Anesthesia for kids — everything parents need to know before surgery

If your dear, sweet, and… child is scheduled to have surgery under general anesthesia, you might be feeling…

"Why, dad? Why?"

And that makes sense. It's stressful. But don't worry — I'm here to answer your questions.

I'm Dr. Elisheva Fiszer, I'm an anesthesiologist, and in the next 5 minutes I'll tell you everything you need to know so you can feel reassured.

Let's gooooo.

## How to prepare a child for anesthesia

First — before anesthesia, the child has to be fasting. The required fasting time depends on what we're talking about.

- 1 hour for water or clear liquids - 3 hours for breast milk - 4 hours for formula - 6 hours for anything else

About chewing gum — there's no problem chewing gum before, as long as they don't swallow it.

By the way, the reason fasting is required before surgery — for both adults and kids — is to prevent stomach contents from rising into the lungs during anesthesia.

You meet the anesthesiologist before surgery, but it might be a few weeks before, the day before, or even the morning of the surgery itself.

The goal of that meeting is to make sure there are no underlying conditions that require special balancing or preparation, and also to get to know you and explain the anesthesia itself.

Part of it is also making sure there's no reason to postpone the surgery — for example, if your child is sick. A little cough, some clear runny nose — that's fine. But if there was a fever over 38.5, if they're congested with green snot, if there were wheezes in the lungs, if they're not behaving or eating normally — basically acting like a textbook sick kid — then the surgery needs to be postponed at least two weeks from the end of the illness. Doing anesthesia during a respiratory illness raises the risk of respiratory complications.

## How the child is put under for surgery

When you arrive at the OR reception, in most cases your child will get a syrup, or sometimes a nasal spray, with a sedative — this isn't the anesthesia yet, but the goal is to relax them so they go into the OR in a nice, mellow state.

Did you ask the anesthesiologist for some of that to take home? Congratulations, you're the 10,000th parent to make that joke. And… no. Forget about it.

Can you go into the OR with them? In many cases yes, one parent is allowed in until the child falls asleep. But the actual decision is made by the anesthesiologist on the spot, and we aim to act in the child's best interest and do what's best for them. And keep in mind: if one of the parents goes in, the calmer one should be the one going in, because a stressed parent stresses out the child. That's not necessarily the parent who most wants to go in.

In small children, the anesthesia itself is almost always done without any painful needle — using a mask with a substance that puts the child to sleep. Only afterward do we insert an IV and continue the anesthesia with a combination of medications.

For older kids — over the age of 9–10, or depending on the child's maturity — we might offer the option of doing the anesthesia through the IV.

From the moment your child starts breathing the anesthetic gas from the mask, it'll take about 1–2 minutes for them to fall asleep. During that time there can be some minor movements, which are completely normal and part of the anesthesia process. If you came in with them, this is the stage where you step out so we can continue caring for them.

In addition to general anesthesia, for certain surgeries we add a form of regional anesthesia to manage the pain from the surgery — of course this is done after they're already asleep and don't feel it.

One type is a caudal block — an injection in the very lower back, right above the tailbone, well below where the spinal cord ends. We inject a one-time substance that gives a few hours of numbing. It anesthetizes the lower abdomen and is well suited for lower-abdominal surgeries like hernia repair, urological surgeries, or leg surgeries.

There's also what's called a "peripheral nerve block" that blocks specific nerves supplying the surgical area.

Sometimes, if it's an extensive and very painful surgery, we'll do an epidural — where we also inject anesthetic into the lower back, but leave a thin catheter to keep delivering the medication after the surgery. You can watch my video on epidurals for more details on that one.

All of these things are of course done after the child is already asleep and doesn't feel the puncture — all so that your child wakes up in as little pain as possible and needs as few IV medications as possible.

Then in the OR: during the surgery the anesthesiologist is in the room the whole time — we don't step out for a second. If we need to take a short break, because it turns out we're human just like you, then another anesthesiologist takes over for that short time — exactly the same for adults and kids.

During the surgery we monitor the child, constantly watching heart rate, blood pressure, oxygen levels, making sure they're breathing well, that they're not in pain, and taking care of them the whole time.

How do we wake them up? At the end of the surgery we stop the anesthesia, and the child wakes up slowly. As they leave the OR they're breathing on their own but usually still a bit sleepy, and from there they go to recovery. When you meet them in recovery, they'll usually look like they're sleeping at night — you don't need to wake them; just wait for them to wake up on their own.

## Are there side effects from anesthesia?

Some children can wake up with something we call emergence delirium — a state where they wake up in a kind of panic, crying. It can be alarming for you, but it's not something to worry about. We'll usually give a slightly calming medication and basically restart them. It has no long-term consequences.

Apart from that, sometimes there's nausea or vomiting after anesthesia, just like with adults.

As with any medical intervention, there are possible risks but they're very, very rare — especially in healthy children. There can be respiratory complications or allergic reactions — but again, very rare, and we also know how to handle the vast majority of these situations. That's why we're there: your child's guardian angels.

**Frequently asked questions:**

**Can anesthesia cause long-term cognitive damage?** If you Google it, you might see various articles claiming anesthesia can cause long-term neurocognitive damage. Here's what you need to know — there was a study that supported the idea that exposure to multiple long anesthetics under the age of two might be linked to mild cognitive impairment. But most of the research in the field was done sub-optimally; a lot of it was done on animals, with doses that don't reflect real anesthesia. The bottom line is there's nothing to worry about with this kind of complication, certainly not for a single relatively short anesthetic.

**Is there a chance my child will remember the surgery? How are you sure they're really asleep?** There are cases of awareness under anesthesia in both adults and children, but they're very rare — around 1 in 1,000. During the anesthesia we use a combination of many different monitors to track the depth of sleep of your child. So the chance of it happening is very low.

That's it. I hope you enjoyed it and that I answered the burning questions about your dear child's anesthesia. You're welcome to write me questions and I'll answer, hit subscribe and like!

Bye for now, and good luck!