Questions You Will Be Asked by Your Anesthesiologist

Anesthesia is administered to your child so that he/she will not feel pain during painful procedures. Anesthesia may also be required for studies ordered by your physician which are not painful but require your child to remain absolutely still, such as CT scans or MRIs. The type of anesthesia, the particular drugs used, as well as how they will be administered, is determined by the nature of the procedure/study planned and your child’s medical condition. This requires asking you and your child (if they are old enough) a number of questions related to their medical history.

The following are some of the questions you may be asked. Further questions may also be asked depending upon the situation.

How old is your child?
What procedure is your child coming for?
Why does your child need this procedure?
Does your child have any other medical problems, such as asthma or a heart murmur?
Did your child have surgery previously? What type?
Did your child or anyone in the family have a problem with anesthesia in the past?
Does your child have any allergies to medications?
Is your child taking any medications at the present time?
When was the last time your child had anything to eat or drink?

For Children Less Than 2 Years of Age:
Was your child the product of a full term pregnancy?
If not, at how many weeks did you deliver?
Did your child have any medical problems after birth?

The Meet Me at Mount Sinai program is the first step in introducing your child to the hospital and surgery. Preparing your child for surgery is important. In fact, it has been proven that children who are prepared for surgery and have support throughout the hospital experience recover more quickly and have fewer problems than those who are not prepared. This program provides an opportunity for you and your child to preview the hospital experience and ask questions in a caring setting, so that your child will be better prepared when it is time for surgery. These sessions are offered in both English and Spanish.

An experienced team that includes a pediatric social worker, a pediatric surgery nurse practitioner, and a child life specialist runs the MEET ME AT MOUNT SINAI program. The pediatric surgery nurse practitioner will perform a pre-operative needs assessment and the pediatric social worker and child life specialist will do a psychosocial evaluation and developmentally appropriate preparation.

This program is designed to meet you and your child’s particular needs. Younger children get their own doll to "doctor" along with a play medical kit and a coloring book about hospitals. With these toys, your child is guided through each step of the hospital experience. For older children and teenagers, the program is tailored to their individual interests and questions. These sessions tend to be more interactive.

For more information call (212) 241-9403.

NPO (Nothing By Mouth) Guidelines

Patients who are undergoing anesthesia of any type are not allowed to eat or drink for some time beforehand. This time period is dependent on the type of food and drink and the age of the patient. It is important that these guidelines are strictly followed. Patients who eat or drink within the restricted time period are at increased risk for their stomach contents to come up (regurgitation) the esophagus (food tube) and enter the lungs (aspiration) while under anesthesia. In many cases, this may result in an aspiration pneumonitis (a type of pneumonia). Treatment may require placement of a breathing tube in the windpipe (intubation), being connected to a breathing machine (mechanical ventilation), and being in an intensive care unit for many days. Sometimes, this type of pneumonia may be life threatening. If these guidelines are not followed, for the safety of your child, the procedure may need to be postponed to another day.

The Following are the NPO Guidelines

1. Formula, Milk, and Solids

• If your child is less than 3 years of age, they may have these foods up until 6 hours prior to the time of surgery.
• If your child is 3 years of age or older, they may have these foods up until 8 hours prior to the time of surgery.

2. Breast Milk—Your child may be fed breast milk up until 4 hours prior to the time of surgery.

3. Clear Liquids—Your child may drink clear liquids up until 2 hours before the time of surgery. Examples of clear liquids are water, Pedialyte, tea, apple juice, jello WITHOUT fruit, and clear broth. FRUIT JUICES WITH PULP ARE NOT ALLOWED.

4. If Your Child Has Any of the Following Problems You Should Only Follow the Guideines Outlined in #1. #2 and #2 Do Not Apply.

• Any disease of the esophagus, stomach, or intestines (e.g., reflux)
• Kidney failure
• Liver disease Obesity
  

These guidelines apply only to The Mount Sinai Hospital and should not be referred to for use at any other hospital. Other hospitals will have their own guidelines that may differ from ours.

Parental Presence in the Operating Room

At The Mount Sinai Hospital, if a child is one year of age or older, one parent MAY be allowed to accompany their child into the operating room for the start of anesthesia. The anesthesiologist will make this decision after interviewing the parents and examining the child. The purpose of parental presence in the operating room is to avoid separation anxiety and to comfort the child. Parents who are anxious and/or crying may make the child more anxious and make the start of anesthesia more difficult. Accompanying the child into the operating room is optional. A parent who feels uncomfortable doing so should not come in because they may not be able to provide the necessary support for the child. Also, any parent who is pregnant is discouraged from coming into the operating room.

The anesthesiologist will explain to the accompanying parent what to expect during the start of anesthesia. Once the child is asleep, the surgical resident or operating room nurse will escort the parent out of the operating room. NO PARENT IS ALLOWED TO STAY IN THE OPERATING ROOM FOR THE SURGICAL PROCEDURE. The parent must leave the operating room at any time when requested to do so by the anesthesiologist.

Types of Anesthesia

There are three types of anesthesia: general, regional, and sedation. The type of anesthesia administered is dependent upon many factors. The type of surgery, the age of the patient, the medical condition of the patient, and patient preference all play a role in determining the appropriate type of anesthesia to administer.

GENERAL ANESTHESIA

In most cases, general anesthesia is the anesthetic of choice for the pediatric patient. General anesthesia can be induced (started) either by inhalation (breathing) of the anesthetic gas via a face mask or by intravenous (IV) injection of anesthetic medications. An inhalation induction is preferable in most cases because there is no need to place a catheter in the vein prior to the child being asleep. In this way, the child does not experience any painful procedure.

Inhalation induction:
Upon entering the operating room, an attempt will be made to place monitors on the child prior to the start of the anesthetic induction. These include; an electrocardiogram to monitor the heart rate and rhythm, blood pressure cuff to monitor the blood pressure, a pulse oximeter to monitor the level of oxygen in the blood, a stethoscope to listen to heart and breath sounds, and a temperature probe to monitor temperature. In some instances, the child will not be cooperative for placement of these monitors prior to the induction of anesthesia and they will be placed once the child is asleep. A clear facemask that was pretreated with a pleasant smell (bubble gum or cherry) will be placed over the child’s nose and mouth. Oxygen and the anesthetic gases are delivered through the facemask. After a few breaths, the anesthetic gas will begin to take effect. At this time, monitors are placed, if they were not attached previously, and a catheter is inserted into a vein. Depending on the surgery, an endotracheal tube (breathing tube) may be placed into the trachea (windpipe) for better control of the airway and breathing.

Intravenous induction:
In certain circumstances, when an inhalation induction may not be safe, induction of anesthesia can be accomplished by injecting anesthetic medications through a catheter into the vein. An IV induction may also be used if an intravenous catheter is already present or if preferred by the child. The advantage of this type of induction is that it is rapid and the child does not have to breathe the anesthetic gases, which may be unpleasant despite the scent placed on the mask. The disadvantage of this method is the need to place a catheter into the vein, which involves a needle stick. If planned far enough in advance, a special ointment that numbs the skin can be applied to the area(s) where the IV will be placed. This ointment takes at least 45 minutes to take effect.

REGIONAL ANESTHESIA
Regional anesthesia numbs the area that is being operated upon. This is accomplished by injecting local anesthetics in the area of the nerves that supply the part of the body that is being operated on. This type of anesthesia, especially in the younger patients, is usually accompanied by general anesthesia. The benefit of using both techniques is that the regional anesthetic will decrease the amount of general anesthesia needed and will provide postoperative pain relief as well.

SEDATION
This type of anesthesia provides pain relief and makes the patient sleepy, but not unconscious. In some situations, additional sedation may be required. This is often indistinguishable from general anesthesia.

Post Anesthesia Care Unit

After the procedure is completed, your child will be awakened in the operating room and transported to the Post Anesthesia Care Unit (PACU). In the PACU, after vital signs are taken and report is given to the nurse who will be taking care of your child, one parent will be allowed at the bedside. If the PACU is not very busy, the nurse in charge may allow both parents in at the same time.

The usual stay in the PACU for patients going home the same day of surgery is 1-2 hours. During that time, your child is monitored for any problems that may arise. The liberal use of intravenous fluids in the operating room and PACU precludes the need to drink before going home. It is not unusual for patients to get carsick after anesthesia.

Your child may be quiet or crying upon arrival to the PACU. Both are normal behaviors after anesthesia. Children usually calm down soon after arrival to the PACU, when they are fully awake and with their parent(s). Sometimes they may need additional pain medication, which will be administered by the PACU nurse. Some children may experience emergence delirium when awakening from general anesthesia. This consists of restlessness, disorientation, crying, combativeness, and difficulty in communicating. Although distressing to see, it is not an unusual event and usually resolves quickly. During this time it is important to comfort and reassure your child while making sure that the child does not hurt him/herself.