• April 26, 2020
  • Dr. Bhavesh Doshi
  • 0

Anesthesia In Children

If your child is going to undergo surgery and anesthesia; hopefully this information will help you understand anesthesia better.

We understand that this is not easy for you. We are here to make it as safe, simple, & pain free as it can be. These are the most common questions that you may be seeking answers for.

What is a pediatric age group?

It ranges from a newborn until 18 years of age.
We take them as neonates, infants, toddlers, preschool, and school-going groups.

What is anesthesia?

Anesthesia is a state in which patients are unconscious and pain-free.

Who is a pediatric anesthesiologist?

Pediatric anesthesiologists are those who are well trained in handling babies and children with their special requirements. They have lots of experience in dealing with small babies as they selectively work with this age group. Other than administering anesthesia, they also take care of, pain relief in the immediate postoperative period.
They are the ones, who love pediatric anesthesia and their little patients.

How do we prepare children for anesthesia?

It depends on the age of the child and the nature of surgery.
Usually, preparation starts right from a preoperative visit. This gives us a chance to understand the child, and at times pick up this extra sensitive who special ire extra special care.
It is imperative for us to make children of the respective age group to understand what they are going through. Age-appropriate information has to be given to them. As it is their body that is going to be operated or a child might not trust us on other similar occasions. For example, a parent might tell the child that he is here only to take a photo or a dressing and would be back home, this child obviously later experiences that this statement was false. He might not then trust his elders.

Preparation  for Paediatric anesthesia is done in the following steps

History – To assess previous illnesses, surgeries, allergies.
Examination – To assess the physical status of the child

Premedication – Fear of separation from parents is seen in children more than 6 months of age. Secondly, most of them have a morbid fear of needles and pricks. Fear of the unknown is also an essential component of their anxiety.

We render these children tranquil with premedication (sedative, anxiolytic) given either orally or intranasally. This makes separation from parents less traumatic. They also take to induction (administration of anesthesia) well. The overall experience is thus pleasant.

How do we give anesthesia?

If the child has intravenous access placed in his hand, then anesthetics medications are given in the same direction, if not, oral drugs are given 30 to 20 minutes before surgery so children calm down and are not distressed by fasting. These drugs can also be given through nose their action is faster although it can irritate, but only for a while.
If the child does not have intravenous access, then local anesthetic cream can also be applied on the hand around 30 minutes prior to a needle puncture so it does not hurt.
Another method is the inhalation of anesthetic gases through a mask.

What is regional anesthesia?

This is a technique where a portion of a patients’ body is made insensate to surgical stimuli by local anesthetic drugs. These are of two types.
Central neuroaxial blockade- In this type, local anesthetic
is injected into spinal or epidural space through a small gauge needle. This is useful for surgeries involving lower limbs, & lower abdominal surgeries.
Peripheral nerve block
-in this type a local anesthetic is injected around a particular nerve or group of nerves. A hand is rendered insensate by depositing local anesthetic around the nerves supplying the brachial plexus and so on.

Is regional anaesthesia safe?

Yes, it essentially safe. it does run a very rare risk of nerve damage. But the advantages definitely outweigh the disadvantages which in any case are rare.

Advantages of regional anesthesia

The effect lasts longer than the duration of surgery, hence the patient gets immediate pain relief after surgery. Decreases the requirement of other medications used for pain relief hence minimizes side effects associated with them. Decreases stress response to surgery.

How do we give pain relief after anesthesias is withdrawn?

We use different modalities for pain relief, they are as follows
Regional anesthesia- Epidural catheters for continuous infusion of local anesthetics or for giving top-ups 2 to 3 times per day, & as when required within a safe dose limit.
oral medications
Intravenous injections
Rectal suppository
Transdermal patches (skin patch) of pain killer drugs.

Why pain relief is essential.

For obvious reason, children and even small babies feel as much pain as an adult, which should be treated. 
Adequate pain relief makes the hospital stay more comfortable
Early mobilization is possible, hence early recovery,& early discharge.
Unrelieved acute pain can lead to chronic pain.
At the same time, we need to keep in mind that zero pain relief is not achieved at all the time but the pain is made comfortably bearable.

What is preoperative fasting? why does a child have to fast before surgery and anesthesia?

Pre-operative Fasting:
When patients receive anesthesia for surgery, they become very relaxed and sleepy. When patients are this sleepy, the muscles of the stomach and throat which normally stop food from coming up into the throat, and then going down into the windpipe or trachea, and then into the lungs, are also relaxed. When patients get food or liquid into their lungs from the stomach, this can cause pneumonia. To minimize the risk of this happening, patients are asked not to eat or drink for a certain length of time before surgery. Anesthesia is therefore much safer.

Type of food or liquid Fasting time before surgery
Fatty or fried food 8 hours
Formula feed, milk 6 hours
Breast milk (infants) 4 hours
Clear liquids 2 hours

Dr. Bhavesh Doshi works with a highly specialized and dedicated team of pediatric anesthetists to take the best care of your young one. Dr. Bhavesh Doshi, a pediatric surgeon in Mumbai performs basic and advanced Paediatric surgery including all thoracoscopy and pediatric urology procedures at: