Pediatric Anesthesia for Orthopedic Surgery

An Interview with Dr. Carlson and Dr. Lee

Andrew C. Lee, MD
Andrew C. Lee, MD
Attending Anesthesiologist, Department of Anesthesiology Hospital for Special Surgery, New York, NY
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College
Assistant Professor, Department of Anesthesiology University of Rochester Medical Center, Rochester, NY
Senior Instructor, Department of Anesthesiology University of Rochester Medical Center, Rochester, NY
Michelle G. Carlson, MD
Michelle G. Carlson, MD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College

In this taped interview, Dr. Carlson presents a series of questions to Dr. Lee regarding the administration of specified anesthetic techniques to young patients prior to orthopedic surgery. Parents are encouraged to view this video if their child will be undergoing an orthopedic surgical procedure.

Visit the Children’s Hand and Arm (CHArm) Center site to learn more about upper extremity pediatric orthopedics at HSS.


Dr. Carlson:

The Charm Center focuses on pediatric patients with upper extremity conditions, a subspecialty in orthopedics. I’d like to ask you a few of questions about the types of anesthesia you use to treat CHArm pediatric patients given their age and conditions.

First, can you explain what these types of anesthesia are that you use for these pediatric upper extremities?

Dr. Lee: So for any kind of case, adults and children, the different types of anesthesia include a general type anesthesia or a regional anesthesia. In the pediatric upper extremity patients at Hospital for Special Surgery we try to do a regional type anesthesia for everyone if possible.

Dr. Carlson: So does that mean that the children have to be asleep or are they not asleep?

Dr. Lee: Typically the patients are asleep as well. They don’t get a deep general anesthesia. They get a deep form of sedation so they’re asleep but breathing on their own and they wake up relatively quickly.  We try to do a regional type anesthesia in addition so that when they wake up they’re not feeling the extremity that was operated on and typically don’t have pain for at least eight to twelve hours.

Dr. Carlson: So is that what’s called twilight anesthesia?

Dr. Lee: It’s the same thing as what we refer to as twilight anesthesia though with children we actually have them a little more asleep than that sort of twilight anesthesia but they wake up a lot faster than they due with a general anesthesia.

Dr. Carlson: So is there a tube in their throat? Is there a machine breathing for them?

Dr. Lee: Typically they don’t get intubated, which is the breathing tube that is put in the trachea to aide in ventilation during general anesthesia. They’re usually just asleep enough so that they’re not aware of their surroundings but they’re breathing on their own and they wake up very quickly. 

Dr. Carlson: So do they have nausea and vomiting afterward?

Dr. Lee: They usually don’t with the type of anesthetics that we use to keep them lightly sleeping. They usually don’t have the typical nausea and vomiting that you get with the general anesthesia that involves nitrous oxide and anesthetic gases.

Dr. Carlson: How do you decide which type of anesthesia is best for the patient? Is it their age or their type of procedure?

Dr. Lee: At Hospital for Special Surgery our specialty is regional anesthesia and that includes children and we do regional anesthesia on patients as young as several months old up until 90 years old, so usually age doesn’t have a bearing on whether or not they get the regional anesthesia. Usually with the younger kids they need to be more deeply sedated than the older kids and adults.

Dr. Carlson: And so after they have the anesthetic, how long after the surgery do they really feel normal? Is it that day or does it take a couple of days?

Dr. Lee: Usually it takes about an hour before they start feeling their normal selves, before they start eating and drinking again and ready to go home if they’re going to go home that day or go to their hospital room. 

Dr. Carlson: What kind of concerns do you hear from parents of kids who are going to have surgery in terms of their anesthesia?

Dr. Lee: Parents are usually preoperatively worried about worried about when their child can eat or drink before the surgery and that differs depending on how old the child is and exactly what they eat or drink before. Usually it’s at least 2 hours before up to about 8 hours before. They’re also very concerned about what kind of pain their child is going to have afterwards and what side effects they’re going to have from the anesthesia and with this regional type anesthesia they usually don’t have pain and usually don’t have a lot of the other side effects of general anesthesia including nausea and vomiting.

Dr. Carlson: How about the kids? What are they concerned about?

Dr. Lee: The kids are usually most worried about when they’re going to have to have an IV put in. That’s usually before they go into the operating room though with the much younger patients we can have them go to sleep before we put an IV in but usually they have to have the IV before. We can numb up their hand before we put an IV in and it’s usually not as traumatic as it would seem.


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