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Anaesthesia, Pain Relief and Sedation

painbustersWe understand that if your child is coming to Alder Hey for a surgical procedure, you’ll have many questions for our teams. We’ve answered some that we’re asked regularly.

A lot of these answers are also in our great new Painbusters – a guide to pain relief at Alder Hey, a family-friendly way of explaining information about pain and anaesthesia.

What is a general anaesthetic?

It is not the same as ordinary sleep but a form of temporary unconsciousness that is carefully controlled by the anaesthetist. During the procedure, different types of medicines are used to relieve the pain and maintain the right level of unconsciousness.

Who gives general anaesthetics?

An anaesthetic may be given by a consultant or registrar anaesthetist. After qualifying as doctors, consultant anaesthetists have studied for at least seven years in the practice of giving anaesthetics. Registrar anaesthetists are qualified doctors undergoing their seven years of training under the supervision of a consultant.

What do anaesthetists do?

They assess your child’s health before the procedure, making sure that your child is as fit as possible before having an anaesthetic. This requires the anaesthetist to make a balanced judgement based on the need to have the procedure carried out weighed against the risks of the anaesthetic. The anaesthetist remains with your child throughout the anaesthetic keeping a careful eye on things like pulse rate and blood pressure.

What should you tell your child before coming to hospital?

Honesty is the best policy. Try to tell your child about what is going to happen in simple terms they can understand. Use this website to answer their questions and your concerns. Some anaesthetists will refuse to anaesthetise children if they have not been told by their carer why they are in hospital. The worst thing for a nervous child is a nervous carer. If possible try to keep calm, for most children the anaesthetic is safer than the trip in the car to the hospital.

We appreciate that this could be your first time, but you are coming to the right place.Go through the information on the website with your child to help them understand what will happen on the day you come to hospital. Together with the ward nurses and play specialists we aim to make a stressful time as easy as possible.

Starving before an operation — why? And for how long?

Parents and carers often complain that their child is thirsty and hungry on the day of the operation. Although this may seen cruel it is a point of safety that the starving guidelines you have been given are followed. The reason for fasting is that we want to decrease the chance of any food or drink in the child’s stomach entering their lungs while they are being operated on. If you have any doubts about the starving times for your child, please contact the day case ward.

  • Children over one year of age will be starved six hours for food and two hours for clear fluid
  • Children under one year of age will be starved six hours for food, four hours for formula milk, three hours for breast milk and two hours for clear fluid

Clear fluid is water, fruit cordial or squash, NOT fizzy drinks or concentrated fruit juice.

Will my child get an injection?

A cream is applied to the skin over a vein on the hand or the foot (usually applied to two sites). Given at least 30 minutes, this cream numbs the skin, in most cases making any injection painless. A plastic tube called a cannula will be inserted into a vein to allow medicines or fluids to be given. This can be done before or after the child is asleep depending on assessment by the anaesthetist of your child’s condition, and whenever possible your child’s preferences.

How does my child go to sleep?

If the cannula is inserted while your child is awake, some medicine can be given into it which will make your child sleepy over 10 seconds.
Alternatively, the anaesthetist may get your child to breathe in a mixture of gases which will make your child sleepy over 30 seconds to a minute.

What happens when my child is asleep?

The anaesthetist stays with your child for the duration of the procedure, and keeps your child asleep by giving them an anaesthetic gas to breathe. The anaesthetist continually observes and monitors your child, and gives anaesthetic medicines as they are required.

What Pain Relief will my child receive?

This depends on the complexity of the surgery. Where possible all patients are given mild pain relieving drugs such as paracetamol and ibuprofen. We also use local anaesthetic drugs (similar to what a dentist would use to numb your gum) via various methods to improve pain control. It may also be necessary to use strong pain relieving drugs e.g. morphine.

When and where do the children wake up?

Your child will be wakened by the anaesthetist at the end of the procedure and taken into the wake up room / recovery. It usually takes around five minutes for children to waken, but they often remain drowsy for an hour afterwards. This is normal. Your child will be returned to the ward when the recovery nurse is happy that they are safely awake. They can then have a nap, or start drinking if they are allowed and interested.

What is a Local Anaesthetic?

Local anaesthetics are drugs used to temporarily stop pain reaching the brain. Common examples include the injection into your gum a dentist performs to allow a tooth extraction, or an epidural used to control labour pain.

What are the common problems after an anaesthetic?

Pain

It is common for you / your child to feel some for discomfort for the first couple of days after surgery. This can be diminished by giving the prescribed pain medicines regularly, and trying to distract yourself/them with TV or playing.

Poor appetite

Following surgery you may have a sore throat or feel a bit sick, this is common on the first day. Take things easy and drink water, don’t force yourself to eat.

Tiredness

After an anaesthetic it is common to feel tired or a bit dizzy for the first day. You may also be a bit clumsy. For this reason it is important you aren’t too adventurous, lie on the sofa and watch TV. No school and no bikes!

Headache

This is a fairly common side effect of an anaesthetic, ensure you have taken your simple pain relief medicines eg paracetamol and that you have drunk enough water. This should pass after the first day.

When should I phone the hospital or my GP?

  • If your pain is not controlled despite taking the medicines you have been given
  • If you are unable to keep fluids down
  • If the operation site is oozing or inflamed looking.
  • If you have any concerns

 

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