Every family has natural concerns when their child is about to have surgery or a procedure under anesthesia.  For those of you researching this subject, we talked to Dr. Joel Saltzman, Chief of Anesthesia at Le Bonheur Children’s Hospital. He provides excellent insight and solid expertise. Here’s what he had to say.

While there are risks associated with anesthesia, the odds of something going wrong are low. Even traveling in a car is riskier than undergoing anesthesia. Advances in monitoring and specialized training and experience have greatly reduced the risk to children. Many parents ask, “what can I do to reduce the risks to my child?” 

Ways to Reduce Risk (www.pedsanesthesia.org)
• Sharing all information about your child’s health (including all medications your child is taking, even those that can be obtained without a doctor’s prescription) with the anesthesiologist prior to the procedure.  This will allow the anesthesiologist to make a decision as to which type of anesthesia and drugs are safest for the patient.
• Adhering to the guidelines you are given regarding limiting eating and drinking before the operation.
• Continuing usual medications unless the anesthesiologist or surgeon recommends against it.
• Ensuring that any other chronic illnesses are being optimally treated; some require pre-operative clearance.
• Having an anesthesiologist who is experienced in the care of children.

All of the Le Bonheur and Le Bonheur East staff members have specialty training and experience with pediatric anesthesia and sedation.  The Pediatric Anesthesia team is experienced in caring for patients from extreme prematurity through adolescence, as well as adult transition patients.  The team recognizes that the child is the patient, but the entire family is going through a stressful experience.  We work to address the anxiety of the patient and the family.  You will likely hear members of the team say; “We treat every child like he or she is our own,” and we truly mean it.

Most children require a general anesthetic for their surgery or procedure.  Prior to surgery the patient and family will be interviewed by members of the anesthesia care team.  During the interview, the patient is offered a list of pleasant smells to choose from: bubble gum, strawberry and other child friendly flavors.  The interview is very important to allow the team to deliver individualized care and maximize safety.

On arrival to the operating room, monitors are placed by the anesthesia care team.  Standard monitors include a pulse oximeter to measure oxygen content, an EKG to monitor the heart, and a blood pressure cuff.  Some children go to sleep more calmly with only the pulse oximeter, which looks like a Band-Aid with a light on their finger; the other monitors are placed as soon as they are asleep.

The flavored mask is given to the child, and the anesthetic gas is added as the child goes to sleep.  After the child is asleep, an IV is started, and additional medications are administered based on the patient’s needs and weight.  The patient’s airway is secured with a breathing tube, LMA, or mask.  Additional gases the patient inhales and exhales are monitored throughout the procedure.  Following surgery, medications either wear off or are reversed.  The patient continues to be monitored throughout the wake-up process and is then transported to the recovery room.

In the recovery room, the anesthesia team and the recovery room nurse reapply monitors and reassess the patient.  While airway and vital signs are continuously monitored, post-operative pain management is also addressed.  Some children awaken agitated, and this needs to be distinguished from post-op pain.  The surgeon and anesthesia team provide for post-op pain prior to leaving the operating room; however, some children require additional medication in recovery.  In all cases, patient safety is paramount.  Parents are invited into the recovery room with their child.

 Families can find more information at:
1. www.pedsanesthesia.org
Click on: “Parents and Families.”
2. www.asahq.org/clinical/PediatricAnesthesia.pdf
3. Le Bonheur Children’s Hospital
www.lebonheur.org click on: “services” “clinical specialties” “Anesthesiology”
Department of Anesthesiology
(901) 287-6060