Pediatric Anesthesia

Frequently Asked Questions (FAQ's)

How long will my child have to go without food or drink before their anesthesia?

  • The answer to this is dependent on the child’s age.  All patients need to have absolutely nothing by mouth for the two (2) hours before the procedure.  This means no chewing-gum, no breath mints, no Lifesavers or cough drops, as well as nothing to drink. 
  • Newborns to 6-month olds may have food until six (6) hours before the procedure, formula or breast milk until four (4) hours before the procedure, then clear liquids (such as water, apple juice or Pedialyte) until two (2) hours before the procedure.  Seven-month olds to 12-month olds may have food until eight (8) hours before the procedure, formula or breast milk until six (6) hours before the procedure, then clear liquids (such as water, apple juice or Pedialyte) until two (2) hours before the procedure.  Thirteen-month olds to 17-year olds may have food until eight (8) hours before the procedure, then clear liquids until two (2) hours before the procedure.  Clear liquids include only the following:  water, Pedialyte, apple juice, grape juice, cranberry juice, Kool-aid, Gatorade, pulp-free popsicles.
  • In general, all prescribed medications should be taken.  Their timing may need to be altered to adhere to the “absolutely nothing by mouth for the 2 hours before the procedure” rule.  Specific medication questions should be discussed with the pediatric anesthesiologist prior to the procedure.

 

I understand the need for my child’s stomach to be empty, but why can’t she/he have just a sip of water or chewing gum or a hard candy?

  • We're glad you asked.  This is important to understand.  A safe elective anesthetic requires an empty stomach.  What we eat and drink is only part of what’s in our stomach.  Some of the most damaging stomach contents are the chemicals, especially acid, that the stomach secretes to start the digestion process.  Our bodies are wired so that just having a hard candy, a cough drop, chewing gum, or even having a small amount of clear liquid in your mouth sends a signal from receptors in your mouth to cells in your stomach and tells them to secrete acid because “food” is on the way—even though it really isn’t!  We need two (2) hours of nothing by or in the mouth to maximize the safety of anesthesia.

 

Will you be there the whole time my child is anesthetized? 

  • Yes.  If the anesthesiologist who began your child’s care must step out for a moment, she/he is replaced by another anesthesiologist.

 

Who will make sure my child’s pain is treated?

  • Most children are given pain medications initially while anesthetized. In the PACU (Post-Anesthesia Care Unit, formerly known as the Recovery Room), the nurses have orders for pain medications from the anesthesiologist.  When the child goes to their hospital room or home, their pain medications are ordered by their surgeon.

 

When can I see my child after the operation?

  • For most procedures, we prefer to have parents and child reunite in the PACU immediately after the first set of vital signs are taken and the patient’s condition is stable.  Space and privacy constraints require limiting PACU visitors to 2 adults per patient.  Children (other than the patient) are not allowed in the PACU.

 

I had a lot of vomiting after my anesthetic. Will my child also have as much of a problem?

  • Not necessarily. Post-operative nausea and vomiting depends on the procedure performed, the anesthetics used and the individual patient. Medications to prevent or treat vomiting are commonly given during the procedure before the patient wakes up. More medication is available in the PACU as well.

 

Can my child take a favorite toy to the operating room?

  • Yes.

 

Where/when will I have to separate from my child before they go to the operating room? 

  • At Sutter Memorial, there is a “holding room” inside the electric doors, but down the hall from the operating rooms. This is where you will go through the final check-in procedure and meet your pediatric anesthesiologist in person. From this room your child will go to the operating room with the nurse and/or anesthesiologist. You will be directed to the waiting room.

My child is afraid of separating from me. How will you handle this?

  • We commonly use a pre-medication called midazolam (Versed). This medication is usually given orally. It provides relaxation, relief from anxiety and some amnesia for the child. It has proven very effective in easing parental/child separation.

 

When will I get to talk to you?  When will I meet you in person?

  • Each pediatric anesthesiologist attempts to call the parent(s) of their patients prior to the procedure. This call is usually made the day or evening (or weekend for Monday procedures) before the procedure. These attempts to contact parents are commonly foiled by wrong numbers, disconnected numbers, blocked numbers, cell phones with no message taking ability, etc.
  • There is always (except in true emergencies) time to talk to the pediatric anesthesiologist in person prior to your child’s procedure. Most commonly, you will meet your child’s pediatric anesthesiologist in person in the holding area, prior to separating from your child.

 

Does a parent have to be the one to give permission/sign the consent for the procedure and anesthesia? Does a parent have to be present with the child on the day of the procedure?

  • In most situations, the child’s parent or legal guardian needs to be the person signing the consent form.  This consent process needs to be witnessed.  The parent is not required to be present at the time of the procedure, although this is usually desirable.

 



 

My child is afraid of needles. How will you handle this?

  • For most elective anesthetics in the OR, children under 8 will not need to be exposed to needles while awake. They become anesthetized breathing through a flavored mask.  Their IV and blood samples (if needed) can be obtained after they are anesthetized.
  • Children aged 8 and older are helped through the IV procedure by the use of a local anesthetic cream which numbs the skin, the presence of Child Life workers, skilled IV starting personnel and, occasionally, the use of an oral pre-medication.

Do you use the “numbing cream” before starting an IV or drawing blood? 

  • Yes. These creams are named EMLA and ELA-max. They diminish the sensation from the needle crossing the skin.

How long does the IV need to stay in?  Does every procedure require an IV?

  • The vast majority of procedures require an IV.  The most common exception to this is the placement of ventilating ear tubes. The IV needs to stay in until the PACU nurse assesses the child to be ready for discharge home.  If the patient is being admitted, the IV will stay in place until discontinued by the surgeon.

 

What if my child gets sick the day/night before the procedure?

  • The best course of action is to contact a staff member at 916/481-2525 who will then page the pediatric anesthesiologist and advise him/her to return your call.

 

Must my child take their clothes off/change into a hospital gown before the procedure?

  • Many times this is not necessary. The ACU (Ambulatory Care Unit) personnel will assist in making this determination.

Are there any things I should bring with me for my child? 

  • Yes. Extra diapers, a favorite book, toy or blanket, and an extra change of clothes (in case of incontinence) are commonly very helpful.

 

How soon afterwards can my child eat?

  • This depends on the procedure being performed.  After a non-operative procedure like a CT scan, MRI or hearing test (ABR), your child may eat as soon as they are awake enough to do so.  For other procedures, check with your anesthesiologist and surgeon for the answer to this question.

 

If I have a question for the anesthesiologist after the procedure, how can I find her/him? 

  • The PACU nurses are able to page the doctor for you while the patient is in the PACU.  Later, you can contact a staff member at 916/481-2525 who will then page the pediatric anesthesiologist and advise him/her to return your call.

 

Are you a pediatric anesthesiologist? What does that mean?

  • Yes. There are currently 6 pediatric anesthesiologists practicing at CASE. All 6 of us have completed a fellowship (additional one or more years of medical training after residency) in pediatric anesthesiology. Our anesthesia practice consists solely of pediatrics.

 

Why am I asked to be at the hospital 1 to 2 hours ahead of the scheduled procedure time? 

  • This is the time needed to complete the registration and medical check-in process.  This includes ample time for the oral pre-medication to have its onset and maximal beneficial effect, as well as time for you to ask any last minute questions of your surgeon or pediatric anesthesiologist.

 

Are there any particular things I should tell you about?

  • Yes. Of particular interest to any anesthesiologist is any family history (family member related to the patient by bloodlines) of malignant hyperthermia, muscular dystrophy, bleeding disorder (especially hemophilia or Von Willebrand’s disease) or other anesthesia-related problems.  Besides family history, any prior history the child has had with a difficult airway or intubation is critical information. Latex allergy or avoidance is also vital to know about ahead of time.

 

Are there any things I should watch for after an anesthetic?

  • The most common side effects of having had a general anesthetic are a sore throat, nausea and vomiting. Children need to be recovered enough to safely ride in their car seat. This includes foremost their ability to maintain their airway. Children will not be discharged from the PACU until they meet the discharge criteria for this area. Your PACU nurse will review post-anesthesia and post-procedure care for your child with you prior to discharge.
  • Once home or admitted to the hospital, persistent vomiting and/or fever are issues that your surgeon or anesthesiologist needs to hear about. A pediatric anesthesiologist is always available via the CASE answering service, 916/481-2525.  A staff member will page the pediatric anesthesiologist and advise him/her to return your call.

 

Should I give my child their medications the night before/morning of their procedure? What if the medication instructions say not to give on an empty stomach?

  • In general, all prescribed medications should be taken. Their timing may need to be altered to adhere to the “absolutely nothing by mouth for the 2 hours before the procedure” rule.  Specific medication questions should be discussed with the pediatric anesthesiologist prior to the procedure. If the child’s surgeon has asked you to stop certain medications ahead of the procedure, please do so.
     
  • If your child uses nebulized medications for reactive airways or asthma, please do give them a treatment prior to their procedure.

 

My child just had an anesthetic a day/week/month ago.  Is it safe to have another anesthetic again so soon?

  • Yes, to the best of our knowledge. We have children whose illness requires them to have anesthesia daily for radiation treatments for weeks at a time. We commonly provide anesthesia weekly for children with new leukemia diagnoses.
  • Our hope is that your child will never need our services. Our commitment is that we will provide the best care available if your child does need our services.