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It is important for your child to have an empty stomach before going for surgery, as if there is food or liquid in the stomach during the anaesthetic, it could come up into the back of the throat and damage the lungs.
These are the times for your child to stop eating and drinking before operating lists:
|Formula feed||Breast milk||Clear fluids|
|Fast from 2.30am||Please feed at 5am then fast until theatre||Please feed at 6am then fast until theatre||Encourage drinks until arrival at the Theatre Admissions Unit|
11am to 12noon admission
|Fast from 7.30am||Please feed at 9.30am then fast until theatre||Please feed at 10.30am then fast until theatre||Encourage drinks until arrival at the Theatre Admissions Unit|
|Food, milk, formula, sweets, fizzy drinks||Breast milk||Clear fluids|
|Fast from 2.30am||Please feed at 6am then fast until theatre||Encourage drinks until arrival at the Theatre Admissions Unit|
11am to 12noon admission
|Fast from 7.30am||Please feed at 10.30am then fast until theatre||Encourage drinks until arrival at the Theatre Admissions Unit|
For various reasons, we may not be able to confirm the order in which operations need to be done until the day. Therefore, we have to ask everyone on an operating list to arrive at TAU at the same time, and to have followed the fasting instructions above.
Some children may have to wait longer than others without food, but being fasted is for their safety.
All children will be seen by the surgeon and anaesthetist before the operating lists starts and the time they have been fasting will be checked.
Unfortunately, children who have eaten or drunk beyond the times given above will not be able to have their operation on that day and will be sent home to wait for another appointment.
There are procedures we follow to make emergency anaesthesia in children with a full stomach as safe as possible. However, we would not give an anaesthetic for a planned operation in these circumstances.
Your child will recover best from an anaesthetic and operation if they are as well as possible on the day of the surgery. If your child has a new cough or cold (sore throat, runny nose, fever), diarrhoea, vomiting or rash, or if you have needed to give paracetamol or ibuprofen to bring a fever down, then it is generally advisable to postpone the operation until at least 2-3 weeks after they have fully recovered.
If your child is unwell, please ring the Theatre Admissions Unit a day or two before the admission date and ask for advice from one of the nurses on duty. The phone numbers are: 0114 271 7343 or 0114 271 7393.
The nurse may advise you not to bring your child to give them time to get better and will arrange a new appointment for you. On some occasions they may ask you to come as planned, as it may be necessary for the anaesthetist to examine your child on the day of surgery in order to decide whether to go ahead or not.
There are several things that you can do to prepare your child for coming into hospital. Unless your child is very young, you should try and explain:
The best time to provide this information will differ between children. Pre-school children probably only need to know the day before, whereas older children may need more time. Adolescents and young people may already have been involved in the discussions and decision to have surgery, so will need information much earlier.
To assist you in discussions with your child, some booklets about having an anaesthetic have been written specifically for children:
You may wish to look at one together with your child, or allow them to read it and discuss the story with them later.
This information booklet from the Royal College of Anaesthetists (rcoa.ac.uk) contains useful information for parents.
Children very easily pick up on their parents’ feelings, so one of the most important things you can do to help your child is to try to remain calm and relaxed yourself. Some of the following points may help to reassure both you and your child:
It is generally better to use positive language when describing unfamiliar procedures to a child. For instance, the word ‘needle’ may be frightening, but if an intravenous cannula is described as a ‘tiny tube in the back of your hand’ it may be less worrying. Anaesthetic gas may be described as ‘sleepy air’ which smells like felt-tip pens.
If you feel it would be helpful for you and your child to visit the hospital and the Theatre Admissions Unit before the operation day, please contact the TAU play specialist and she will organise a time for you to come and have a look around. You can contact her on 0114 271 7343 or 0114 271 7393.
Your child’s anaesthetist will come to meet you and your child before the operating list begins. They will assess your child and make sure they are fit and well for the operation, and will explain the plan for the anaesthetic to you.
There may be some options for you to consider, but sometimes the anaesthetist has to decide which techniques or medicines would be best for your child. The anaesthetist will also talk to you about pain relief for your child after the operation, and any measures taken to avoid sickness.
You will have the opportunity to ask questions. You might find it useful to write down anything you wish to ask
Except for very small babies, we encourage one parent or carer to accompany their child to the anaesthetic room. A second parent is welcome to wait outside theatres until the child is anaesthetised.
A nurse or theatre escort will bring you and your child to the anaesthetic room and help to look after you both.
It may be possible for small children to be given their anaesthetic (either by anaesthetic gas or injection) while sitting on your knee. Your child will be lifted gently onto the theatre trolley as soon as they become sleepy. Older children will be comfortable on the trolley before the anaesthetic is started.
After your child becomes anaesthetised, the escort will guide you out of theatres and give you directions to refreshment areas and a pager to tell you when to return to theatre reception to wait for your child to be ready for you in the recovery room.
Some parents may find it upsetting to see their child become anaesthetised, as they become unconscious very rapidly after the anaesthetic is given. If you would rather not be there as the anaesthetic is given, it is possible for you to leave immediately before the anaesthetic starts.
Some children are a little confused or disorientated as they wake up, but this soon improves as the anaesthetic continues to wear off.
Occasionally, however, an episode of greater agitation called ’emergence delirium’ may occur, which is associated with a longer period of disorientation, during which the child may cry and roll around.
We cannot predict if a child is likely to get emergence delirium, but it does seem to be more common in pre-school-age children.
The nurses in PACU are experienced in looking after children with emergence delirium and will be able to decide whether more pain relief will help.
They will also be able to explain to you what is happening and advise you on how best to comfort your child until they settle. Usually this is after about ten minutes, although it may take a little longer.
The anaesthetist will use a combination of medicines and local anaesthetic techniques to ensure your child as pain free as possible when they wake up from the anaesthetic.
We use specialised children’s pain scores to assess your child’s pain at regular intervals after surgery, so that extra medicines can be given when necessary.
The anaesthetist will use an anaesthetic technique to try to avoid post-operative nausea and vomiting. Unfortunately, a small proportion of children are still sick after an anaesthetic. Usually this recovers rapidly, but if it persists, extra medicines can be given to help.
When you take your child home after the operation, you should be given some advice on how best to keep them comfortable.
After day case surgery, you will usually need to give your child regular doses of simple painkillers like paracetamol and ibuprofen for a few days after the operation.
It is much better to give the medicines regularly to maintain a steady level of pain relief, rather than waiting for your child to become uncomfortable and then giving medicines to treat pain.
It is also important to remember that your child may appear pain-free immediately after the operation if a local anaesthetic technique has been used, but that they may become uncomfortable later.
It is important to give the regular medicines before the local anaesthetic wears off.
If your child experiences severe pain in spite of the medicines advised by the hospital, please phone TAU for further advice (call 0114 271 7343 or 0114 271 7393 between 7.30am and 8pm Monday to Friday) or contact your GP.
The infographic found from the Royal College of Anaesthetists (rcoa.ac.uk) gives a summary of the important information you should know.
This information intends to provide additional information regarding side effects and risks associated with general anaesthesia in children. Please read this information if you have further questions after reading the information sent to you by post.
These include sore throat, feeling sick or vomiting, feeling dizzy, feeling confused or agitated on waking up, having a headache and suffering pain on waking up. These side effects are common, affecting between 10 and 20 of 100 children.
It is rare for serious complications to occur. All of our anaesthetists are experienced at dealing with these complications and the vast majority of children go on to recover fully. This information can be difficult to read and feel frightening or overwhelming. Please try not to worry. To try and put things into perspective please consider that we take risks every day that we don’t worry about too much. An example would be your risk of being involved in a car accident during a 1000-mile trip which is 1 in 366, and a 1 in 240 risk of dying in a car accident over your entire lifetime.
A general anaesthetic can lead to problems with breathing, affecting the voice box or airways in the lungs. This can cause low oxygen levels, which can be harmful if not corrected quickly. A large study of complications of anaesthesia in children reported 240 episodes of breathing complications for every 10,000 anaesthetics.
Most of these breathing problems can be treated quickly and have no lasting consequences but rarely they can require admission to intensive care or even lead to death or permanent injury.
Breathing problems are more common in children with coughs and colds.
During anaesthesia it is possible for food or liquid in a child’s stomach to come up the food pipe and enter the lungs. This can cause damage to lungs and lead to infection. This is a very rare occurrence. A large study of complications in children reported 9 cases of aspiration per 10,000 anaesthetics.
Children are asked not to eat before general anaesthesia to reduce this risk.
When a patient is under general anaesthesia, the anaesthetist is required to make sure the airway is not blocked and that the lungs are ventilated with oxygen. Often a tube is placed into the lungs to facilitate this. Very rarely this can be difficult and in extreme circumstances oxygen levels can drop and lead to harm or even cardiac arrest. Anaesthetists are trained to deal with this complication and very rarely are required to make a small hole in the windpipe at the front of the neck to save a patient’s life.
A big national audit estimated there are about 6 deaths per million general anaesthetics due to complications of airway management.
These are very uncommon in healthy children.
Occasionally general anaesthesia can lead to an unusually slow or unusually fast heart rate or a low blood pressure. This is usually easily treated.
Allergic reactions can occur to various substances including medicines, latex or the cleaning solutions used on the skin. They are often mild reactions but can be life threatening. The risk is estimated as 2 to 3 reactions per 100 000 anaesthetics.
This is the situation when a patient under anaesthesia has some recollection of events when they were intended to be unconscious. This is extremely rare, and a large audit found 1 to 2 reports of awareness in children per 100,000 anaesthetics. Anaesthetists constantly monitor how much anaesthetic is being given and will be looking for any signs of this.
It is possible to make mistakes when giving medicines. The wrong medicine may be given or the wrong dose of a medicine may be given. It is also possible for a medicine to be given by the wrong route, for instance a local anaesthetic could be given into a vein. The outcome of this can vary from no harm to life threatening. The risk of this happening is 5 errors per 10000 anaesthetics.
During an anaesthetic medicines are given via small plastic tubes called cannulas. It is possible for cannulas to become misplaced and for medicines given through a misplaced cannula to cause injury.
All essential equipment is checked on a daily basis but it is still possible for these to malfunction.
Very rarely it is possible for patients undergoing anaesthesia to suffer significant injuries to eyes (5 in 10,000), lips, tongues or voice boxes (70 in 10, 000) and for teeth to be damaged (1 in 10,000). Nerves can be stretched and damaged during positioning although great care is taken to prevent this from happening. There is a risk of pressure sores especially with longer procedures.
A nerve block is the injection of local anaesthetic around a nerve to numb the nerve. This is often performed in addition to a general anaesthetic in order to provide pain relief post operatively. The risks of having a nerve block include nerve damage. This can be caused by injury from the needle, a blood clot, infection or the toxic effects of the drug injected. Usually any nerve damage is temporary. The risk of permanent nerve damage is rare and estimated to be between 1 in 2000 and 1 in 5000 nerve blocks.
Overall, for every million anaesthetics given, about 10 people die as a result of a complication of the anaesthetic. This includes people of all ages, including the very elderly. Cardiac arrest occurs when the heart stops pumping blood to the body. This is reported as occurring in 3 out of every 10,000 anaesthetics and a study in children found that even after cardiac arrest, most patients recovered without injury.
Children who experience a complication of anaesthesia may be admitted to intensive care for further treatment. The risk of this occurring is 1 in 10,000 anaesthetics.
Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.
Resource Type: Article
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