General Anesthesia Questions
- What is Anesthesiology?
- What is a Pediatric Anesthesiologist?
- Where Can I Find A Pediatric Anesthesiologist?
- What Is The Difference Between "anesthetist" and "anesthesiologist?
Preparing For Your Child’s Anesthesia
- How Can I As A Parent Help?
- What Can I Expect Before Surgery?
- Will I Be Charged For The Anesthesia Services?
- Who, Exactly, Provides Anesthesia For My Child?
- What Happens Before Surgery?
- What Sort Of Anesthetic Will My Child Receive?
- Can I Go Back To The Operating Room With My Child?
- Can I Stay With My Child During The Surgery?
- While My Child Is Falling Asleep Or Waking Up, Will S/he Say Anything Odd Or Bad?
- Will My Child Dream While S/he's Under Anesthesia?
- Will My Child Wake Up In The Middle Of The Operation?
- How Long Will It Take To Wake Up?
- Will My Child Be Sick To His/her Stomach Afterwards?
- How Will You Take Care Of Post-operative Pain?
- When Can My Child Eat Again?!
- My Child Has A Cold, Runny Nose, Or Fever. What Should I Do?
- How Safe Is The Anesthesia For My Child?
- Some Medical Words You May Hear
Office-Based Dental Anesthesia
- What is Office-Based Anesthesia?
- How Is Office-based Dental Anesthesia Different From Hospital-based Anesthesia?
- How Safe Is Office-based Anesthesia?
- What Can I Expect With Office-Based Dental Anesthesia?
- Am I Not Overdoing It By Having My Child Undergo Anesthesia For Dental Work?
What is Anesthesiology? This is the practice of medicine allowing surgical procedures to be done painlessly (usually while asleep). It also involves pain relief in patients before, during and after surgery.
Pediatric anesthesiology is the sub-specialty of anesthesia dedicated to the care of infants, children, and teenagers. Pediatric anesthesiologists are experienced in the perioperative medical management of premature newborns to teenagers and providing care during surgical emergencies, correction of birth defects, and other conditions unique to childhood. Pediatric anesthesiologists understand the stress and anxiety in both their patients and their patients' parents that are associated with hospitals and surgery, and are dedicated to providing care that is both expert and caring.
What is a Pediatric Anesthesiologist? The education of today's anesthesiologists has kept pace with their expanding role in offering the highest quality health care available anywhere in the world. After completing medical school training, doctors enter a four-year anesthesiology residency training program. Sub-specialty training (known as a Fellowship) in pediatric anesthesia is then taken for an additional year or more to concentrate on the special skills and knowledge needed for the management of the infant and child. Thus, the pediatric anesthesiologist has the following training: • At least 4 years of medical school • One year of internship and 3 years of residency in anesthesiology • At least 1 year fellowship training in pediatric anesthesiology and/or 3 years training in pediatrics • Certification from the American Board of Anesthesiologists. If your child has an illness, an injury, or a disease that requires surgery, a Pediatric Anesthesiologist has the experience and qualifications to assist in the treatment and to help ensure a successful surgery for your child. Most pediatric surgeons utilize a pediatric anesthesiologist. Many children requiring surgery have very complex medical problems that affect many parts of the body. The pediatric anesthesiologist is best qualified to evaluate these complex problems and plan a safe anesthetic for each child. Through special training and experience, pediatric anesthesiologists provide the safest care for infants and children undergoing anesthesia.
Where Can I Find A Pediatric Anesthesiologist? Pediatric anesthesiologists practice in a variety of medical institutions including children's hospitals, university medical centers, free-standing surgical centers, and large community hospitals. Most pediatric surgeons deliver care to children in the operating room and utilize a pediatric anesthesiologist.
What Is The Difference Between "anesthetist" and "anesthesiologist? An "anesthetist" is a term used to describe a specially trained nurse who is licensed to administer anesthesia under physician supervision (in most states). An "anesthesiologist" is a medical doctor who has completed a Residency in Anesthesia after graduating from Medical School and who usually limits his or her practice to administering anesthesia.
Preparing For Your Child’s Anesthesia
How Can I As A Parent Help? Children tolerate surgery and anesthesia better when they are well prepared. As with all of us, children have natural fears of the unknown. Anything you can do to relieve these anxieties and to inform your child about the coming events in the hospital and the operating room will greatly improve your child’s experience. Your composure as a parent is essential. Nothing calms a child more than a confident parent. Although it is natural for parents to have anxiety when their children are having surgery, it is best not to convey this to your child. Reassure your child that everything done during the hospital stay will be explained beforehand.
What Can I Expect Before Surgery? Your anesthesiologist will attempt to call you the night before surgery. You will be asked questions about your child’s general health. After receiving this information, the anesthesiologist should discuss the planned anesthetic with you. The discussion may include whether or not your child will receive anything for sedation before surgery, how the anesthetic will be initiated and maintained, what to expect after emergence from anesthesia, any potential risks from anesthesia, and other pertinent anesthetic details. The anesthesiologist will also give instructions concerning food and liquid intake. If your child routinely takes any medications, the anesthesiologist will give instructions on if and when to take these medications the night before and/or the morning of surgery. This is the best time for you to ask questions and express concerns about anesthesia to the anesthesiologist. Sometimes minor illnesses, such as sniffles and colds, may cause problems during some types of surgery and anesthesia. For this reason, the anesthesiologist may feel it is best to postpone surgery. Remember, the anesthesiologist always has your child’s safety in mind.
Will I Be Charged For The Anesthesia Services? The anesthesiologist is a consulting physician who evaluates your child before the operation; ensures a safe, individualized anesthetic during the entire surgery and provides pain relief following the operation. Like other medical specialists, the anesthesiologist will charge for professional services, and this fee will be separate from the surgeon’s fee or hospital’s charges. We will be happy to work with you in regards to any outstanding balances not covered by your insurance plan. You may speak to our financial department to set up a payment plan if necessary.
Who, Exactly, Provides Anesthesia For My Child? In many pediatric medical centers anesthesia is delivered by an "anesthesia care team" (ACT). These team members include a pediatric anesthesiologist and either a certified registered nurse anesthetist (CRNA) or anesthesiology resident. CRNAs are advanced practice nurses with graduate level education in anesthesia. Physicians of North Texas Children’s Anesthesia believe that children, parents and surgeons deserve the pediatric anesthesiologist’s undivided attention and therefore provide “one-on-one” physician anesthesia.
What Happens Before Surgery? In many pediatric medical centers anesthesia is delivered by an “anesthesia care team” (ACT). These team members include a pediatric anesthesiologist and either a certified registered nurse anesthetist (CRNA), Anesthesiology Assistant (AA), or anesthesiology resident. CRNAs are advanced practice nurses with graduate level education in anesthesia. Physicians of North Texas Children’s Anesthesia believe that children, parents and surgeons deserve the pediatric anesthesiologist’s undivided attention and therefore provide “one-on-one” physician anesthesia. We do not employ nurse anesthetists or anesthesiology assistants. A physician will be caring for your child the entire time.
What Sort Of Anesthetic Will My Child Receive? In the majority of children, we administer a general anesthetic, which means that your child will be completely asleep for the surgical procedure. This is usually done by having your child breathe anesthetic gases from a mask that fits over the nose and mouth. This procedure is completely painless, and will take a few minutes to fall asleep. In some older teenagers, an IV may be placed in order to receive IV medicine to fall asleep. Both methods (breathing from the mask, or the intravenous medicine) are safe and effective. In the majority of cases, your child will be kept asleep with anesthetic gases, even if they have fallen asleep with a “shot”. If not already in place, an intravenous line (‘iv”) will usually be placed after your child is asleep – they will not feel it. For those younger children that require an IV before they go to sleep, we can often have the nurses put some local anesthetic cream on your child’s skin, which numbs it a little – this, however, usually takes up to an hour or so to work, and so is not always practical. In addition, your anesthesiologist may discuss regional anesthesia with you prior to the surgery. This is the injection of local anesthetic (“numbing”) medication near or around the area to be operated on in your sleeping child to allow them to wake up with minimal pain. This may last for several hours after surgery. Sometimes, where regional anesthesia is not appropriate for your child, your surgeon or anesthesiologist will supplement the intravenous pain medication that your anesthesiologist gives your child with local anesthesia around the surgical site; this is similar to a dentist numbing the teeth prior to dental surgery. This may last for many hours after surgery.
Can I Go Back To The Operating Room With My Child? Every Hospital and Surgicenter has it’s own policy regarding the presence of parents in the operating rooms. Most hospitals do not allow parents to come back to the operating rooms; please enquire when you’re booking for the surgery whether you will be allowed to come back to the operating room, if you so wish. If you are allowed to come back to the Operating Room, you will be allowed to stay only until your child is asleep and then be escorted back to the waiting area.
Can I Stay With My Child During The Surgery? To avoid distraction to the surgeon, anesthesiologist and nursing staff, as well as to reduce the incidence of infection in the Operating Room environment, hospitals and surgicenters do not allow parents to stay in the Operating Room to watch their children’s surgery.
Will My Child Dream While S/he's Under Anesthesia? No, dreams do not occur under general anesthesia. After your child wakes up in the recovery area, they may doze off again and then they can sometimes dream.
Will My Child Wake Up In The Middle Of The Operation? No, this is highly unlikely. The anesthesiologist will stay right with your child at all times, and makes sure that they are fast asleep. Sometimes, people have reported hearing things while anesthetized, but, again, this is highly unlikely. In just about all these very rare cases, no pain has been reported.
How Long Will It Take To Wake Up? When the surgery has finished we will stop the anesthetic medications and allow your child to awaken. This usually takes less than 10 minutes. Your child will then be taken to the recovery room where they will be monitored by a recovery room nurse. At this time the surgeon will come talk to you about the surgery. Usually, once the recovery room nurses have recorded your child’s vital signs and satisfied themselves that your child is stable, you will be allowed to come back and be with them.
Will My Child Be Sick To His/her Stomach Afterwards? When your parents (or even you!) were children and possibly had anesthesia, there were different anesthetic medications available that had a lot of nausea and vomiting associated with them. These days, anesthesia medicines do not cause much nausea and vomiting. However, certain surgeries, such as tonsillectomies and eye surgery have a higher association with this problem, as do most strong pain medicines (narcotics), or even swallowing blood. Because this is such an unpleasant side effect, your anesthesiologist will probably try very hard to give your child medications to try and prevent this problem from occurring.
How Will You Take Care Of Post-operative Pain? There are many ways of taking care of pain. As mentioned above, we often use intravenous medication, regional anesthesia, or a combination of both to take care of acute post-operative pain. If your child remains in the hospital overnight, your anesthesiologist or surgeon may prescribe a PCA (patient-controlled analgesia) pump for several days or offer the option of an epidural block. In an epidural block, a needle is placed between the bones of the lower back into a space called the epidural space. A small catheter is then threaded through the needle into the space and the needle removed. The catheter is then taped in place so it doesn't move. Local anesthetic solution or a combination of local anesthetic mixed with a low dose of narcotics can then be injected through the catheter or a continuous infusion can be maintained for several days. An epidural provides excellent pain relief for hip surgery and major abdominal surgery. Though an epidural in adults is often performed prior to the surgery while the adult is still awake, in children it is done after they are anesthetized because it is difficult for them to lie still while it is being done. After your child is awake and is in the recovery room, the recovery room nurse and the anesthesiologist work together to ensure that the child is as comfortable as possible. For outpatient surgery or by the time you are discharged from the hospital, any pain your child has should be easily treated with simple analgesics that your child can take by mouth such as "Motrin" (ibuprofen), "Tylenol" (acetominophen) or "Tylenol" with codeine or hydrocodone. Children also benefit from simple comfort measures such as cuddling with a parent or having a familiar and loved toy or stuffed animal nearby.
When Can My Child Eat Again?! With very few exceptions (stomach or bowel surgery, for example), your child can eat or drink as soon as they feel like doing so! In fact, some hospitals like to see children at least drink something before discharge from the recovery area. Some babies having mouth surgery (cleft lip or cleft palate surgery) may not be able to nurse for a few days.
My Child Has A Cold, Runny Nose, Or Fever. What Should I Do? If your child is not having a ear, nose or throat surgery, it may mean that the surgery should be rescheduled. If your child has a cold, congestion, cough, fever, or a runny nose please call your surgeon or the medical center.
How Safe Is The Anesthesia For My Child? Anesthesia is very safe today. The anesthetic risks depend on your child's medical history, and we will discuss them with you before your child's surgery. Complications from anesthesia have declined dramatically over the last 25 years. Since 1970, the number of anesthesiologists has more than doubled and, at the same time and at virtually the same rate, patient outcomes have improved. In just the last decade, estimates for the number of deaths attributed to anesthesia have dropped 25-fold from 1 in 10,000 anesthetics to 1 in 250,000 today. Indeed, the risk of a "routine" anesthetic is many times smaller than the risk of being injured while driving a car.
Some Medical Words You May Hear IV – a small tube, about the thickness of a pencil lead, placed into a vein. Typically, a sharp needle makes a hole in the skin and the tube is slid off over the needle. The needle is then thrown away and plastic tubing is attached so that fluids can be given to your child. Medications can also be given to your child in the tubing.
Preop/Holding area – Your child will come here to get dressed for surgery and meet their anesthesiologist. They may receive some medicine to calm them before going to the operating room. Vital Signs – The anesthesia provider will be constantly watching your child's heart rate, heart rhythm, blood pressure, temperature, breathing and oxygen levels. These are the vital signs.
PACU or Recovery Room – Your child will go directly from the operating room to the recovery room, also known as the Post Anesthesia Care Unit or PACU. This area is manned by specially trained staff whose job is to continue the monitoring of your child and administer medications, if necessary, to take care of pain, nausea and other factors associated with anesthesia. After the procedure, the surgeon will usually come and talk with you. Either the surgeon or one of the recovery room staff will bring you to be with your child.
Post-operative or step-down area – After the recovery room, your child will go to the post-operative area to get dressed. Home instructions will be given to you at this point. If your child is scheduled to be admitted to the hospital, you will then be taken to a hospital room.
Office-Based Dental Anesthesia – Aegis Anesthesia
How Is Office-based Dental Anesthesia Different From Hospital-based Anesthesia? In office-based anesthesia, we use slightly different medications to sedate your child. These medications are administered at levels that provide deep sedation not general anesthesia. The monitoring equipment and safety precautions used are exactly the same as hospital-based anesthesia. Typically, we tend to look after healthy patients in a doctor's or dentist's office. We expect all patients to go home within a short time of their surgical procedure.
How Safe Is Office-based Anesthesia? Aegis Anesthesia physicians employ exactly the same monitoring standards and equipment in your doctor's or dentist's office as we would use in a hospital. There is a pediatric anesthesiologist in constant attendance as well as either a Registered Nurse or an Anesthesia Technician. Full resuscitation equipment and medications are immediately available.
What Can I Expect With Office-Based Dental Anesthesia? You will be contacted before the procedure by our staff and a short interview will determine whether your child is a suitable candidate for office-based anesthesia. Closer to the date (usually the night before), your anesthesiologist will attempt to contact you and discuss any questions you might have. Fasting rules for solids and liquids should be observed (see Parent Information page). It would be extremely helpful if you could spray each nostril with oxymetazoline ("Afrin" is one trade name) spray the night before and before leaving the house for your appointment on the day of the procedure. Children on prescribed inhalers should begin treatment 24 hours before the procedure. All regular morning medications should be taken with a sip of water (if required) before leaving the house. Preferably, ibuprofen ("Motrin" or "Advil") should be stopped a week before the procedure. Acetaminophen ("Tylenol") is fine. Your child may wear whatever you or they are comfortable with, but it would be helpful if they wore a loose-fitting short-sleeve top, so that we can get to the upper arm. If your child wears pull-ups when sleeping at night, you might consider them wearing one to the dental office. You will come back to the dental chair with your child. We will administer "laughing gas" (nitrous oxide mixed with oxygen) to your child either with the dental nose mask or our face mask, both of which smell like fruit. The nitrous oxide has good pain-relieving properties so your child should respond less to the intramuscular medications ("shot") we will administer next. It will take about 2 to 3 minutes before your child becomes co-operative enough for us to begin work on him or her. At this point we will escourt you back to the waiting area. If the dental surgery is likely to last more than 20 minutes, we will insert an intravenous line ("iv") through which we will administer more sedative medicine. Once the surgery is over, it will take about 15 to 20 minutes for your child to wake up. His or her behaviour will be very different for the next 4 to 6 hours. We, will, however, let you go home once your child expresses a wish to and obeys a simple command. You may stay as long as you like until you feel comfortable going home. For the rest of the day, we reccommend that your child "take it easy" – nap, watch TV, read quietly.
Am I Not Overdoing It By Having My Child Undergo Anesthesia For Dental Work? Each child responds differently in the dentist's chair. If your child is unable or unwilling to co-operate enough for your dentist to achieve his or her treatment goal, there needs to be a discussion between you and your dentist about how to achieve this. Your dentist will consult with you and us when she or he feels that the only way to work on your child's teeth is with the use of sedation/anesthesia that we can more expertly deliver to her or him.
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