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Anaesthesia

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 and video)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. Rees Bear has an anaesthetic is now available to watch 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 by the Royal College of Anaesthetists is supplemented by an interactive web guide containing more comprehensive information.

Your child’s general anaesthetic (PDF)
This leaflet by the Royal College of Anaesthetists explains what to expect when your child comes into hospital to have an operation or investigation under general anaesthesia.

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)

 Food, milk, formula, sweets, fizzy drinksBreast milkClear fluids
Morning list
7.30am admission
Fast from 2.30amPlease 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 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.

Please view our Risk Infographic on common events and risks in anaesthesia before reading further information below.

This information intends to provide additional information regarding side effects and risks associated with general anaesthesia in children. Please read this information if you have further questions after reading the information sent to you by post.

Common side effects of general anesthesia

These include sore throat, feeling sick or vomiting, feeling dizzy, feeling confused or agitated on waking up, having a headache and suffering pain on waking up. These side effects are common, affecting between 10 and 20 of 100 children.

Are there any serious risks associated with my child’s anaesthetic?

It is rare for serious complications to occur. All of our anaesthetists are experienced at dealing with these complications and the vast majority of children go on to recover fully. This information can be difficult to read and feel frightening or overwhelming. Please try not to worry. To try and put things into perspective please consider that we take risks every day that we don’t worry about too much. An example would be your risk of being involved in a car accident during a 1000-mile trip which is 1 in 366, and a 1 in 240 risk of dying in a car accident over your entire lifetime.

Breathing problems

A general anaesthetic can lead to problems with breathing, affecting the voice box or airways in the lungs. This can cause low oxygen levels, which can be harmful if not corrected quickly. A large study of complications of anaesthesia in children reported 240 episodes of breathing complications for every 10,000 anaesthetics.
Most of these breathing problems can be treated quickly and have no lasting consequences but rarely they can require admission to intensive care or even lead to death or permanent injury.
Breathing problems are more common in children with coughs and colds.

Aspiration of stomach juices

During anaesthesia it is possible for food or liquid in a child’s stomach to come up the food pipe and enter the lungs. This can cause damage to lungs and lead to infection. This is a very rare occurrence. A large study of complications in children reported 9 cases of aspiration per 10,000 anaesthetics.
Children are asked not to eat before general anaesthesia to reduce this risk.

Complications of airway management

When a patient is under general anaesthesia, the anaesthetist is required to make sure the airway is not blocked and that the lungs are ventilated with oxygen. Often a tube is placed into the lungs to facilitate this. Very rarely this can be difficult and in extreme circumstances oxygen levels can drop and lead to harm or even cardiac arrest. Anaesthetists are trained to deal with this complication and very rarely are required to make a small hole in the windpipe at the front of the neck to save a patient’s life.
A big national audit estimated there are about 6 deaths per million general anaesthetics due to complications of airway management.

Heart problems

These are very uncommon in healthy children.
Occasionally general anaesthesia can lead to an unusually slow or unusually fast heart rate or a low blood pressure. This is usually easily treated.

Allergic reaction

Allergic reactions can occur to various substances including medicines, latex or the cleaning solutions used on the skin. They are often mild reactions but can be life threatening. The risk is estimated as 2 to 3 reactions per 100 000 anaesthetics.

Awareness

This is the situation when a patient under anaesthesia has some recollection of events when they were intended to be unconscious. This is extremely rare, and a large audit found 1 to 2 reports of awareness in children per 100,000 anaesthetics. Anaesthetists constantly monitor how much anaesthetic is being given and will be looking for any signs of this.

Medication errors and equipment failure

It is possible to make mistakes when giving medicines. The wrong medicine may be given or the wrong dose of a medicine may be given. It is also possible for a medicine to be given by the wrong route, for instance a local anaesthetic could be given into a vein. The outcome of this can vary from no harm to life threatening. The risk of this happening is 5 errors per 10000 anaesthetics.
During an anaesthetic medicines are given via small plastic tubes called cannulas. It is possible for cannulas to become misplaced and for medicines given through a misplaced cannula to cause injury.
All essential equipment is checked on a daily basis but it is still possible for these to malfunction.

Inadvertent injuries during surgery and anaesthesia

Very rarely it is possible for patients undergoing anaesthesia to suffer significant injuries to eyes (5 in 10,000), lips, tongues or voice boxes (70 in 10, 000) and for teeth to be damaged (1 in 10,000). Nerves can be stretched and damaged during positioning although great care is taken to prevent this from happening. There is a risk of pressure sores especially with longer procedures.

Complications from peripheral nerve block

A nerve block is the injection of local anaesthetic around a nerve to numb the nerve. This is often performed in addition to a general anaesthetic in order to provide pain relief post operatively. The risks of having a nerve block include nerve damage. This can be caused by injury from the needle, a blood clot, infection or the toxic effects of the drug injected. Usually any nerve damage is temporary. The risk of permanent nerve damage is rare and estimated to be between 1 in 2000 and 1 in 5000 nerve blocks.

Death, cardiac arrest and unplanned admission to intensive care

Overall, for every million anaesthetics given, about 10 people die as a result of a complication of the anaesthetic. This includes people of all ages, including the very elderly. Cardiac arrest occurs when the heart stops pumping blood to the body. This is reported as occurring in 3 out of every 10,000 anaesthetics and a study in children found that even after cardiac arrest, most patients recovered without injury.
Children who experience a complication of anaesthesia may be admitted to intensive care for further treatment. The risk of this occurring is 1 in 10,000 anaesthetics.

References

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