ASK THE EXPERT: Dr. Zayas Answers Your Questions About Pediatric Anesthesiology
Q1. How does pediatric anesthesiology differ from anesthesia for adults? Is there one type that’s used more commonly in children?
A pediatric anesthesiologist is an anesthesiologist (an M.D.) with specialized training in administering anesthesia to children. Many of the same anesthetic techniques, drugs and gases used to provide anesthesia for adults are also used in children. However, the process of putting a child to sleep is usually different. Adults have an intravenous placed before administration of anesthesia whereas young children are usually put to sleep by letting them breathe gases via a mask and placing the intravenous after they are asleep. The most common type of anesthesia used in children is General Anesthesia where medications are given intravenously and by breathing them in to ensure that the patient is completely unconscious during surgery. An alternative to general anesthesia is Regional Anesthesia where the anesthesiologist numbs the pertinent part of the body using a local anesthetic. The patient is typically sedated and sleeps during surgery, although if they chose to stay awake they would feel nothing. Perhaps the most familiar type of regional anesthesia is a spinal or an epidural, both of which numb the patient from the waist down. However for surgery on the shoulder, foot or arm, just the operative limb is numbed. Growing numbers of medical centers are providing regional anesthesia for children, thereby avoiding the need for general anesthesia.
Q2. What are some good questions to ask my child’s anesthesiologist before surgery?
Ask the anesthesiologist about the type of anesthetic that will be used during surgery and their common side effects. Also inquire as to how your child might act or feel coming out of the anesthetic. It is also important to ask what medical conditions may have an impact on the anesthesia.
Q3. What happens during anesthesia? How does the body not feel the pain?
During general anesthesia, the patient is made unconscious using a number of drugs – the drugs are administered via a breathing tube or mask and also intravenously. Pain medications such as morphine, muscle relaxants, and drugs such as propofol (which produce sleep quickly) are administered intravenously. Regional anesthesia removes all feeling around the operative site, hence the body does not feel pain.
Q4. Do you have any tips for preparing a child for surgery and explaining anesthesia? Is there anything parents need to be aware of with regard to recovering from anesthesia?
First, it is important for parents to remain calm and matter of fact so that anxiety is not transferred to the child. Although over-explaining the process to the child is typically not helpful, the child should be assured they will sleep throughout the surgery and not feel anything. It is important for parents to understand that recovery from anesthesia is variable depending on the type of surgery and anesthesia. Children may be irritable and cranky after general anesthesia. Children waking up after regional anesthesia are usually more calm and relaxed, in part because they have no pain.
Q5. Is it possible to have an allergic reaction to anesthesia? How does a doctor determine which type is best?
True “allergy” to anesthesia, Malignant Hyperthermia is exceedingly rare (1:10,000 to 1:65,000). Susceptible patients can have regional and general anesthesia safely by avoiding anesthetic drugs that produce malignant hyperthermia. The anesthesiologist will choose the most appropriate type of anesthetic based on your child’s age, maturity, medical history and the type of surgery.
Dr. Victor Zayas is board-certified in both Anesthesiology and Pediatrics and serves as the Director of Pediatric Anesthesiology at Hospital for Special Surgery. He has authored several book chapters and manuscripts on various topics in Anesthesiology, including scoliosis surgery and problem oriented management.