Definition and Overview
The majority of surgical procedures performed to treat various medical conditions require the use of anaesthesia. These are used to eliminate or at least minimize surgical pain and can be given topically (applied directly on the skin), injected locally, or through an intravenous drip.
However, when it is a child that is about to undergo a surgical procedure, special care must be taken before anaesthesia can be provided. Too little of the anaesthetic can make the procedure especially traumatic for the young patient while too much of it can damage the child’s systems. This is why many hospitals and clinics offer pre-surgical anaesthetic consultation for young children and their parents or guardians.
Many parents suffer from unease or even extreme anxiety when their children are about to undergo surgical procedures. Thus, it is normal for them to have a lot of questions not only about the surgery but also the pre-operative care for the young patient.
There are three general kinds of anaesthetics that can be used in paediatric surgery. General anaesthetics will put the child to sleep, and is ideal for more complex and lengthy procedures. This can also be prescribed for anxious patients, or for procedures that target sensitive areas. Young patients can also be given regional anaesthesia, where a large part of the patient’s body is numbed. Finally, local anesthesia is given for minor procedures and it works by making the targeted part of the body numb throughout the procedure.
The consultation that revolves around the anaesthesia to be used for the surgery can be performed a couple of days before the operation. An anaesthesiologist, a licensed medical professional specialising in the prescription and delivery of anaesthetics, will meet with the parents or guardians to address all their concerns and questions.
Who Should Undergo and Expected Results
All young patients and their parents or legal guardians must undergo a paediatric pre-surgery anaesthesia consultation to discuss their expectations, the possible risks and complications, and pre- and post-surgery care for the patient. This is mainly to calm anxious patients and parents, and also to provide them with ample information that would help in the recovery process.
The consultation also aims to make both the patient and their parents or legal guardians more confident in proceeding with the surgical procedure. It is also expected that they will be equipped with enough knowledge to facilitate a smoother recovery process. The anaesthesiologist and surgeon performing the surgical procedure will also be better informed about the patient’s pain and anaesthetic tolerance and other specificities, which will increase the chances of surgical success.
How is the Procedure Performed?
This type of consultation is scheduled a couple of days before the surgical procedure. If a legal guardian is accompanying the young patient, he or she might be required to bring valid documents proving the status of guardianship. Knowledge of the child’s health and family history, as well as additional medical information from the patient’s paediatrician or primary healthcare provider, will also come in handy.
This consultation is a part of a pre-operative medical evaluation. The anaesthesiologist will generally ask questions falling under the following categories:
1. General health issues
a. Has the child suffered from any type of illness caused by bacterial infection? If so, how long ago was the incident?
b. Has the child been showing symptoms such as coughing, sneezing or wheezing? Are there respiratory issues in the recent past?
c. Has the child suffered from a recent fever?
d. Is the child suffering from allergies to certain medications?
2. Common coexisting illnesses
a. Was the child born prematurely?
b. Was the child diagnosed with an intellectual impairment?
c. Was the child diagnosed with seizure disorders? Is the child taking medication for such?
d. Was the child diagnosed with gastroesophageal reflux, chronic lung disease, Down Syndrome, congenital heart disease or diabetes?
e. Does the child have a cleft lip or palate?
Routine laboratory tests and diagnostic imaging procedures might also be required to determine the child’s general health and assess coexisting illnesses (if there are any). The patient’s blood count and chemistry, as well as certain internal structures, will be closely observed and analysed to ensure that no complications will occur once the patient is placed under anesthesia.
The technique that will be used will also be discussed with the patient and his or her family. The paediatric anaesthesiologist will also make a recommendation based on the results of lab tests and information obtained from the parents or guardians. Techniques that can be used include:
- Inhalation induction
- Rectal induction
- Intravenous induction
- Topical application
The type of numbing agent will also be discussed. After the consultation, the anaesthesiologist will forward the information he gathered to the operating surgeon.
Possible Risks and Complication
The consultation itself is a safe procedure, but without it, the patient might suffer adverse effects that could lead to serious complications including death.
- Cote CJ, Lerman J, Anderson BJ. A Practice of Anesthesia for Infants and Children. 5th ed. Philadelphia, PA: Elsevier Saunders; 2013.