An operation is always an important moment in the life of a
child. Hospitals can be a positive experience and a place to learn.
Parents have an important role in preparing your child to make this
as positive and non-frightening as possible. This booklet will help
you explain what to expect when your child has an anaesthetic. In
the days before hospitalization look at the booklet together,
preferably reading it together like a storybook. Let your child
tell you what they are expecting and answer their questions
truthfully. Avoid lying about the procedures even if you think it
is reassuring. If you have any questions about the surgery ask the
surgeon or anaesthetist before the operation.
What is an anaesthetist?
An Anaesthetist is a doctor who has spent many years of
additional training in anaesthetics after they graduate as doctors.
You can be reassured about the ability and qualifications of the
anaesthetist who will manage your child during surgery. Specialist
paediatric anaesthetists in Australia are among the world's most
highly trained doctors, having spent years undergoing special
training in anaesthesia, pain control and resuscitation and
managing medical emergencies. The anaesthetist's role is to ensure
your child doesn't feel anything during the surgery and we want
your child to experience as little pain and discomfort as possible
after the operation. While your child is asleep, their anaesthetist
will stay with them at all times during the operation and monitor
them closely. Today's equipment is able to tell us a great deal
about the patient during anaesthesia and allows us to control the
delivery of anaesthetic drugs very carefully. Today there is so
much monitoring in the operating theatre that it looks like the
cockpit of a jumbo jet.
Why must children fast?
We know children don't like being hungry and thirsty but no food
or drink is a must! If you don't follow this rule the operation may
be cancelled or postponed in your child's best interest. The reason
is that when anaesthetised, the stomach stops working and the cough
and other protective reflexes stop working. If there is food or
fluid in the stomach it can passively run back into the mouth and go down
into the lungs.
The following guidelines are issued by the Department of
Anaesthesia and Pain Management of the Royal Children's Hospital
concerning fasting for all patients, whether surgical, medical or
undergoing a general anaesthetic or sedation.
For all patients having an anaesthetic, please note recent changes in fasting guidelines for clear fluids introduced October 2015.
The goal of these guidelines is to minimise the fasting
times for clear liquids to 1 hour. There is always an effort
made to organise an operating list order such that the youngest
patients are early in the list, and thus have the shortest fasting
times. If your child is scheduled for later in the list, your
anaesthetist may allow them to have a drink of clear liquids, or a breast feed, if time permits, however this
is not always possible.
These guidelines can only be modified after discussion
with the anaesthetist. If the guidelines are breached without
discussion with your child's anaesthetist, then this may result in
the operation being delayed or even rescheduled for another
For children less than 6 months of
- Please plan for the last breast feed to finish
no later than 3 hours before the start of an
elective list. So, for a morning list that starts at 8:30 am,
breast feed to finish by 5:30 am. For an afternoon list that starts
at 1:30 pm, breast feed to finish by 10:30 am. Clear liquids are able to be offered up to 1 HOUR before the start of surgery.
- Please plan for a formula or cow's milk feed to
finish no later than 4 hours before
surgery (finish at 4:30 am for a morning list,and 9:30am for an
afternoon list). Clear liquids are able to be offered up to 1 HOUR before the start of surgery.
For all other patients:
- No milk, food, lollies or chewing gum
for at least 6 hours before the start of an
elective list (nothing after 2:30am for a morning list, and nothing
after 7:30am for an afternoon list)
- Clear liquids are allowed up to 1 hour before the start of an elective list.
Clear liquids are transparent when held
to the light. They include
glucose-based drinks, cordials and clear juices.
This does not include particulate or
milk-based products or jelly.
Patients with a specific staggered admission
- The fasting orders above should be applied to that specific
Cardiac Surgery patients:
- Lists start at 8am, so fasting times above should be applied to
this start time, OR a specific staggered admission
time, if your child has been given one.
- Please continue regular oral medications unless otherwise
requested by your anaesthetist or other medical staff involved in
your child's treatment
- Medications can be taken with a sip of clear liquid.
What to do if you are unsure about appropriate fasting times,
or any other aspect of planning for your child's elective
Contact the Pre-Admission Resource Centre (PARC,www.rch.org.au/preadmission/contact.cfm?doc_id=12069)
on 9345 4115 or 9345 4193 during office hours.
Emergency surgery and anaesthesia
Patients should be fasted from first contact until further
instructions from the duty anaesthetist.
The preoperative examination: What is it and why?
What should I tell the anaesthetist? As much as possible! Your
anaesthetist will want to know about:
- when your child last had anything to eat or drink
- any recent coughs or colds and fevers
- any previous anaesthetics or family problems with
- abnormal reactions to drugs or allergies
- any history of asthma, bronchitis, heart problems or other
- whether your child is on any medication at present
- any loose teeth
A pre-med is any thing given prior to the operation, which
reduces discomfort after the operation.
The two common forms are:
- An anaesthetic cream is applied to the back of your child's
hand and a plastic dressing applied as a cover. This cream slowly
penetrates the skin and numbs the area. After 60 minutes the skin
is anaesthetized and the pain associated with needles is markedly
reduced. Some children get a mild reaction to the cream or dressing
with some redness.
- Some children will also be prescribed a mixture or drops in the
nose or mouth. This is commonly paracetamol (panadol) with or
without a sedative, which calms the child. Children rarely get a
'needle' pre-med anymore.
Parents in the anaesthetic room
The attitude of doctors to parents in the anaesthetic room has
changed. One of the parents may be allowed to accompany the child
during induction of anaesthesia. If you are very nervous or upset
it is best not to come into the anaesthetic room. Your anxiety is
conveyed to the child and makes induction of anaesthesia more
difficult. In some circumstances you will not be allowed to
accompany your child. For children less than 6 months of age,
emergency cases and most night and weekend cases we are unable to
allow parents in the room for safety reasons. You must accept that
our primary concern is the child and agree to leave when you are
not feeling well, when we ask you to leave and when the child is
asleep. It is common for parents to get distressed when their child
is anaesthetized. With intravenous anaesthesia your child may
become unconscious rapidly and look pale and floppy. It is natural
to get a little teary. Your anaesthetist expects this and will be
reassuring. We ALWAYS take good care of your children.
Separation from parents
Infants up to 6 months of age are minimally upset by separation
from parents and home situation and have the least psychological
impact from surgery even if it is major. Children from 6 months to
4 years are the most vulnerable because the child's separation
anxiety is at it's maximum. Children are becoming old enough to
remember, especially negative experiences, but not old enough to
understand the need for surgery and hospitalization. To help in
this age group premedication is common if they are upset. With this
group parents at induction are most helpful. School age children
are usually less upset about separation and more concerned about
the surgical procedure. Sometimes they prefer not to be accompanied
by their parents.
What are the different types of anaesthesia?
What is a general anaesthetic?
Occasionally parents are concerned about anaesthetics for their
children because of bad experiences they had with anaesthetics as a
child. Anaesthetics have changed and now most people find
anaesthesia a pleasant experience as the latest agents produce a
feeling of well-being. Premedication often affects the memory after
the event so children rarely remember going off to sleep.There is
no such thing as a light anaesthetic. Every time someone has an
anaesthetic the same procedures and safety considerations are put
into place. Only the length of the anaesthetic and the type of
surgery varies. Small children and occasionally adults can go to
sleep with a potent anaesthetic gas mixed with oxygen and nitrous
oxide (laughing gas). The newer gases do not have a particularly
unpleasant smell. A drip placed in the vein is a way of
Ôfast-trackingÕ the onset of anaesthesia. These drugs cause sleep
within a few seconds and rapid awakening at the end of the
operation. During the operation it is important to control the
breathing of the patient carefully. It is sometimes necessary to
introduce a tube into the airway and take over control of breathing
until the end of the operation. Because this tube is in contact
with the vocal cords patients sometimes wake with sore throats or
What is a regional anaesthetic?
Regional anaesthesia is a way of blocking painful sensations
from a limb or part of the body during and after surgery with local
anaesthetic. There are a great number of techniques of local and
regional anaesthesia whereby most parts of the body can be numbed.
In children local anaesthetic is injected after the children are
sedated or anaesthetized. The best known are epidural and spinal
- Epidural anaesthesia: A special needle is placed between the
bones of the back (vertebrae) and a piece of fine tubing called a
catheter is placed in the epidural space. Once the catheter is in
position the needle is removed and the fine catheter taped to the
skin. Anaesthetic drugs are injected through the catheter into this
space and can reach the nerves directly, blocking painful
sensations. (This technique is very common for pain relief during
labour and delivery). After major surgery a small pump
delivers the local anaesthetic continuously for two to four days
after the operation.
- Caudal anaesthesia: The principles are similar to epidural
anaesthesia but the needle is placed at the very bottom of the
spine. This is a very common form of anaesthetic for children and
has been demonstrated to be very safe.
- Spinal anaesthesia: The local anaesthetic is placed in direct
contact with the nerves at the lower end of the spinal column with
a thin needle. With this technique movement of the legs and pain
are both blocked. This is used for shorter operations and is not
continued after the operation.
- Local anaesthesia: The skin around the area being operated on
is infiltrated with local anaesthetic or specific nerves supplying
that area are blocked to produce localized pain relief.
What happens in the recovery room?
Every anaesthetized patient must spend time in the recovery room
after an operation. The nursing staff in recovery room are
specifically trained to look after children who have been
anaesthetised. Among other things, the staff ensure your child:
- is recovering appropriately from the effects of the
- is not in pain
- does not require drugs for nausea or vomiting
- does not have excessive bleeding from the operation site
The recovery room has a number of monitors similar to those in
the anaesthetic room. Sometimes your child will require extra
oxygen given with a mask to help recover from the anaesthetic.
After the operation
Common problems after the operation are:
A number of measures are used to relieve pain after the operation.
Panadol is often given as a pre-med for pain after the operation.
During the operation pain
relieving drugs (analgesics) are given as required, and
local anaesthetic is used. Children sometimes have a
suppository placed in their bottom after they are asleep to provide
analgesia for the two to three hours post operation. The
suppository works slowly and is most effective as the local
anaesthetic is wearing off. After the operation further analgesia
is ordered as appropriate. These medications are usually taken
orally, or, for more severe pain, into the vein via the
cannula placed at the start of the anaesthetic. A
P.C.A. (Patient Controlled Analgesia) delivery device is used
by the This delivers analgesic drugs into the drip with a mechanism
to increase the delivery if pain persists. If your child has pain
they can get extra analgesia through the needle already in their
hand or from a mixture to drink. We usually recommend continuing
paracetamol every four hours for at least 24 hours after
- Nausea and vomiting may occur. Certain operations especially
ear, nose and throat operations and those on the eyes are
associated with nausea after the operation. The incidence has been
reduced in recent years with the use of new drugs. The anaesthetist
will often give your child drugs to decrease vomiting.
- Bleeding and bruising. Bleeding from the operation site is
closely monitored and the surgeon notified if it is excessive.
- Sore throats, muscle aches and headaches may occur and usually
respond to simple pain relief mixtures. Children sometimes complain
of blurred or double vision as they are recovering from
When can we go home?
Over half of all surgery is now done on a same day basis where
you come into hospital on the day of operation and leave on the
same day. If your operation is this type you can usually leave 1-2
hours after waking from the anaesthetic. For more major surgery the
length of hospital stay is often longer and is determined by the