In this section
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.
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.
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.
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
Solids - cease 6 hours before start of elective list
Formula and Cow's Milk (All Ages) - cease 4 hours before start of elective list
Breast Milk (All Ages) - cease 3 hours before start of elective list
Clear Fluids (All Ages) - cease 1 hour before start of elective list - there will be a 'sip until send' stipulation for emergency list patients and inpatient elective cases (i.e. NOT nil by mouth)
Note that morning lists start at 8:30am, and afternoon lists at 1:30pm
Cardiac Lists start at 8:00am.
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.
If concerned or questions arise, please contact the specific Anaesthetist for the list, or ext 52000
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.
Patients should be fasted from first contact until further
instructions from the duty anaesthetist.
What should I tell the anaesthetist? As much as possible! Your
anaesthetist will want to know about:
A pre-med is any thing given prior to the operation, which
reduces discomfort after the operation.
The two common forms are:
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.
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.
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
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
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:
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.
Common problems after the operation are:
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