ANESTHESIA in CHILDREN - Anesthesiology and Reanimation
Anesthesia is also used in children similar to the adult anesthesia. Surgical interventions cannot be performed without anesthesia. Anesthesia applications are carried out through three different methods: General, regional and local anesthesia.
What is the general anesthesia?
Does it have same meaning with narcosis?
General anesthesia is complete loss of sensory functions along with temporary loss of consciousness. 'General Anesthesia' is also colloquially referred as 'Narcosis' in our country. Although the narcosis seems like to have same meaning with the anesthesia, it is a significant numbness state which occurs through advanced disappearance of sensitivity without loss of consciousness.
What is the regional anesthesia?
It is removal of senses in a part of the body. Anesthetized person is aware of what is happening around him/her during the surgery. For example, the pain sensation of hand can be eliminated by regional blocking. Pain sensation in the surgery site can be also eliminated by applying epidural or spinal anesthesia, or in other words, by blocking the spinal nerves with local anesthetics. In appropriate pediatric patient, regional anesthesia is applied by an experienced anesthetist according to the type of the surgical intervention.
What is the local anesthesia and the sedation?
In which cases are these methods preferred?
Local anesthesia eliminates the sensation of pain only in a small part of body. For example, it may be used for suturing in case of a skin cut. Sedation is used for relaxing and tranquilizing patients. Conscious is open and temporary loss of memory may occur. It is generally used for supporting local and regional anesthesia.
How is the appropriate anesthesia method determined in children?
After the age, psychological condition, majority of the surgical intervention and the complete medical history of the child (diseases, habits, allergies, etc.) are evaluated, the anesthetist and the surgeon jointly determine the anesthesia method and family's approval is also received
Is it necessary to inform the child about the anesthesia and the surgery?
Information regarding his/her disease and the surgical intervention should be explained to child in an appropriate way. Reducing fear and anxiety in children bears extra responsibility not only for the physician but also for the families and especially the parents. In Turkey, expressions which had been used for intimidating children in the past, such as "if you misbehave, the doctor will sting you with a needle", are still among the problems that physicians encounter today. Similarly, stories which are told to children by parents before the surgery, such as "doctor will just take a picture of you", lead to negative psychological effects on children. Therefore, children should be informed correctly and psychologically prepared in order to enable them to trust to the family and the physician and to tolerate the preoperative and postoperative periods as well.
If could not prepare your child well for the stress of the surgery, what may your anesthetist do?
Your child surely feels fear and anxiety because he/she will be separated from you and will enter into an unknown environment (operating theater). He/she may be restless and s/he may cry. This situation can be tolerated in a short while in children who have been prepared well for this process. In children who have not been prepared well for this process, anesthetist applies tranquillizer drugs (sedation) orally or intranasally (into the nose) before the surgery. This procedure, which is a routine one in our hospital, is applicable to all children. The underlying reason is to prevent children's fears due to the separation from parents.
Can I enter the surgery room to assist my child in overcoming this fear of separation?
A companion in the operating theater is not applicable today because operating theaters are sterile environments. Children can tolerate this situation well in our hospital because sedation is applied before the surgery. For families who are extremely requesting to accompany, only one parent is allowed to accompany the child to the entrance of the operating theater in company with a nurse.
Is there any difference between pediatric general anesthesia and adult general anesthesia?
Under normal circumstances, general anesthesia is started by opening a vascular access. Children generally do not let this due to fear and anxiety. Therefore, pediatric anesthesia is generally started by making them breathe anesthetic gases through a mask or drink anesthetics added fruit juice, or through intramuscular anesthetics. Afterwards, vascular access is obtained and anesthetic drug is injected based on the weight of the child.
How do children recover from the anesthesia?
Recovery is dependent on many factors such as type of the anesthetic agent used and the duration of the surgery. Anesthetics are discontinued when the surgery is finished. When the effects of the drugs disappear and vital functions turn to normal, he/she is transferred to the recovery room. He/she is kept there until s/he starts to give response to the verbal stimuli.
Is it possible to reduce postoperative pain in children?
It is surely possible. Various painkillers can be given to children through different administration routes (intravascular, rectal, intramuscular, and oral) with regards the child's age, weight and the pain level. In our hospital, painkillers are administered intravenously to the children, immediately after the surgery or from oral route after oral intake starts.
How safe is the general anesthesia?
The existence of modern patient monitoring devices, better drugs and especially anesthetists, who may use them, make the anesthesia increasingly safe. While the rate of mortality caused by the anesthesia was 1/10.000 in 1982, the figure is now 1/200.000.
What are the ways to make the general anesthesia safer?
I. Pre-operative examination: Child must be examined by the anesthetist before the surgery and his/her medical history must be obtained. The previous medical problems (diseases, habits, allergy, etc.) and general anesthesia history are addressed in the examination. Symptoms such as fever, nasal discharge and cough which are associated with the infection in children should not be present before the surgery and the anesthesia, since the anesthesia and surgical interventions applied under these conditions may harm children, if surgical intervention is not an emergency case.
2. Empty stomach: Fasting is necessary for at least 4 hours in infants aged below I year and for 6-8 hours in older children before the anesthesia. Some liquids except milk (water, pulpless fruit juice) can be given until the last 2-3 hours. Foods and drinks consumed outside of your knowledge within this period can lead to serious medical problems; therefore, you must inform your physician.
What are the side effects of anesthesia?
The most significant effects are as follows; the incidence of nausea and vomiting, sore throat and long term somnolence is 10 %, 10 % and 0.5%, respectively.
Does general anesthesia cause damage in brain cells of children?
It has not been shown in any medical reference that modern anesthetics lead to permanent damages in children, even in repetitive applications
Is there any test to show whether an allergy against anesthetics is present?There is not any routine test method to determine the presence of an allergy only against anesthesia drugs yet. Pseudocholinesterase enzyme level had been assayed against a group of myrorelaxant drugs, which had been commonly used in the anesthesia in previous years, but had lost popularity in recent years. This is not one of our routine tests because we do not use this drug in the MESA Hospital.