Pediatric anesthesia for ambulatory and same-day procedures

Having a surgical procedure can be a scary time for a child and stressful for his or her parents. Howard County Anesthesia Associates, PA wants to alleviate your concerns by helping you better understand the anesthesia process from start to finish and what is required of you before, during and after your child’s hospital visit.

Frequently Asked Questions:

Q: Why must my child fast before surgery?
A: Fasting prior to surgery is required to reduce the risk of your child breathing in any food or liquid while under anesthesia. While rare, this is very serious complication and parents need to strictly follow our recommendations and very specific policies regarding children’s ages and time periods for fasting, which are based on safety standards. We will recommend a fasting time that is as short as possible.

The following guidelines for fasting times prior to surgery apply to healthy patients who are having elective surgery. A history of diabetes or reflux may require longer fasting times:

• Clear liquids – two hours
• Breast milk – four hours
• Infant formula – six hours
• Nonhuman milk – six hours
• Light meal – six hours

Q: What if my child becomes ill prior to surgery?
A: Please let your doctor know before the scheduled day of surgery if your child is coming down with an illness or has any nausea or vomiting. Even minor illnesses, such as the sniffles, may cause problems during surgery in small children, and your doctor and anesthesiologist may recommend postponing surgery. Please call (410) 740-7795 and ask for the anesthesiologist on call if you have any concerns.

Q: How can I help alleviate my child’s fears?
A: Talk with your child and make a plan for what to do if he or she feels nervous. Some things that might help are reading a book, telling a story, taking deep breaths or talking about something fun you like to do together.
Stay calm – your child will take cues from you. Comfort and encourage your child, stay close, hold hands, respect his or her feelings and let your child know he or she is doing a good job.

Q: Who will provide anesthesia?
A: A team consisting of our anesthesiologists working with a certified nurse anesthetist will care for your child.

Q: Will my child receive any sedatives before surgery?
A: Many children need less sedation when their parents can help them through the stress of a procedure. Some children, however, may require medicine, given by mouth or injection, to calm them before a procedure. Your anesthesiologist will determine the time and type of such premedication if required. 

Q: May I enter the operating room with my child?
A: Depending upon the circumstances, you may be permitted to be in the operating room. Please feel free to discuss the options with your anesthesiologist. 

Q: How will my child receive anesthesia?
A: Most children under the age of ten initially receive anesthesia by breathing a combination of anesthetic medications and oxygen through a mask. After they are asleep, they may require an intravenous line (IV) for fluid and additional anesthetic medications. Older children, like adults, often receive anesthesia through an IV. Your anesthesiologist will discuss these options with you and your child. 

Q: What will happen as my child falls asleep?
A: Your child’s breathing may become heavier or louder and his body limp and relaxed with deeper sleep. Sometimes there is an “excitement phase” when you may notice subtle or active movement, but your child will be unaware of this and it will pass quickly. Your child’s eyes may be only partially closed. All of this is completely normal and your anesthesiologist will let you know when your child is asleep and it is time for you to leave.

Q: How Long Will It Take for My Child to Go to Sleep?
A: It takes approximately 30 to 60 seconds to go to sleep when breathing through a mask; when a child receives anesthesia through an IV, it takes less than 10 seconds.

Once your child is asleep, a nurse will escort you from the OR to the surgical waiting area so that the staff can focus on taking care of your child. We recommend that you eat something while your child is in surgery as you will need energy to help your child during recovery.

Q: When will I see my child after surgery?
A: Anesthesiologists frequently allow parents to be with their child in the Post Anesthesia Care Unit (PACU) but sometimes this may not be possible. We will make every effort to reunite you with your child as soon as possible.

Q: What Can Parents Expect in the (PACU)?
A: Each child wakes up differently – some more quickly than others. How quickly children wake up is affected by the length of surgery and the types of medications used.

Frequently children wake up disoriented, crying and restless with their eyes open even though they may not be fully awake. This is very common and does not always mean your child is experiencing pain. Most children do not remember this transition period.

As the anesthesia continues to wear off after several minutes, your child should begin to relax. Sometimes children receive pain or sedative medications to help calm them even when they are not experiencing pain. The staff will carefully monitor your child to assess pain and will let you know what is happening.

Q: How long will my child remain in the PACU?
A: This depends on the type of surgery your child has, how much anesthesia was required, how quickly he or she wakes up, and what medications are given in the PACU. The average recovery time is 90 minutes, but with shorter surgeries, such as ear tube insertion, the stay is usually between 30 and 60 minutes.

Please call (410) 884-4501 if you would like to schedule a preoperative tour.