Members of the Department of Anesthesiology, Critical Care & Pain Management at the Hospital for Special Surgery (HSS) recognize that pediatric patients have special needs. We work with your surgeons, pediatricians, and nurses to make your child’s experience a positive one. By using this multidisciplinary team approach, we will care for your child—and for you—during your child’s surgery and throughout your family’s stay with us. The anesthesiologists at HSS who care for children have highly specialized training in all aspects of pediatric anesthesiology and the management of pediatric pain. These dedicated and caring physicians have many years of experience treating children before, during, and after surgery.
The Department offers a unique approach to anesthesia and pain management—it is called regional anesthesia. It is used for many types of operations and procedures; a familiar example is an epidural for a pregnant woman in labor. Regional anesthesia is especially good for orthopedic surgery because we can temporarily “block” sensation to the extremity that is being repaired by the surgeons. You may hear the term “block” used to mean regional anesthesia. At HSS, we perform over 25,000 regional anesthetics a year in the operating room (OR).
Just like an adult, a child who has an operation on his/ her hip or leg may receive a spinal for anesthesia and an epidural catheter to be used for pain management after surgery. Sometimes patients having foot or ankle surgery have a small catheter placed in the back of the knee to provide pain-relief during their hospital stay. We call these techniques “nerve blocks.” With the advances of modern science, we now use ultrasound to guide the majority of our nerve blocks. In children, the blocks are performed in the operating room after they are asleep.
There are many advantages to using regional anesthesia including a lower anesthetic requirement, superior pain-control, and fewer side effects such as nausea and drowsiness. Regional anesthesia also reduces the amount of narcotic pain medications required after surgery. Not all patients are candidates for regional anesthesia, and your anesthesiologist will discuss this with you before surgery. For example, general anesthesia is required for spine surgery.
After surgery, there will always be some discomfort. We may not be able to keep your child completely pain-free but we use a variety of techniques to keep the pain under control during your child’s recuperation. Our goal is to keep your child comfortable using safe and effective methods. It is important to keep on top of the pain, by treating pain early. It is much easier to treat mild pain than waiting until the pain is severe.
Most children staying overnight in the hospital receive “pain pumps,” in addition to oral pain medications. The pump administers pain medication via a “no-shots” system, either through an IV, an epidural catheter, or a catheter placed near a nerve in the arm or leg. The pain pump will be activated by a button, either Patient-Controlled Analgesia (PCA) or Nurse-Controlled Analgesia (NCA,) depending on the patient’s developmental age. For the safety of the child, parents are not allowed to push the pain button. If the patient can not use the button, the nurse will push it for him/her.
The day of surgery, you will go to the admitting office and then to the pre-operative holding area. There your child will get ready for surgery: nurses will take vital signs; your child will change into a gown; your surgeon will write his/her initials on the site of surgery.
You will meet your anesthesiologist and at this time the full plan for the anesthesia will be discussed and explained. Televisions are available and patients are welcome to bring a favorite toy, book, video with portable DVD player, or music to use while they are waiting. For most patients, the nurse will place a “numbing cream” on the child’s hands for IV placement. Some patients will receive pre-medication to help with anxiety. The majority of patients age 5 years and older receive an IV by the nurse in the holding area, after the cream has made the skin numb.
Many parents are concerned that their child will remember something from the surgery, or that the procedures we do in the OR will cause their child unnecessary discomfort. We recognize and appreciate your concerns. Our job as anesthesiologists is to keep our patients safe and asleep during surgery. If your child is having regional anesthesia, he/she will be asleep before we start the block. Regardless of what type of surgery or anesthesia they have, the vast majority of patients do not remember being in the OR. Your anesthesiologist will be with your child at all times until he/she is settled in the recovery room.
When the surgery is finished, your anesthesiologist takes your child to the Post Anesthesia Care Unit (PACU.) It is important for your child’s recovery to have you nearby when he/she wakes up from surgery, so as soon as the nurses in the PACU obtain their initial assessment, they will call for you. While you are in the PACU, please follow the nurse’s instructions regarding touching, feeding and waking your child.
Depending on what type of procedure your child had, he/she will stay in the PACU for a minimum of one hour before going to the hospital room. Some patients go home the day of surgery and some spend the night in the PACU for observation and pain management. If your child spends the night in the hospital, one adult is permitted to stay with him/her.
It is common for children to have a “cold,” or an upper respiratory infection during the winter months. Flu strains and/or other viruses may be present in the environment throughout the seasons and may cause problems with breathing, or result in more serious infections. If your anesthesiologist is concerned about your child having any symptoms of a cold, flu, infection, or breathing problem on the day of surgery, the procedure will be delayed until your child is better.
If you have any concerns or questions about your child’s present or recent health, please call your surgeon and pediatrician to discuss them before the day of the operation.
Most children cannot tolerate staying still for the length of an MRI examination. If your surgeon orders an MRI with anesthesia, an Anesthesiologist will provide enough sedation so that your child sleeps for the entire exam. For MRI, anesthesia is administered with an IV catheter. When your child arrives, the nurse in the holding area will apply numbing cream to her hands and/or feet, depending on the age of your child and on which area of the body is being evaluated by the MRI. Most children go home within an hour or two of MRI completion.
It is natural for parents to be concerned about the effects of anesthesia on their child. Our number one priority is your child’s safety and this principle is the basis for everything that we do and every decision that we make regarding your child’s anesthesia. On the day of surgery, you will have time to discuss your concerns with your child’s anesthesiologist. There are a few things that you can do to maximize your child’s safety: follow the instructions given to you about feeding your child on the day of surgery, answer all questions honestly, bring a list of your child’s medications, and let the doctor know if your child has had a recent cold or an episode of croup.
HSS prides itself on being a leader in all aspects of orthopedics, including research. Occasionally we want to gather information about your child’s anesthetic and post-operative pain management in order to assess our own performance. We need your permission to do so, so if we plan on collecting data from your child’s medical record, we will ask you before surgery. All proposed research projects are extensively reviewed by an IRB, or Investigational Review Board, a group of experienced scientists, doctors, and other patient advocates. When conducting research on children, the review process is especially stringent because children are considered a “vulnerable population.” Your participation is always voluntary and if you agree to participate in a project, all of your medical information remains confidential.