where we talk about common health concerns in kids in a way that's clear, practical, and reassuring for families. I'm Lynn Woo, one of the pediatric urologists at Cleveland Clinic Children's, and most of the time on this podcast we've been focusing on topics specific to pediatric urology. But today, I wanted to step a little outside of that, because when I'm talking to families about upcoming surgery, one of the biggest sources of anxiety isn't actually the surgery itself, it's anesthesia. And parents understandably have lots of questions about is it safe and how their child will be monitored and will their child have pain? What are risks? So we thought it'd be really helpful to have an open, honest conversation about what actually happens during pediatric anesthesia and how we work to keep kids safe throughout the entire surgical process.

And I'm really lucky today to be joined by my friend and colleague, Dr. Pilar Castro. She's a board certified pediatric anesthesiologist at Cleveland Clinic Children's with over 24 years of experience. On a personal note, she's someone I feel incredibly comfortable and confident partnering with in the operating room, because as you'll hear, she's got a very calm, reassuring presence and has wonderful rapport with both kids and their families. Dr. Castro, thank you so much for being here today. Tell me a little bit about yourself.

Dr. Pilar Castro:

Thank you so much, Lynn, for inviting me. I've been looking forward to our conversation. In our group, we're very passionate about how we care for kids and I know that we have an excellent teamworking environ- environment and relationship. Um, I've been at Cleveland Clinic for 24 years. I did all my training here. Uh, one of my passions is education and the other one, of course, is how we deliver care for the kids. Currently, I'm the vice chair of the division and I stopped being a fellowship ground director a couple of years ago, but definitely everything that we do in the operating room and around us is always about educating everyone, including the parents and the children, so I'm glad to be here.

Dr. Lynn Woo:

I love that. So without further delay, let's just dive in. How safe is anesthesia for children?

Dr. Pilar Castro:

Actually, it's quite safe, even though everybody is very stressed out, especially parents and the teenagers, I think most of them <laugh> about the anesthetic. Large studies have shown us that pediatric anesthetics are quite safe and over two million anesthetics have been delivered without finding, like, significant complications. This is especially important in children that are healthy. It's different when we move on, and I know we're gonna be discussing that later to kids that are younger or have other, uh, medical problems, the statistics change. But when we talk about problems with anesthesia itself, we know that in otherwise healthy children, deaths get close to nearly zero.

Dr. Lynn Woo:

So what are some of the specific risks of anesthesia?

Dr. Pilar Castro:

Yeah, so we can divide the risk of anesthesia into things that can be minor to things that can be more complex. So the most common issues that kids can experience after an anesthetic are a potential of, of having a sore throat from the breathing device that we make place. They can also wake up a little bit agitated and confused after the anesthetic. That can happen in one out of 10 children.

Now, there could also be discomfort at the site of the IV site if they have to stay in the hospital afterwards and things like that can happen also in, like, one in 100 patients. As we move on to more uncommon things, we can see breathing problems with happening more frequently than heart problems in children being the most common complications. These include airway temporary closing up, which we call laryngospasm, or when kids especially have a cold, they can develop something called bronchospasm, which is their airways closing and then the oxygen levels can drop really easily.

We know that, so in pediatric anesthesia we prepare for those moments. We've seen though in very, very large studies, especially including Europe, that after 31,000 children that were anesthetized, about 5% had a significant event. We also have a registry here in the United States called the Wake Up Safe Data that shows us that complications under anesthesia are extremely rare in healthy children.

Heart related problems are s - are things that can also happen such as drop in the blood pressure or abnormal heart rhythms. Those tend to be even more rare and are less common than breathing issues. And as I mentioned before, it's more common for children to wake up a little bit agitated that happens in up to 30% of children, especially if they are less than five years old and some children also about 10% or so can exp- experience nausea and vomiting and a little bit of a sore throat after the anesthetic.

Dr. Lynn Woo:

That's really helpful. So I'm hearing from you that there's some minor things that can happen just with, as the results of going to sleep or getting the IVs that are needed, but the overall really scary or serious complications like breathing or heart problems are really, really rare, especially after going through these large databases in both United States and Europe. In talking about some of these more serious risks involving breathing or the heart, what happens if those things happen in the OR- or what do we do if we encounter those unusual complications during a surgery?

Dr. Pilar Castro:

Thanks for that question, Lynn. I think it's really important. First of all, we work, uh, with a dedicated group of pediatric anesthesiologists and also nurse anesthetist and when we're working with our residents, also we're right there monitoring the patients constantly and in a teamwork environment that is highly dedicated to taking care of children. In anesthesiology, we are trained to anticipate and prevent things from happening. That's kind of like part of our DNA. We continuously watch the patients carefully to make sure their vital signs are working well and especially that the kid is getting the correct amount of anesthesia for the type of procedure that they may be coming for.

Most things that quote unquote we can say go wrong during anesthetic can be recognized and treated quickly. I think that's the most important message here. For instance, allergic reactions can be detected and treated and if your child has some form of respiratory or cardiac complication, we're monitoring your child and we will act accordingly. We'll ask for help if necessary. We, we'll call our colleagues, we'll call cardiologists if needed, we call the intensive care specialist to come and give us a hand.

So in summary, the operating room is a dynamic and highly functioning environment where there are systems that are followed in case help is needed. If your child also needs to be observed closely because once in a while, just to give you an example, uh, you and I have experienced this in the operating room. A child comes with a cold and we decide to proceed because it's kind of like an urgent procedure and the child may develop some drops in their oxygen levels but may be able to be extubated and has to be observed overnight on the floor just to make sure that they progress nicely through the night.

Well, we have ways to go ahead, contact the pediatricians, admit the patients, make sure they're follow up. And if in the event something like an allergic reaction or something more serious happens and the kid needs to be admitted to the ICU, we'll collaborate with the ICU team to try to sort out what happened in the operating room and what is the plan of care moving forward.

Dr. Lynn Woo:

I mean, I'm definitely hearing that the key to being safe is sort of anticipating and preventing any problems before we get there. But would you agree, and I try to tell families this, or I've, I've said this to families before that we really don't anticipate any big problems or complications. However, should something unexpected occur, we're in a really great setup with the monitoring and the multiple team members who have full control of your child's airway, so able to control breathing, able to give medications or administer any additional life-saving support right in the moment.

Dr. Pilar Castro:

Yeah, I think that's correct. I think that especially our jobs as anesthesiologists and as part of the anesthesia team as well, is that we want to provide the best possible care for the patients, but our job is also to like make sure our surgeons can operate without having to worry that the patient is being monitored carefully. So even though you are, guys are never anticipating anything, our job is to anticipate the potential issues we may have and we're ready for that.

Just to give you an example, we always have emergency medications. We don't start the case without certain medications in case anything goes wrong. So if an allergic reaction, reaction happens, we have, or hypotension, the blood pressure goes down, we have epinephrine ready. We'll always have something called a bronchodilator in case the kid starts wheezing or having bronchospasm during the surgery ready to go.

Our suction is always ready in case the kid is going to start throwing up upon, coming out from the anesthetic. So all these like safety systems that we put in place are the things that help us make sure that every step of the way, we can control as much as we can.

Dr. Lynn Woo:

I think it's definitely like a reassurance on the surgeon's end to know that we've got this excellent team of anesthesiologists providing that care. And you had talked about it being a team just within your anesthesia group with your nurses and nurse anesthetists and of course, you know, adding in the surgeons, I feel like we're kind of part of this overall bigger team, you know, trying to make sure that the child is completely safe from the time that they enter that OR until the time that they're leaving that OR. Let's go back to kind of, again, the, the safety and risks. Is there a time where anesthesia is safer for kids and is there a magic age at which anesthesia is safer?

Dr. Pilar Castro:

Yeah. So even though there's really not a magic age, there's definitely enough data that shows that younger children, especially infants, which are children less than a year old and neonates are at high risk for complications. The reason being it completely makes sense, which is the fact that their physiology is a little bit more fragile, their bodies are smaller, so it takes more finesse to care for those kids and having an experience anesthesiologist trained in pediatric anesthesia is going to make a significant difference.

So I would say that in general, we really don't anesthetize children less than six months old unless there's a significant reason why the child needs to undergo the surgery. It's going to be something that is urgent or can potentially affect their development so that's when we anesthetize babies less than six months old. Some registries have shown that definitely less than three years old is still like the critical time when the safety mechanisms need to be in place and training makes a difference and having pediatric anesthesiologist trained to care for your child becomes critical.

But the neonates and the babies that are less than six months old are definitely at higher risk for complications. We haven't even touched upon the fact that we also take care of children that have other illnesses that surround their development, you know. It's different to care for a child that also has a congenital heart disease or that can have like asthma that is not well controlled or has some neurologic illness or syndrome that may be affecting their development as well. So the more comorbidities or other illnesses that we have, they higher the risk of that anesthetic and those children are usually care at tertiary care centers and not in their community.

Dr. Lynn Woo:

Right. So I mean, I think that's one of the things that is so important and great about Cleveland Clinic Children's is we are seeing kind of a very wide range of medical problems and I'm hearing that really the experience and qualifications of your anesthesiologist matters, particularly in kids that may not have a totally straightforward health history. It's been really helpful to hear about the age cutoff and I just want to clarify though that even though it's higher risk in babies, your team certainly has a lot of experience in caring for even babies that are a few hours old or a few days old and can safely administer anesthesia for babies that are seriously ill and require more urgent surgical procedures.

Dr. Pilar Castro:

When we train as pediatric anesthesiologists and also our dedicated, uh, nurse anesthetists that work with us, we do care for babies, as you said, that are a few hours old, sometimes they're premature and there may be less than a pound or like a couple of pounds for weight to adolescents that have potentially significant comorbidities. So even though we don't take care of babies that are in the neonatal ICU every day, we do it frequently enough and this is a tertiary care center where the team feels very comfortable caring for the sickest of patients.

Dr. Lynn Woo:

And that's great. Now one of the things that parents will often ask is whether anesthesia is going to affect their child's development and whether the medicines have some bad side effects on the brain or their behavior after surgery. Can you speak to that?

Dr. Pilar Castro:

Yeah, thank you for that question, Lynn. I think that's an important question and it was actually raised, uh, 10 years ago when in 2016, the FDA came up with a warning safety issue with general aesthetics because there were studies done where there were differences involvement after they were exposed to prolonged anesthetics and also to multiple anesthetics. Now the reassuring part though is that based on the best available research, we know that a single short anesthetic is very unlikely to harm a child's brain development. There have been well-designed studies in children, they include at least three of the largest trials. One of them is called the GAS trial, there one is the PANDA, and the other one is the mask. Those trials included pairs of siblings, included also twins, one kid exposed and no signaling not exposed to the anesthetic, as well as children anesthetized with general anesthesia and with something called regional anesthesia. And they did comparisons between the ceilings in different shapes.

The results of these studies were very reassuring and showed that one short anesthetic in a young child appears to be safe for brain development based on the strongest elements available. What we know though is the way we anesthetize kids matter. Maintaining their blood pressure at a good level, maintaining their oxygen levels at a good level, working collaboratively with the surgeon to make sure that surgery is moving swiftly, all of that matters to make sure the outcomes for children are excellent.

The other thing that we know is that, I have to say though, that multiple or very long anesthesia sessions though may be linked to small effects on behavior, attention and motor skills. But it's very hard to tell whether this is caused by the anesthesia itself or by the fact that kids that come multiple procedures are coming from multiple procedures anesthetic may be having an underlying cause, like I would say like a biologic cause that is making them come for these frequent procedures. So causation is very hard to determine.

Dr. Lynn Woo:

I mean, that completely makes sense and I think that I do try to explain that frequently too that as you had mentioned, you know, a single, short, straightforward anesthesia exposure really is very safe. Some of the data does, however, raise awareness about whether there are changes after multiple surgeries or multiple anesthetic exposures, but it's very hard to tease out how much of that is anesthesia-related or related to an, you know, an underlying medical issue that's requiring that child to need so many repeated surgeries or, or anesthetics.

Dr. Pilar Castro:

That's exactly right. I have to say that it's, I think that what you are telling the parents is, is what we do know in anesthesiology and I want to make sure that parents understand that if sur - if a surgery is medically necessary, the benefits of doing the procedure almost always outweigh any theoretical brain development risk. A child should never be denied a needed surgery because of these concerns.

Dr. Lynn Woo:

I think it's really great to hear that. Well, let's jump away from the discussion about risks and safety and let's go into what actually happens on the day of surgery, because I think that's another big question parents have. How will my child be going to sleep and, you know, what is the, the sequence of events that I can expect when I arrive for surgery?

Dr. Pilar Castro:

That's probably my favorite part, you know, because depending on the kid's age, then that things can go in very different ways. Your child is gona be checked in by our nurses if the patient is coming from home. I'm not gonna talk about not eating quite yet because I know we're gonna be potentially discussing this later, but then we're gonna have a nice discussion with the family and with the child depending on where their stage of development about how do they want to go to sleep.

Most children, I would say, that are less than 10 years old, if they're undergoing a general aesthetic, they want to go to sleep with something that is called an inhalation induction. What that means is that unless it's strictly necessary because there are like clear indications from the surgical perspective or because the underlying illness that the kid may have requires us to place an IV, I will say that most children that are less than 10 years old go to sleep with anesthetic air.

Dr. Lynn Woo:

So they can just breathe and go to sleep that way without any kind of pokes or prods or any other painful, scary procedures.

Dr. Pilar Castro:

That's correct. We also have the advantage at many of the children's hospitals like ours of having a dedicated team of child life specialists that will help us kind of like alleviate any fears, distract the patients, play with them, answer questions to make the, the child's experience as easy as possible. They will frequently accompany the child to the operating room and we will find any form of distraction to make things easier for them.

Once the child is asleep and as I explained, most of them go to sleep with the mask and the anesthetic air, they will place an IV. So at that point the child won't, will be completely under the anesthesia and undergoing all the monitors that we place to make sure that their whole body is working appropriately. And then depending on, on the procedure, we may or may not place a breathing device.

Many times we do just to support their breathing and to support their oxygen levels and depending on the surgery, we'll choose the type of breathing device, which probably is beyond the scope of our conversation, but it will be at the discretion of the anesthesiologist to decide what's best for the child from the breathing device perspective.

The entire time the child is going to be monitored with different monitors such as blood pressure that is being cycled at least every five minutes, continuous electrocardiography to look at the heart rhythm, oxygen levels are being monitored the entire time and even the temperature when the procedure is going to be longer than 30 minutes is frequently monitored because especially in little babies, it makes a big difference.

The way the child is breathing is also monitored by measuring the amount of carbon dioxide that is expired from the body and that's called capnography and that allows us also to understand the amount of air that is going into the child and the amount of like that carbon dioxide that is coming out of the child too.

As you can see, there's a lot of science behind it, but once the child is asleep, there's really nothing that, that patient is going to be aware of from the consciousness perspective.

Dr. Lynn Woo:

I'm glad you brought that up, because I think the next natural question is from a, you know, a child asking me or a family asking me, "Is my child gonna feel pain or..." I think some of the older kids will directly ask me, "But am I gonna wake up? Is it possible that I would be awake or that I won't get enough medicine and I'll know what's going on or I'll feel something?"

Dr. Pilar Castro:

I understand parents' concerns. It's completely natural to worry about that, right? Your child's comfort level during surgery. Let me reassure you, no. Children really will not feel any pain during surgery while under general anesthesia. General anesthesia is a specifically designed to ensure the child is completely unconscious and unable to feel pain throughout the entire procedure. And I can tell you a little bit of how that works if you want me to. It's actually quite interesting. It's one of my favorite things.

So how does general anesthesia work? General anesthesia works in three important ways. First, it makes your child completely unconscious, which means they will be in a sleep-like state very different than regular sleep. That's why you cannot wake them up in the middle of the procedure, just like you would wake up from a nap. And the child will have no awareness of what is happening around them, nor will feel, feel any pain.

The anesthetic also will block all pain signals. The medications that we use on the anesthetic gases prevent their brain from receiving any pain messages from the body. And then sometimes also we don't want the child to move, especially if our surgeon is working on very delicate parts of their bodies. So we use something called mass relaxants that are often used so the body stays perfectly still, which helps the surgeon work safely.

Dr. Lynn Woo:

I really appreciate that in the middle of surgery.

Now, you had talked about some of the pain signals. I know that, you know, in working with you and your colleagues, sometimes you'll do some nerve blocks to help our patients during the surgery and then have to control their pain after they've woken up. Can you just briefly discuss what these nerve blocks are?

Dr. Pilar Castro:

Yes, absolutely. So what we will describe is a category called like regional anesthesia. Regional anesthesia is a way to block pain in a specific part of your child's body by placing numbing medicine that we also call a local aesthetic near the nerves that carry pain signals. Think of nerves like telephone wires, that same pain messages to a brain. A nerve block temporally disconnects those wires so the brain never gets the pain message. This is different from general anesthesia, which puts your child completely to sleep. Regional anesthesia only numbs the area where the surgery or procedure is happening.

Now I have to tell you, all children or I will say 99% of children will be under general anesthesia. So we do these extra nerve procedures or regional anesthesia so the requirements of the anesthetic are lower because those pain signals are blocked and also there's extended period of time where that area of the body will be numb after the child wakes up from the general anesthetic.

Dr. Lynn Woo:

I think that's a huge bonus. I feel like the ability for us to even, you know, decrease pain further and then keep those pain signals dulled down even after the anesthesia is over is a really helpful thing for kids coming out of surgery.

Dr. Pilar Castro:

Yeah, no, I, it definitely I think also like serves the purpose of it allows us to use less medications such as opioids like morphine or fentanyl during the anesthetic or even after the anesthetic.

Dr. Lynn Woo:

I mean, I think that's really huge. Yeah. I think trying to minimize exposure to some of those really heavier narcotic type medications is key. And so what about after the wake up? What can I expect? Will my child act differently?

Dr. Pilar Castro:

Well, once their kids wake, can wake up differently, you know, just, and the same thing for adults. Like soon as the child is either extubated or we decide to like bring the patient from the OR to the recovery room, once that patient is in the recovery room, soon enough the parents are called to be there with the child and at the beginning your child may just appear very, very sleepy.

As time passes, they will like regain consciousness and most of the time they wake up fairly in a fairly nice way. But I have to tell you though that especially in younger children, there's something called emergency delirium that can happen. What that is, is kind of like imagine like your brain kind of, like being in, on a limbo type of state. They're not fully awake, but they are not fully under the anesthesia. So the brain is in that process of going, of becoming conscious or consciousness is being regained and the child may appear agitated, they may start thrashing around.

So I like to reassure the parents and tell them that in 20 minutes, half an hour, they'll be back to who they were before they went to sleep. It happens up to 30% of the times, especially preschool children and we know so that it, it's more common for shorter anesthetics for boys as well. And unfortunately when your parents are anxious, it's also more common than when your parents are not anxious. We have a way to treat it. So when we have an IV, first of all, we need to make sure that the child is not having pain and this is what's really happening, that they're in this state of like progressing to being fully conscious, but we have a way to treat it with medications in the recovery room.

First, so they kind of like peacefully wake up and second, they don't hurt themselves and third because it's very disturbing, especially for the parents to see them that way.

So that's like the immediate result of like that could potentially happen. We will make sure that we address pain and we make sure that if the child is old enough to let us know if they're having pain, we have medications that are ready to treat it. We have already given them also medications before we wake them up to prevent nausea and vomiting and that's something that we will frequently assess in the recovery room with the nurses that are very important part of the team, our recovery room nurses that are dedicated to only take care of children.

From the longer term perspective, once in a while, some children can develop some behavioral issues such as sometimes night terrors if they were especially very anxious going into the anesthetic or the procedure, some kids regress and let's say they were already trained to use the potty and now they are start having things like bedwetting and things like that. Those things usually resolve within a couple of weeks, but we know that sometimes that can happen.

Dr. Lynn Woo:

All right and going back, I think we were starting to talk about it, but we, I got right into the operating room. We have some specific instructions for patients that are going to be undergoing planned surgery and anesthesia. And one of the biggest areas I think of anxiety for parents is our rule about not eating or drinking for a set period of time before a child goes under anesthesia. Can you speak just briefly to that rule and why that's important for the safety of the surgery and anesthesia?

Dr. Pilar Castro:

Yeah, absolutely. That is critical to understand why we ask them we don't really want to star them before they come for surgery. It's just a matter of safety. The main reason children must stop eating and drinking before surgery is to keep their stomachs empty so that food or liquid doesn't accidentally go into their lungs while they are asleep under anesthesia because when you're anesthetized, you lose all your like airway reflexes, so your swallowing and your ability to close your breathing pipe so nothing goes in there. So that's why we ask them not to eat after a certain period of time.

When this happens and food or liquid goes into their windpipe and into their lungs, this is what we call aspiration. And while it is rare, it can cause serious breathing problems. Now at the same time, we have become more aware that children also don't do well when they spend many hours without drinking something and we know it's safe to drink up to two hours. Sometimes we even send one hour before surgery as long as it's clear liquids.

Now, there's a little bit of a controversy here between this side of the Atlantic and the other side of the Atlantic. So in Europe, they literalize MPO guidelines to the point that they say that they can drink up to one hour before surgery and this is clear liquids, liquids you can see through such as apple juice, anything you can see through. Uh, here in the United States, the American Society of Anesthesiologist still says two hours for clear liquids, but I think it's important that the parents know that because that way the child will be more comfortable and the experience will be better for them.

Dr. Lynn Woo:

And what might happen then if a child does... Does kind of drink or eat within that very close window to their surgery time.

Dr. Pilar Castro:

Yeah, especially eating becomes problematic and we always ask the parents to, and the child, especially to be extremely honest to us, because if there's food left in the stomach that could, as soon as that child loses their reflexes when we get them off to sleep, like I explained before, that food could potentially come into their lungs and that can cause significant breathing problems and the child may aspirate and may end up in the intensive care unit with a breathing tube for a little while. It is extremely rare, but it can happen.

Dr. Lynn Woo:

Got it. So it sounds like it's very important to kind of follow all of those instructions very carefully. Now, before we are finished, I wanted to ask something that I'm not sure if it's a wives' tale, but it definitely is said a lot. Is it true that red heads need different or more anesthesia?

Dr. Pilar Castro:

Thank you for the question. And you know, for many years, that's one of the things we thought about and there's some data about it because there's like this gene that causes people to have red hair that is also related to pain sensation and all of that. But the idea that red heads need dramatically more anesthesia is nowadays thought to be an oversimplification.

While there are real measurable genetic differences in how people with red hair process pain and respond to certain drugs, particularly the local anesthetics, which are those medications that are the nominal medications like lidocaine. The largest studies of actual surgical patients have not found that anesthesia management needs to be changed based on her color alone.

Now, if a patient with red hair indicates challenges with achieving numbness during treatments or minor procedures with medications such as lidocaine, those nominal medication, scientific evidence definitely supports this experience. So I would say that even though nowadays we think it's not that different, if somebody's telling you, especially when you're using a local anesthetic that let's say a patient at the dentist that they're still having sensation, is definitely true.

Dr. Lynn Woo:

So you definitely try to get to know the family and the history of that patient and then individualize your care plan. But again, you've got all your medicines right within arm's reach if we need it to keep the patient safe.

Dr. Pilar Castro:

Yeah. And you know, now that you're bringing that up, I honestly think that the science is not quite there, but we're all very different. So the amount of anesthesia medications that one person needs may be different than the amount of anesthesia that somebody else needs. And that's a little bit genetically determined we just don't have enough scientific data quite yet, but I envision in 30 or 40 years, people come in with a card with all the like genetic information to tell you what do you metabolize faster, what do you metabolize in a slower way, and depending on that, we'll be able to titrate medications accordingly.

We're not quite there yet, but I know that in our specialty such as like neurology, when they titrate anticonvulsants or like even medications such as anticoagulants and psych - and also psychiatric medications, there's more knowledge these days on who responds better to one thing versus the other.

Dr. Lynn Woo:

Oh, that's very interesting. And I look forward to like the continued individualization of, of healthcare for parents. Before we finish, I just wanted to have some parting advice for families and ask you to let us know is there anything parents can do to specifically make the anesthesia and surgery day as safe as possible for their child?

Dr. Pilar Castro:

That question summarizes everything that we really try to do as physicians and also our nurses in their preoperative environment, but the parents play the most important role in their -

Dr. Lynn Woo:

So they're, they're part of our team too.

Dr. Pilar Castro:

Of course, they are. So I think that one of the most important things is to prepare your child with easy to understand terms if he or she's old enough to realize that he or she's undergoing a procedure and an anesthetic. Honesty is important. You know your child well, you know what information they're able to handle. Children can usually understand things faster than we think. So being honest with them is critical.

Partner with your surgeon, your anesthesia team, and also the child life specialist to define your child's anxiety level and his or her coping mechanisms. Yo know your child best than any of us. Child life isn't, as I explained before, they are an important ally in the care of the children in the appropriative setting. If distraction and other techniques are not enough, we may have to use medicine. So there are things we can do to make the experience better for the kid to help your child before going to the OR decrease his or her anxiety. So pretty much what you just said, partner with your healthcare team is extremely important.

I would also like to emphasize that staying calm really makes a huge difference. As a parent being calm is you are the center of the universe, especially for the younger kids and your child will pick up on your anxiety and may get even more... If they see you crying or they see you worried because they don't know where they are, they don't know who are the people they're with. And if you're looking like you're really not comfortable and at ease with the team, they're going to pick on that up as well. And then the fourth thing I would like to bring up is make sure that you avoid exposing your child to friends or family that may be sick with some sort of respiratory infection, you know? If they have a cold or any type of respiratory infection or even a gastrointestinal infection, avoid contact with those people prior to the procedure.

I know sometimes it's hard to do if you have a child that you take to daycare or they have siblings, but hand washing, wearing masks, being cognizant of that matters. If your child is sick with a cold the morning of surgery, unfortunately that increases the risk of complications under anesthesia and the anesthesiologist will explain to you what those are.

Dr. Lynn Woo:

Dr. Castro, thank you so much for being with us today. I think the biggest takeaway I hope our audience hears is that if your child needs surgery, pediatric anesthesiology is incredibly safe and very carefully managed. And here at Cleveland Clinic Children's, we have an entire team starting with our child life, as you said, and our nursing support and anesthesia and surgery who are all focused on keeping kids safe every step of the way.

So if you have any questions, it's definitely okay to ask. Understanding what's happening is key in reducing your anxiety and as Dr. Castro said, the anxiety in your kids. Our goal is to make big medical moments that could be scary feel less overwhelming and we hope you'll feel a litle bit more at ease if your child should ever need surgery. If you would like to schedule an appointment with pediatric urology or any other specialty at Cleveland Clinic Children's, please call 216.444.KIDS, that's 216.444.5437.

Thank you so much. We'll see you next time.

Dr. Richard So:

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the little health tips coming, subscribe wherever you get your podcasts or visit clevelandclinicchildrens.org/littlehealth.