Anaesthesia

patient going to surgery

Your child’s safety is our primary concern. Our anaesthetists specialise in looking after children with a variety of complex medical problems and bringing them safely through surgery.

We are also skilled in a variety of specialised pain treatments to make children much more comfortable when they awake after surgery. This makes the stress of going through an operation much more bearable for you and your child.

Most people think of paediatric anaesthetists as doctors who put children into a deep sleep to enable them to have their operation.

While this is true, this is only a part of what we do at Sheffield Children’s Hospital.

Our anaesthetists’ involvement in your child’s care extends beyond the operating theatre to other areas including sedation for MRI scans and other diagnostic tests, intensive care and the treatment of difficult long term pain conditions.

Further information

Rees Bear has an anaesthetic (PDF)books
An illustrated story for younger children about having an anaesthetic, which is ideal for reading with a parent or carer. You can also watch a review of the story on YouTube.

Davy the Detective – finding out about anaesthetics (PDF)
A comic strip style resource for older children, showing a boy’s investigations to find the information he needs before an anaesthetic. You can also watch a review of the comic on YouTube.

Activities for children (external website)
A range of downloadable activities featuring Rees Bear and Davy the Detective.

General anaesthesia – a brief guide for young people (PDF)
This succinct leaflet for young people is supplemented by an interactive web guide containing more comprehensive information.

My Daycase Operation (external website and PDF)
A leaflet illustrated with WIDGIT symbols explaining the steps in the journey from arrival at Theatre Admissions Unit to going home again. Flashcards are also included to allow a timeline to be created for individual children. If you feel this approach would be useful for your child, please contact the TAU play specialist on 0114 271 7343 / 0114 271 7393, who will be able to help you prepare your child before coming to hospital and on the day of surgery.

Further information is available from the Association of Paediatric Anaesthetists of Great Britain and Ireland and The Royal College of Anaesthetists.

FAQs

It is important for your child to have an empty stomach before going for surgery, as if there is food or liquid in the stomach during the anaesthetic, it could come up into the back of the throat and damage the lungs.

These are the times for your child to stop eating and drinking before operating lists:

Eating times before operation (under 12 months)

 Solid food
(if weaned)
Formula feedBreast milkClear fluids
Morning list
7.30am admission
Fast from 2.30amPlease feed at 5am then fast until theatrePlease feed at 6am then fast until theatreEncourage drinks until arrival at the Theatre Admissions Unit
Afternoon list
11am-12noon admission
Fast from 7.30amPlease feed at 9.30am then fast until theatrePlease feed at 10.30am then fast until theatreEncourage drinks until arrival at the Theatre Admissions Unit

Eating times before operation (over 12 months)

 Solid food
(if weaned)
Formula feedBreast milkClear fluids
Morning list
7.30am admission
Fast from 2.30amPlease feed at 5am then fast until theatrePlease feed at 6am then fast until theatreEncourage drinks until arrival at the Theatre Admissions Unit
Afternoon list
11am-12noon admission
Fast from 7.30amPlease feed at 9.30am then fast until theatrePlease feed at 10.30am then fast until theatreEncourage drinks until arrival at the Theatre Admissions Unit

For various reasons, we may not be able to confirm the order in which operations need to be done until the day. Therefore, we have to ask everyone on an operating list to arrive at TAU at the same time, and to have followed the fasting instructions above.

Some children may have to wait longer than others without food, but being fasted is for their safety.

All children will be seen by the surgeon and anaesthetist before the operating lists starts and the time they have been fasting will be checked.

Unfortunately, children who have eaten or drunk beyond the times given above will not be able to have their operation on that day and will be sent home to wait for another appointment.

There are procedures we follow to make emergency anaesthesia in children with a full stomach as safe as possible. However, we would not give an anaesthetic for a planned operation in these circumstances.

Your child will recover best from an anaesthetic and operation if they are as well as possible on the day of the surgery. If your child has a new cough or cold (sore throat, runny nose, fever), diarrhoea, vomiting or rash, or if you have needed to give paracetamol or ibuprofen to bring a fever down, then it is generally advisable to postpone the operation until at least 2-3 weeks after they have fully recovered.

If your child is unwell, please ring the Theatre Admissions Unit a day or two before the admission date and ask for advice from one of the nurses on duty. The phone numbers are: 0114 271 7343 or 0114 271 7393.

The nurse may advise you not to bring your child to give them time to get better and will arrange a new appointment for you. On some occasions they may ask you to come as planned, as it may be necessary for the anaesthetist to examine your child on the day of surgery in order to decide whether to go ahead or not.

There are several things that you can do to prepare your child for coming into hospital. Unless your child is very young, you should try and explain:

  • that they are going to the hospital
  • that they will be having an operation or investigation
  • some basic information about what will happen to them while they are in hospital
  • if your child is due to stay in hospital, let them know you will be able to stay too

The best time to provide this information will differ between children. Pre-school children probably only need to know the day before, whereas older children may need more time. Adolescents and young people may already have been involved in the discussions and decision to have surgery, so will need information much earlier.

To assist you in discussions with your child, some booklets about having an anaesthetic have been written specifically for children:

You may wish to look at one together with your child, or allow them to read it and discuss the story with them later.

Children very easily pick up on their parents’ feelings, so one of the most important things you can do to help your child is to try to remain calm and relaxed yourself. Some of the following points may help to reassure both you and your child:

  • an anaesthetic is when a doctor gives you medicine so that you don’t feel, hear or see anything during a test or operation – it’s a bit like a really deep sleep
  • anaesthetics can be started with a tiny tube in your hand or a mask – it might be possible to choose
  • you can usually have cream on your hands to stop the tiny tube from feeling too sore
  • the anaesthetist is a doctor who gives you the anaesthetic and stays with you all the way through the operation to look after you and keep you safe
  • the doctor gives you the anaesthetic for as long as you need it and when they stop the anaesthetic you wake up
  • usually a parent or carer can be there as your anaesthetic is started and will be with you again when you wake up
  • you will be given medicines during the anaesthetic to stop you from feeling sore or sick when you wake up, but you can have more medicine if you need it

It is generally better to use positive language when describing unfamiliar procedures to a child. For instance, the word ‘needle’ may be frightening, but if an intravenous cannula is described as a ‘tiny tube in the back of your hand’ it may be less worrying. Anaesthetic gas may be described as ‘sleepy air’ which smells like felt-tip pens.

If you feel it would be helpful for you and your child to visit the hospital and the Theatre Admissions Unit before the operation day, please contact the TAU play specialist and she will organise a time for you to come and have a look around. You can contact her on 0114 271 7343 or 0114 271 7393.

Your child’s anaesthetist will come to meet you and your child before the operating list begins. They will assess your child and make sure they are fit and well for the operation, and will explain the plan for the anaesthetic to you.

There may be some options for you to consider, but sometimes the anaesthetist has to decide which techniques or medicines would be best for your child. The anaesthetist will also talk to you about pain relief for your child after the operation, and any measures taken to avoid sickness.

You will have the opportunity to ask questions. You might find it useful to write down anything you wish to ask, to help you remember on the day.

Except for very small babies, we encourage one parent or carer to accompany their child to the anaesthetic room. A second parent is welcome to wait outside theatres until the child is anaesthetised.

A nurse or theatre escort will bring you and your child to the anaesthetic room and help to look after you both.

It may be possible for small children to be given their anaesthetic (either by anaesthetic gas or injection) while sitting on your knee. Your child will be lifted gently onto the theatre trolley as soon as they become sleepy. Older children will be comfortable on the trolley before the anaesthetic is started.

After your child becomes anaesthetised, the escort will guide you out of theatres and give you directions to refreshment areas and a pager to tell you when to return to theatre reception to wait for your child to be ready for you in the recovery room.

Some parents may find it upsetting to see their child become anaesthetised, as they become unconscious very rapidly after the anaesthetic is given. If you would rather not be there as the anaesthetic is given, it is possible for you to leave immediately before the anaesthetic starts.

We aim to reunite parents with their children as soon as they are safely awake.

Your child will begin to recover from the anaesthetic in the care of a nurse in the Post-Anaesthetic Care Unit (PACU).

Some children wake up from an anaesthetic very quickly, whereas others take much longer. The nurse will ask you to come and join your child in PACU as soon as they are beginning to open their eyes.

Some children are a little confused or disorientated as they wake up, but this soon improves as the anaesthetic continues to wear off.

Occasionally, however, an episode of greater agitation called ’emergence delirium’ may occur, which is associated with a longer period of disorientation, during which the child may cry and roll around.

We cannot predict if a child is likely to get emergence delirium, but it does seem to be more common in pre-school-age children.

The nurses in PACU are experienced in looking after children with emergence delirium and will be able to decide whether more pain relief will help.

They will also be able to explain to you what is happening and advise you on how best to comfort your child until they settle. Usually this is after about ten minutes, although it may take a little longer.

The anaesthetist will use a combination of medicines and local anaesthetic techniques to ensure your child as pain free as possible when they wake up from the anaesthetic.

We use specialised children’s pain scores to assess your child’s pain at regular intervals after surgery, so that extra medicines can be given when necessary.

The anaesthetist will use an anaesthetic technique to try to avoid post-operative nausea and vomiting. Unfortunately, a small proportion of children are still sick after an anaesthetic. Usually this recovers rapidly, but if it persists, extra medicines can be given to help.

When you take your child home after the operation, you should be given some advice on how best to keep them comfortable.

After day case surgery, you will usually need to give your child regular doses of simple painkillers like paracetamol and ibuprofen for a few days after the operation.

It is much better to give the medicines regularly to maintain a steady level of pain relief, rather than waiting for your child to become uncomfortable and then giving medicines to treat pain.

It is also important to remember that your child may appear pain-free immediately after the operation if a local anaesthetic technique has been used, but that they may become uncomfortable later.

It is important to give the regular medicines before the local anaesthetic wears off.

If your child experiences severe pain in spite of the medicines advised by the hospital, please phone TAU for further advice (call 0114 271 7343 or 0114 271 7393 between 7.30am and 8pm Monday to Friday) or contact your GP.

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