About your child’s anaesthetic
What is a general anaesthetic?
A general anaesthetic is a form of drug-induced temporary unconsciousness that is carefully administered and controlled by an anaesthetist. This helps to facilitate painful surgeries or even painless procedures that the child is unable to stay still for.
Who gives general anaesthetics?
An anaesthetic may be given by a consultant or specialty trainee anaesthetist. After qualifying as doctors, consultant anaesthetists will have completed their studies in the practice of giving anaesthetics (minimum 7 years). Specialty trainee anaesthetists are qualified doctors who are mid-way through their 7 years of specialist training in anaesthesia; they work under the supervision of a consultant.
What do anaesthetists do?
An anaesthetist will assess your child’s health before his/ her procedure. Pre-operatively, they put plans in place to optimise your child to be as fit for surgery as possible. In complex cases, this often requires the anaesthetist to balance the need and urgency to proceed with an operation/ procedure against the risks of anaesthesia and surgery.
The anaesthetist administers the anaesthetic and remains with your child throughout their operation to maintain safety—they keep a careful eye on your child’s vital signs (e.g., blood oxygen levels, pulse rate, blood pressure, temperature), and will respond quickly to any abnormalities. Anaesthetists are also skilled in pain management; they will ensure that your child receives all the appropriate medications to maximise comfort for when they come round from their anaesthetic.
What should you tell your child before coming to hospital?
Honesty is the best policy. Lying to your child or not telling them that they will be undergoing surgery can severely traumatise them. This can result in irreparable loss of trust in the parents/ carers who have lied to them. Such negative and potentially long-lasting psychological consequences of not being honest with the child means that many anaesthetists will refuse to anaesthetise children who have not been told of the reason that they are in hospital.
Try to explain to your child what will happen in simple terms that they can understand. Use information provided in this FAQ section and from the links provided in the “Useful Resources” section to help answer their questions and your concerns.
We appreciate that this may be the first time you are bringing your child in for an operation, and this can be nerve-racking. However, try and keep calm, especially in front of your child. Children look to their carers for cues on how to respond to unfamiliar surroundings and circumstances. If you are particularly anxious or tearful, they will sense your anxiety and may consequently interpret the hospital environment as threatening—this worsens their own anxiety and quality of their hospital experience. It can also severely reduce their degree of co-operation during their hospital stay.
Fasting before an operation — Why? And for how long?
Fasting is essential for safety. If your child is not appropriately fasted, it is likely that elective operations will be cancelled. Fasting is mandatory because it helps to decrease the probability of any residual food/ drink in the child’s stomach coming up to the back of their throat and entering their lungs while they are under anaesthesia (a process called “pulmonary aspiration”). Pulmonary aspiration can cause lung injury, which can sometimes be severe enough to warrant admission to the Intensive Care Unit.
Under 1 years old
Food: 6 hours
Formula: 4 hours
Breast milk: 3 hours
Clear fluids (sips only): 0 hours
Over 1 year old
Food: 6 hours
Formula: 6 hours
Breast milk: 6 hours
Clear fluids (sips only): 0 hours
Clear fluid is water, fruit cordial or squash, NOT fizzy drinks or concentrated fruit juice.
Boiled sweets are considered food. Fluid thickeners are also treated as food.
However, your child should have their usual medications on the day of their surgery, unless you have been instructed not to do so.
If you have any doubts about the fasting times for your child, please contact the day case ward.
What happens when you arrive in the hospital?
Upon arrival, we will check your child’s temperature, pulse and breathing rate, and measure their oxygen levels and blood pressure. He/ she will also have his/ her height and weight recorded. We will request a urine sample for pregnancy testing in any girl aged 12 years or more. Please ensure that your daughter (if she is 12 or older) does not have a wee on arrival at the hospital without first speaking to a member of nursing staff.
A surgeon will examine your child and obtain/ confirm consent for the procedure.
An anaesthetist will then come and assess your child and discuss their anaesthetic prior to the operation. This is the time to inform the anaesthetist of any previous problems your child may have had under anaesthesia, or any serious adverse events/ reactions that other family members may have experienced whilst under anaesthesia. During this discussion, you may ask any questions and raise any concerns you have about the anaesthetic.
Will my child get an injection?
A numbing cream will be applied to the skin over a vein on the hand or the foot. Given at least 30 minutes, this cream numbs the skin to make most injections painless. Occasionally, a very cold spray is used to numb the skin instead.
After we have allowed the cream some time to work, a plastic tube called a cannula will then be inserted into a vein to allow medicines or fluids to be given. This can be done before or after the child is asleep, at the anaesthetist’s discretion. Whenever possible, we will take yours and your child’s preferences into consideration.
How does my child go to sleep?
Usually, one parent/ carer is allowed to accompany the child into the anaesthetic room. Depending on your child’s preferences and condition, they may be anaesthetised either on the trolley/ bed, or sat on your knee. Occasionally, a child may be taken straight into operating room to be anaesthetised in there (parents will not be allowed into the operating room).
If a cannula is inserted while your child is awake, anaesthetic medication can be given into it which will make your child sleepy within 10 to 20 seconds. Alternatively, the anaesthetist may get your child to breathe in a mixture of anaesthetic gases that can take up to a minute to work.
Once your child is asleep, you will be asked to leave the anaesthetic room with a nurse escort. For the safety of your child, you MUST leave without delay when asked to do so.
What happens when my child is asleep?
The anaesthetist stays with your child for the duration of the procedure and monitors them closely.
Additional lines and tubes may be inserted while your child is anaesthetised.
Anaesthesia is maintained either with anaesthetic gases that your child breathes in and out, or by a continuous infusion of anaesthetic medication into the veins. Blood, fluids, antibiotics, pain relief and anti-sickness medications will also be administered as necessary during the operation.
What pain relief will my child receive?
This depends on the surgery being performed. Where possible, all patients will be given simple pain-relieving medications such as paracetamol and ibuprofen. Sometimes, stronger pain-killers such as morphine may be needed.
We are also able to use local anaesthetic medication via various methods to improve pain control (known as “regional anaesthesia”)—the anaesthetist will discuss this with you in detail if this is deemed to be appropriate.
When and where do the children wake up?
Your child will be woken by the anaesthetist at the end of the procedure and taken into the “recovery area”. It usually takes around 5-10 minutes for children to rouse from their anaesthetic (although this can be longer). Once the recovery nurse is satisfied that your child is sufficiently awake, safe, stable and comfortable, your child will then be returned to the ward. It is quite normal for children to remain drowsy for an hour or so after their general anaesthetic, so they can continue to sleep once they get back to the ward. Alternatively, if they are quite alert post-op, they may start to eat/ drink if they are allowed and are interested.
What are the common problems after an anaesthetic?
Pain
It is common for your child to feel some discomfort from the site of surgery for the first few days post-op. They may also complain of a sore throat. This can be controlled by giving the prescribed pain-relieving medications regularly.
Poor appetite
Nausea and vomiting are known side effects of a general anaesthetic. Anti-sickness medications may be prescribed to control this. Encourage your child to take things easy and drink water. They do not need to be forced to eat.
Tiredness
After an anaesthetic, it is common to feel tired or a bit dizzy and clumsy for the first day. Take time to rest. No school and no bikes!
Headache
This is a fairly common side effect of an anaesthetic, relieved by simple pain-killers e.g. paracetamol and adequate hydration. This should pass after the first day.
When should I phone the hospital or my GP?
- If pain is poorly controlled despite taking the pain-killers that have been given.
- If your child is unable to keep fluids down.
- If the operation site is oozing or looks inflamed.
- If you have any concerns as parent/ carer.