Anesthesia - Patient Education and Resources

Anesthesia - Patient Education and Resources

Find education and resources for children’s pediatric anesthesia at Penn State Children’s Hospital. Get answers to questions about anesthesia and surgery.

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FAQs about pediatric anesthesia and children’s surgery

Is it normal for children to be anxious about having surgery?

It’s normal for children to be anxious about surgery and being away from their parents. This is partly because they can’t think the way adults do about why they’re having surgery. Children who may be more likely to be anxious may have:

  • Shy personalities
  • A history of surgeries and hospitalization
  • Very anxious parents

Children may show signs of anxiety while in pre-surgery by:

  • Not talking
  • Fearing hospital staff
  • Crying

How can we help my child’s anxiety about surgery?

Start in the surgeon's office

  • That’s where you and your child are hopefully starting to trust and bond with the doctor who’ll do the procedure.
  • Many surgeons have brochures in their offices that you can read. They may even have videos to watch which will tell you and your child about the procedure

Try to be ready yourself

  • Don’t be afraid to ask questions or talk about your concerns.
  • Try to do this ahead of time with your surgeon and anesthesiologist.

Let us know if you’re anxious

  • Talk about it with your child's doctors.
  • Try to talk without your child there.
  • When you’re comfortable and confident, your child will likely be also.
  • Try not to apologize to your child about the surgery.
  • Instead, be matter-of-fact about the surgery; this will help ease worry and fear.

Can you help my child feel less anxious on surgery day?

There are two main ways to lower anxiety on surgery day:

  • Explain the process in a comforting way
  • Give medicines

Child Life Specialists explain the process

At Penn State Children’s Hospital, our specially trained staff of Child Life specialists meet with each child as they’re getting ready for surgery. These experts:

  • Help children cope with the stress of surgery
  • Guide children through the process by teaching age-appropriate coping skills and using distraction
  • Assist children who have special needs such as autism

For example, a Child Life Specialist may:

  • Let your child play with a scented facemask and give instructions on how to breathe with it.
  • Show your child other medical tools so they can examine, touch and play with them.

This can make the whole process seem less scary. This and other forms of age-appropriate play therapy greatly help the child cope with having surgery.

Pediatric Anesthesia staff helps by giving medicine

  • Your child's anesthesiologist will try to calm fears by soothing the child and/or giving the child a sedative medication either by mouth or through an IV.  This is called a “pre-medication.”
  • The oral form is given 15 to 30 minutes before surgery. The IV form (given in a vein) is given just before leaving the pre-surgery area.
  • The medicine works by:
    • Calming the child
    • Relieving anxiety
    • Clouding the memories of going to the operating room

Help from home

Bring a familiar item from home such as a:

  • Stuffed toy
  • Blanket
  • Game
  • Tablet (like an iPad®)
  • Video game

These items may comfort and distract the child, and help make the process smoother. Children are usually allowed to bring those items into the operating room with them. If your child has special needs such as autism or any other type of developmental delay, please let the staff know ahead of time about the child’s likes, dislikes or sensitivities.

During the child’s surgery

Once in the operating room (OR), most children are anesthetized or sedated (go to sleep) when they breathe a mixture of oxygen and anesthetic gas through a mask.

  • This allows the anesthesiologist to wait until the patient is all the way asleep to start the IV.
  • That way, the child won’t have the unpleasant experience of being stuck with a needle while awake.
  • Before your child goes into OR, make sure you take the time to talk to the staff anesthesiologist who will care for your child during surgery.
  • The anesthesiologist will be happy to discuss the details of the treatment plan for your child and answer any of your questions. 

How do you know how much anesthesia to give my child?

Most medicines and fluids are given based on the child's weight. That’s why we weigh your child before surgery. Along with weight-based dosing, we monitor:

  • Responses to surgical stimulation
  • Levels of anesthetic gases in the exhaled air
  • Vital signs such as:
    • Blood pressure
    • Heart rate
    • Oxygenation and carbon dioxide

These things let us know when we have reached the right level of anesthesia. 

How safe is anesthesia for children?

Anesthesia for children is very safe, thanks in large part to better monitoring devices such as the pulse oximeter and better anesthesia drugs.

The pulse oximeter measures oxygen better

The greatest improvement in monitoring started with the pulse oximeter. The reason this monitor adds so much to patient safety is because it helps us see that as long as oxygen goes to the lungs and is taken up into the blood stream, then vital organs are getting what they need to keep working. The pulse oximeter measures how much oxygen your child’s blood is carrying.

  • A reading of 98% means that the child's blood is carrying 98% of the oxygen it’s able to carry.
  • Any number over 94% is good for most people.

Anesthesia drugs now work better

Better anesthesia drug design, along with a better understanding of what makes one anesthetic safer than another, have led to new inhalational drugs (drugs that are breathed in) that are safer than the ones that used to be available, even in high doses. Here’s how they work:

  • Most children are anesthetized (go to sleep) when the child is asked to breathe a mixture of gases that have both oxygen and anesthetic agents.
  • These gases have a mild odor which we can cover up by having the child choose a nice scent to rub in the mask and make it more pleasant.
  • The gases that are breathed in work very quickly so the child is unconscious within a few minutes.
  • Once the anesthesia is turned off and the mask is removed, the child usually starts waking up.

Specially trained pediatric anesthesiologists

At Penn State Children’s Hospital, our team of pediatric anesthesiologists:

  • Have done their anesthesiology residency
  • Have added specialized training (called a Fellowship) in anesthesia care for infants and children

Along with our excellent pediatric surgeons, children receive the highest level of surgical care at our hospital.

What are the risks of anesthesia?

It’s natural for a parent or guardian whose child is having surgery to wonder whether the anesthesia is safe for the child. Even though anesthesia today is much safer than it’s ever been, all anesthesia has some risk. In fact, sometimes it’s hard to separate the anesthesia risks from the risks of the surgery. Anesthesia aims to:

  • Take away the pain and discomfort of surgery
  • Make it easier for the procedure to be a success

These benefits must be weighed against the risks of the anesthesia itself.

The risks of anesthesia will vary

Anesthesia risks will vary based on:

  • The type of surgery
  • Whether it’s an emergency
  • The child’s age
  • Any other problems or illnesses

Also, each type of anesthetic has a certain set of risks and side effects that come with it. The anesthesiologist will talk to you about the types of anesthesia that may be used for your child, and the risks and benefits of each. 

How long will my child be sedated?

It depends on the sedative medicine used and how the child responds. Children show different responses to sedatives. It’s often hard to tell how sedated or sleepy the child will be after the procedure.

  • Some children may need to be monitored and observed in the recovery room until they’re awake.
  • Some children may be awake at the end of the procedure and ready to go home soon after.
  • Many children will have a type of confusion when they wake up from anesthesia, called emergence delirium.
    • For a short time - usually 30 minutes or less - they may be irritable or can’t be comforted.
    • This is a normal response to anesthesia and is very common in preschool-aged children. 

How long will my child stay in the hospital?

The decision about whether the child needs to stay in the hospital is based on the type of surgery. It’s usually the surgeon who decides how long the child will stay after waking up from anesthesia.

When can my child start normal activities?

Most children are able to start a few normal activities just hours after surgery:

  • Eating
  • Drinking
  • Walking

The surgeon will also decide when it’s best for your child to become normally active again.

How do I explain surgery to my child?

Children of all ages need to know that someone will be with them at all times. Tell your child to feel free to ask any questions at any time before the procedure. If needed, write down the questions so they can be answered later. It’s also important to choose your words carefully. For example:

  • You might want to say that the medicine will be given right away if they feel "sore" after surgery, instead of saying if they have "pain."
  • When explaining the surgery, you could use the words "make an opening" instead of "cut."

Explaining surgery to teenagers

Teenagers are more like adults in the way they’re able to understand things like surgery. What will happen to them should be explained in open, honest detail. Teens most often worry about concepts such as:

  • Body disfigurement, like scars
  • Pain
  • Needles
  • Diagnosis
  • Prognosis (the likely outcome of a disease or sickness)
  • Death

Often teens will have questions without telling anyone and will try to hide their fears. To handle that you may want to:

  • Talk about the surgery before meeting with the surgeon and anesthesiologist.
  • Write down your teen’s questions ahead of time so they can be answered, even if the teen is shy about asking the surgeon or anesthesiologist questions in person.

Explaining surgery to school-age children

School-age children also need an upfront and honest explanation at a level that’s right for their age. In a direct but simple way, they need to be told:

  • The surgery needs to be done to fix a problem that will not go away by itself.
  • Although you’ll be apart from them for a while, they’ll see you again when they wake up.
  • Assure them that someone will be with them at all times while they are asleep.

Let your child guide your talk by asking what worries he or she may have. Try to respond to them clearly and honestly.

Explaining surgery to children ages 3 to 7

Young children ages 3 to 7 have limits to their understanding about certain things. Make sure to tell them:

  • They will be apart from you for only a short time and will be okay.
  • Someone will stay with them to make sure they will be fine.

More tips for talking to young children

  • Use age-appropriate words like "boo-boos" and "Band-Aids®.”
  • It’s helpful at this age to show them the facemask and calm children with an anxiety-relieving medicine.
  • Some parents try to keep young children from knowing they’re going to have surgery. This isn’t a good idea because it:
    • Builds distrust and fear later on
    • Makes a child worry about medical procedures over time

Should we consider cancelling surgery if a child has a cold?

It depends. In the past, children with colds had their anesthesia and surgery cancelled until they felt better. This was based on concerns that the anesthetic made the cold worse and raised the risk of problems during surgery.

Because we know much more about how anesthesia affects colds, it’s much less common now to cancel surgery for children with colds.

How anesthesiologists care for kids with colds

  • A major role of the anesthesiologist is to make sure your child breathes freely when asleep for surgery. For kids with colds, this is more of a challenge because:
    • They may have many secretions (mucus)
    • Their air passages may be swollen and more sensitive

Sometimes this can cause coughing and narrowing or closing of the airways. If these things happen, they are usually mild and easily treated. Still, they can also cause concern.

Reasons to cancel surgery for a child with a cold

Deciding to cancel surgery for the child with a cold is based on a number of reasons. Usually it’s safe to anesthetize children when:

  • Their cold is limited to the nose
  • Secretions (mucus) are clear
  • They don’t have a fever
  • They aren’t sleepy or sluggish

On the other hand, surgery should most likely be canceled when children:

  • Look sick
  • Have a fever over 100°F
  • Have yellow or green mucus

One thing that may also need to be taken into account is whether the surgery is urgent. Decisions about surgery should be talked about with your child’s anesthesiologist and surgeon. They can help decide whether your child’s surgery needs to be canceled.

When should I reschedule my child’s surgery if it’s canceled because of a cold?

Research shows that children with colds may have sensitive air passages, or airways, for a number of weeks after the symptoms are gone. Sensitive air passages are more likely to cause problems during surgery, so it’s usually best to wait a few weeks until the airways have fully healed.

How long to wait before rescheduling surgery varies and you should decide after speaking with your anesthesiologist and surgeon. If your child's surgery was canceled, it’s most likely because the symptoms were severe enough to cause worry.

In these cases:

  • The recommended wait time is two or more weeks.
  • The wait allows the air passages enough time to get better.

If your child had a bacterial infection of the lungs or airways, give him or her antibiotics and postpone surgery for at least four weeks.

What problems could children with colds have during surgery? 

Research shows that children with colds may have a slight chance of more problems during anesthesia than children who are healthy.

Because children with colds have more mucus and may have more sensitive airways, they might react to the anesthetic gas. This can cause:

  • Coughing
  • Airway spasms
  • A drop in the oxygen level in the blood

Studies of children who have colds and need surgery have found a number of causes that can increase the chance of problems. These causes include:

  • A history of asthma
  • Children who need a breathing tube for their surgery
  • Children who have a lot of mucus or nasal congestion
  • Surgery that has to do with the airways (such as a tonsillectomy)
  • Being around tobacco smoke
  • A history of snoring
  • Being born prematurely
  • The type of anesthetic gas or drugs used

There are rare cases of children with colds who’ve gotten pneumonia after anesthesia and surgery, however there isn’t proof that the anesthetic was the direct cause. Studies show that anesthesia does not appear to make the cold last longer or become worse in most children.

Because of my child’s cold, will the anesthetic care change?

Whether or not your child has a cold, he or she will have the best possible monitoring and care. Children with colds often have more mucus and may have more sensitive air passages. Because of this, your child's care may be changed a little, but it will still use high-quality, standard methods.

  • It’s very important to remove as much of the mucus as possible.
  • We carefully suction the nose and air passages to do this.
  • In some cases, we may use a drug to dry up the mucus.
  • We give your child fluids through an IV to keep mucus from getting too thick.
  • As we always do, your child will be monitored at all times to measure the oxygen levels in the blood.
  • If your child needs a breathing tube during surgery, the anesthesiologist might choose one that limits contact with the sensitive parts of the airway.
  • Sometimes the anesthesiologist will also choose an anesthetic gas or drug that helps keep the the air passages from being irritated.

In spite of all the best efforts, problems may arise. Keep in mind that if that happens, anesthesiologists have a number of drugs and methods that can treat these problems.

Does my child have to fast before surgery?

Yes, your child will have to fast.

Why does my child need to fast before surgery?

All children must fast before surgery. That’s because of the anesthesia, not because of the surgery. Here’s why:

  • When patients receive anesthesia for surgery, they become very relaxed and sleepy.
  • When patients are this sleepy, the muscles of the stomach and throat are also relaxed.
  • The stomach and throat muscles normally stop food from coming up into the throat, then going down into the trachea (windpipe), and then into the lungs.
  • If those muscles are relaxed, they can’t do the job of stopping food from going into the lungs.
  • When patients get food or liquid into their lungs from the stomach, this can cause pneumonia or even death.
  • To cut down on the risk of this taking place, patients are asked not to eat or drink for some time before surgery.
  • If the stomach is empty, the risk of anything coming up from the stomach and getting into the lungs is very low.
  • This makes anesthesia much safer.

Keep in mind that some surgeries that involve the gastrointestinal tract (stomach and intestines) may have special fasting rules that relate to the procedure.

How long should my child fast before surgery?

Food and milk take longer to empty from the stomach than clear liquids. To make sure the stomach is as empty as it can be by the time anesthesia is started, patients must be fasting longer from food or milk than from clear liquids.

You should always check to see what your doctor recommends. Here are some fasting times for different types of food and liquids that are often recommended:

  • Type of food or liquid and the fasting time before surgery
    • Fatty or fried food: 8 hours
    • Light meal, milk, formula: 6 hours
    • Breast milk (infants): 4 hours
    • Clear liquids: 2 hours

What are clear liquids?

Clear liquids are any liquids that you can see through. Some examples of clear liquids are:

  • Water
  • Electrolyte solutions (such as Pedialyte or Gatorade)
  • Apple juice.

Any liquid that you can’t see through, such as orange juice or milk, empties from the stomach more slowly. When it comes to fasting, these should be treated as a "light meal.”

Can a child take medicines before surgery?

You’ll want to ask your anesthesiologist this question ahead of time, because:

  • Some medicines should be taken until just before surgery.
  • Other medicines may need to be stopped before the day of surgery.
  • Usually medicines that are taken with a sip of water before surgery don’t make the stomach "full,” and won’t raise the risk of problems from the anesthesia.

Food, drink and medicines during emergency surgery

Emergency surgery can’t be planned ahead of time. If your child has to have that kind of surgery here’s what may happen:

  • The child won’t be allowed to eat or drink before surgery.
  • An IV will be started, which will help the child get fluid through a vein.
  • If the child’s stomach is not empty, but surgery cannot wait, the anesthesiologist will use special safety measures to cut reduce the risk of any stomach contents getting into the child’s lungs.
  • These safety measures are very effective.

Could my child need a blood transfusion during surgery?

A blood transfusion is a safe, common procedure in which blood is given to a patient through an intravenous (IV) line in a blood vessel.

The chances your child will need a blood transfusion are very small if your child is:

  • Healthy
  • The procedure is simple

The chances go up if your child is:

  • Very anemic
  • Having complex surgery, such as heart surgery

Children lose very little blood in most of the surgeries they have. However, one thing your child may be given through an IV is a balanced salt solution known as "crystalloid.” Crystalloids, which don’t contain human or animal tissue, help:

  • Make up for the child not having anything to drink before surgery
  • Replace fluid and minor blood losses during the operation

How would a blood transfusion help my child?

Without enough red blood cells, the body may starve for oxygen. Not having enough oxygen can lead to life-threatening problems such as brain or heart damage. A blood transfusion helps bring in enough red blood cells to carry oxygen throughout the body.

Other parts of the blood include:

  • Coagulation factors (a group of proteins) and platelets (cell pieces), which are needed to form clots that help stop bleeding.
    • The surgery team may need to transfuse these parts of the blood during and/or after the procedure to help cut down on the loss of red blood cells.
  • Colloids, such as albumin, which are the protein part of blood, may also be used to help treat blood loss.

FAQs about pediatric recovery from surgery

How soon can I see my child after surgery?

Usually, a family member can be with the child shortly after he or she is taken to the pediatric recovery room. We ask that:

  • Only one or two family members at a time be present
  • You wait until the nurse calls for you before you come to the pediatric recovery room

Keep in mind, your child may be upset or confused when first waking up, or may be slow to wake up. This will go away over time.

Why was my child upset after surgery?

Here’s another way that adults and children are different when it comes to surgery: When children first wake up, they’re more likely to have a condition called "emergence delirium.”

What is “emergence delirium” like?

The best way we can describe “emergence delirium” is to ask you to imagine waking up in a hotel room in the middle of the night. For a brief moment you’re confused and not sure where you are. It can even give you a moment of panic.

The same thing sometimes happens to children who are in pediatric recovery.

  • They wake up in a strange room, with strangers all around them, and Mom and Dad are not close by.
  • Even though we know from what teenagers and adults have told us - which is that most patients don’t remember what happens in the recovery area - a younger child may still be very upset at the time.

The parents’ role in recovery

Here at Penn State Children’s Hospital, we make sure to bring a parent to the bedside as soon as the child starts to wake up. The best medicine is often a familiar face, a soothing voice and being held in a parent’s arms. This approach:

  • Helps give the parents a major role in their child's recovery
  • Helps make sure a child isn’t taking too much medicine when what’s really needed is some TLC

Still, if a child continues to be very upset, we may talk with you about adding pain medicine or sedation.

What safety measures should I take once my child is home?

Based on the medicine used, children may stay sleepy and unsteady on their feet for a few hours after surgery. That’s why we recommend that children who are sedated be watched closely on the ride home. Other safety measures include:

  • A responsible adult should stay with the child for 12 to 24 hours after sedation.
  • Because the following activities need the child to use coordination, he or she shouldn’t try these or similar activities for 12 to 24 hours, or until you’re sure the child is stable:
    • Swimming
    • Using playground equipment
    • Climbing
    • Bike riding
    • Roller blading or skating

Sometimes we may decide it’s best for your child to stay in the hospital overnight for observation, for example if your baby was premature.

FAQs about pediatric MRI

What is MRI?

Magnetic resonance imaging, known as MRI, uses a powerful magnetic field to scan and capture images of parts of the child’s body. It does not use harmful radiation. 

Why do some children need anesthesia for MRI scanning?

The MRI scanning takes place in a special room on a special table, inside a long tube or tunnel. Most young children, and even some adults, may not do well with the scanning because:

  • The magnet makes a thumping, droning sound during the scan. These loud noises sound like a motorcycle engine and can scare a child.
  • If they’re awake, some children may also feel claustrophobic (afraid of being in a closed space) during the scan.
  • The MRI scan may take between 45 minutes to four hours based on the body parts to be studied. Some children may not be able to stay still during that time.

Since any movement from your child may affect the image quality, children are referred for sedation or general anesthesia.

Is the MRI scan painful?

No, MRI scanning is not painful.

How do doctors decide on sedating a child for an MRI?

Doctors and nurses who care for the child during the MRI procedure will decide on the need for sedation based on the child’s:

  • Age
  • Health history
  • Past medical procedures

You may be asked for important information that will help to us know whether or not to sedate the child.

What happens when children get anesthesia for an MRI scan?

You’ll get a phone call from a nurse who works in the MRI area. The nurse will tell you what to expect and give you instructions about how your child should fast for the general anesthesia.

On the day of the procedure:

  • Your child will be seen first by a nurse who will complete a checklist.
  • Next, you and your child will be seen by the anesthesiology team, which includes:
    • An attending pediatric anesthesiologist.
    • A resident anesthesiologist or a CRNA (certified registered nurse anesthetist).
  • The anesthesia team will get a detailed history of your child and then examine the child.
  • After that, you’ll sign a consent form that allows us to use anesthesia.

The “induction room” is where your child will go to have the anesthesia or sedation administered (prepared and given). “Induction” simply means the child will be induced or made to sleep by using anesthesia medicine. The process follows these steps:

  • In younger children, anesthesia is most often given using anesthetic gases through a face mask. This is called “gas induction.”
  • Once the child is asleep, an intravenous (IV) drip begins and anesthesia is constantly given either through a gas mask or an IV.
  • In some cases, the anesthesiologist may insert a "breathing tube" that goes down the throat to help the child breathe better. The tube is removed as the child wakes up.
  • After being given anesthesia, the child will be moved into the MRI scanner where the anesthetic administration will continue.

Our expert pediatric anesthetic team will monitor your child all through the MRI scanning.

IV anesthetic medicine in older children

Older children are better able to handle an IV line placement. Intravenous anesthetic medicine may be given to induce sleep instead of a “gas induction.” The attending anesthesiologist chooses which method to use.

The “excitement phase” of anesthesia

If you decide to be there when your child is being anesthetized, you may see your child:

  • Resist the mask
  • Splutter
  • Cough
  • Make gurgling sounds
  • Roll his or her eyeballs

This is called the “excitement phase” of anesthesia. It happens in most children before they drift off to sleep. Please don’t worry when you see it. Also, keep in mind that the anesthesiologist may ask you to step out of the room at any time while your child is given the anesthesia.

Why can't my child eat or drink before the MRI?

All children must fast before the MRI. That’s because of the anesthesia, not because of the scan. Here’s why:

  • When patients receive anesthesia for an MRI, they become very relaxed and sleepy.
  • When patients are this sleepy, the muscles of the stomach and throat are also relaxed.
  • The stomach and throat muscles normally stop food from coming up into the throat, then going down into the trachea (windpipe), and then into the lungs.
  • If the stomach and throat muscles are relaxed, they can’t do the job of stopping food from going into the lungs.
  • When patients get food or liquid into their lungs from the stomach, this can cause pneumonia or even death.
  • To cut down on the risk of this taking place, patients are asked not to eat or drink for some time before anesthesia is given.
  • If the stomach is empty, the risk of anything coming up from the stomach and getting into the lungs is very low. This makes anesthesia much safer.

How long will the MRI scan take?

  • The MRI may take between 45 minutes and up to 4 hours. It depends on:
    • The body parts to be studied
    • How complex the anesthesia care is
  • Although we make every effort to stay on schedule, there will be times when we run behind schedule.
    • This may be based on how complex the children’s care is at the Hershey Medical Center or it may be for technical reasons.
    • If there’s a delay in the schedule, we’ll let you know how long it may be.
    • You can choose to wait or you can schedule a new appointment.
  • Parents and family members can wait in the MRI waiting room. You can also go get something to eat (please give your cell phone number to the MRI nurses).

What happens after the MRI scan is done?

After the MRI scan is done, your child will be moved to the recovery area. A specialized pediatric nurse will monitor your child there.

When your child is awake and cleared for discharge by the anesthesia team, your child will be able to go home. This is usually about 45-60 minutes after the MRI exam is done.

If you have questions about your child’s care at any time, please ask a member of our staff.

Can I be there during the MRI scan?

You can be with your child:

  • While your child is being given anesthesia
  • Until your child is asleep

Once your child is asleep, we’ll escort you to the MRI waiting room. We’ll call you back as soon as your child is in the recovery area.

Please note that we may ask you to leave for these reasons:

  • During the IV line placement
  • When the breathing tube is being inserted (if one is needed)

Can I bring my child’s favorite toy to the MRI procedure?

Yes, feel free to bring your child’s toy with you.