If Your child is going to undergo surgery and anaesthesia; hopefully this information will help you understand anaesthesia better.

we understand that this is not easy for you. we are here to make it as safe, simple, & pain free as it can be. These are the most common questions that you may be seeking answers for.

What is a paediatric age group?

it ranges from a new born till 18 years of age.
We take them as neonates, infants, toddlers, preschool and school going groups.

What is anaesthesia?

Anaesthesia is a state in which patients are unconscious and pain free.

Who is a paediatric anaesthesiologist?

Paediatric anaesthesiologists are those who are well trained in handling babies and children with their special requirements. They have lots of experience in dealing with small babies as they selectively work with this age group. Other than administering anaesthesia, they also take care of, pain relief in the immediate post operative period.
They are the ones, who love paediatric anaesthesia and their little patients!!

How do we prepare children for anaesthesia?

It depends on the age of the child and nature of surgery.
Usually preparation starts right from a preoperative visit. This gives us chance to understand the child, and at times pick up this extra sensitive who special ire extra special care.
It is imperative for us to make children of the respective age group to understand what they are going through. Age appropriate information HAS to be given to them .As it is their body which is going to be operated or a child might not trust us on other similar occasions.For example, a parent might tell the child that he is here only to take a photo or a dressing and would be back home, this child obviously later experiences that this statement was false.
He might not then trust his elders.

Preparation is done in proper steps. These are as follows

History-to assess previous illness, surgeries, allergies.
Examination-to assess the physical status.
Premedication-fear of separation from parents is seen in children more than 6 months of age .secondly most of them have a morbid fear of needles and pricks. Fear of unknown is also an essential component of their anxiety.
we render these child tranquil with premedication (sedative, anxiolytic) given either orally or intranasally. This makes separation from parents less traumatic. They also take to induction (administration of anaesthesia) well. The over all experience is thus pleasant.

How do we give anaesthesia?

If child has a intravenous access placed in his hand , then anaesthetics medications are given through the same directly. if not ,oral drugs are give 30 to 20 minutes before surgery so children calm down and are not distressed by fasting. These drugs can also be given through nose their action is faster although it can irritate, but only for a while.
If child does not have intravenous access, then local anaesthetic cream can also be applied on the hand around 30 minutes prior to a needle puncture so it does not hurt.
Other method is inhalation of anaesthetic gases through a mask.

What is regional anaesthesia?

This is a technique where a portion of a patients' body is made insensate to surgical stimuli by local anaesthetic drugs. These are of two types.
Central neuroaxial blockade-in this type local anaesthetic is injected into spinal or epidural space through a small gauge needle. This is useful for surgeries involving lower limbs,& lower abdominal surgeries.
Peripheral nerve block-in this type a local anaesthetic is injected around a particular nerve or group of nerves. A hand is rendered insensate by depositing local anaesthetic around the nerves supplying the brachial plexus and so on.

Is regional anaesthesia safe?

Yes it essentially safe. it does run a very rare risk of nerve damage. But the advantages definitely outweigh the disadvantages which in any case are rare.

Advantages of regional anaesthesia

Effect lasts longer than the duration of surgery, hence patient gets immediate pain relief after surgery. Decreases requirement of other medications used for pain relief, hence minimizes side effects associated with them. Decreases stress response to surgery.

How do we give pain relief after anaesthesias is withdrawn?

we use different modalities for pain relief, they are as follows
Regional anaesthesia-epidural catheters for continuous infusion of local anesthetics or for giving top ups 2 to 3 times per day, & as when required with in a safe dose limit.
oral medications
Intravenous injections
Rectal suppository
Transdermal patches (skin patch) of pain killer drugs.

Why pain relief is essential.

For obvious reason, children and even small babies feel as much pain as any adult , which should be treated.
Adequate pain relief makes hospital stay more comfortable
Early mobilization is possible, hence early recovery,& early discharge.
Unrelieved acute pain can lead to chronic pain.
At the same time , we need to keep in mind that zero pain relief is not achieved at all the time but pain is made comfortably bearable.

What is preoperative fasting?, why does a child had to fast before surgery and anesthesia?

Pre-operative Fasting:
When patients receive anesthesia for surgery, they become very relaxed and sleepy. When patients are this sleepy, the muscles of the stomach and throat which normally stop food from coming up into the throat, and then going down into the windpipe or trachea, and then into the lungs, are also relaxed. When patients get food or liquid into their lungs from the stomach, this can cause pneumonia . To minimize the risk of this happening, patients are asked not to eat or drink for a certain length of time before surgery. Anesthesia is therefore much safer.

Type of food or liquid

Fasting time before surgery

Fatty or fried food

8 hours

Formula feed, milk

6 hours

Breast milk (infants)

4 hours

Clear liquids

2 hours

Applications Open - Jan 2018

Contact: vrushaliponde@gmail.com

Fellowship in Pediatric Regional Anaestheia