General anaesthesia, also sometimes called general anaesthetic or GA, is where a mixture of medicines is given to your child to keep them in a carefully controlled unconscious state, or ‘sleep’. General anaesthesia is usually used for major surgery (e.g. heart, brain, bone and spine surgery) and also more minor surgery (e.g. a hernia repair and ear, nose or throat surgery).
Children can go to sleep for surgery by one of two ways – your anaesthetist will talk to you about the best way for your child to have general anaesthesia.
After surgery, your child will receive ongoing care. Depending on the type of care your child needs after surgery, they may be able to go home directly, moved to another ward or to the paediatric intensive care unit (PICU).
What to expect with general anaesthesia
An anaesthetist (also called an anaesthesiologist) is a specialist doctor who gives your child their general anaesthetic medicines and monitors your child closely during their surgery. Your child will need to fast before their surgery for the general anaesthetic to be safe. See our fact sheet Preparing your child for surgery – fasting.
You will meet the anaesthetist looking after your child before your child’s surgery. This usually happens on the morning of the surgery, but you may also meet them at a preadmission appointment a few days before the surgery.
Your child’s anaesthetist will:
- ask questions about your child’s health, including medical problems, allergies and whether they have had general anaesthesia before
- explain what happens to your child in the operating theatre and answer any questions you have about anaesthesia.
A local anaesthetic cream (e.g. AnGel cream or EMLA) may be applied, to numb some areas of skin where a drip (intravenous or IV cannula) is put in. The cream can take 45 to 90 minutes to work and will reduce the pain associated with having the drip inserted.
Some children will also have a medicine to help them relax before their surgery – this is called a premedication, more commonly called a premed. A premed can be given 15 to 60 minutes before surgery – the medicines usually used for children are midazolam or clonidine. These medicines are usually mixed with a small amount of syrup, cordial or paracetamol mixture (e.g. Panadol) for your child to drink. You can discuss any questions you have about a premed with the anaesthetist.
Your child should continue taking their regular oral medicines at the usual time unless otherwise requested by your doctor. Medicines can be taken on the day of surgery with a sip of clear liquid.
If your child takes blood thinners (e.g. aspirin, warfarin) or medicines for diabetes (e.g. insulin), they may need to be stopped or adjusted before the surgery. You should contact your doctor at least two weeks before your child's scheduled surgery for a plan in taking these medicines.
Your child will need to fast (not have anything to eat or drink) for a few hours before their surgery. Check the fasting instructions in your admission letter and make sure you understand when your child needs to fast. If your child has not appropriately fasted, their surgery may be delayed or cancelled. See our fact sheet Preparing your child for surgery – Fasting.
Your child moves from the waiting room to an area outside the operating theatres called the pre-operative holding area (usually referred to as preop hold). Your child will be checked in by nursing staff and will wait here while they are getting ready for surgery. The nurses will get your child ready by:
- helping to dress them a hospital gown
- checking their patient identification (ID) bands
- going through a pre-surgery checklist with you.
Your child is then wheeled on a bed to a room beside the operating theatre. You can come along with them to this room and stay with them until they are asleep.
Your anaesthetist will talk to you about the best way for your child to have general anaesthesia. Children can go to sleep by one of two ways. Both methods will put your child to sleep quite quickly and keep your child asleep throughout the operation.
Medicine through a drip
Most children will have a drip (IV cannula) put into a vein. This is done before going to sleep or after they have fallen asleep.
- Numbing cream is usually put on the skin, or ice or Coolsense can be used. Distraction is also helpful.
- A small needle is used to insert the drip, but the metal part (the needle) is then taken out and only a plastic tube or ‘straw’ (the drip) stays in the vein.
- The drip is secured to the skin using tapes and dressings so it will not come out.
- The anaesthesia medicine is given into this drip. It may feel cold as it goes up your child’s arm.
- It takes seconds to go to sleep with this medicine.
Breathing medicine through a face mask
- Some children go to sleep with a vapour (gas) medicine given to them with a mask that is placed over their mouth and nose.
- Your child can choose a flavoured smell to go in the clear plastic mask.
- The mask is then held snugly over their nose and mouth.
- Your child then breathes in a ‘laughing gas’ and ‘sleepy gas’ mixture.
- It takes a minute or two to go to sleep this way.
It is normal for your child to wriggle, cough, breathe noisily or snore as they go to sleep.
When your child is asleep, the anaesthetist will insert a breathing tube, and other equipment if required. They will also attach some monitoring. This may take up to an hour or more to complete, especially if your child is having complex major surgery.
The breathing tube is removed at the end of surgery in the operating theatre or sometimes in the post-anaesthesia care unit (PACU, also called recovery). Your child probably won’t remember this tube coming out, but they may have a sore throat or croaky voice for a few hours after. Your child will also have a drip and a dressing over their surgical wound.
Your child will be moved to the PACU. The nurses will call you a little while after they arrive so you can be with your child as they wake up. Your child may be sent directly home from here, or they may be moved to a ward for a night or two.
If your child has more complex or major surgery, they will be transferred to the paediatric intensive care unit (PICU) after their surgery is finished.
Care after surgery
Depending on the surgery, it may take from a few days up to a few weeks for your child to recover. Nurses will monitor your child during their hospital stay for the following common problems as they recover from surgery:
Nausea and vomiting
The anaesthesia plan for your child will usually include medicines to reduce the chance of feeling sick (nausea or vomiting) when your child wakes after surgery. If your child feels sick or vomits after surgery, there are medicines that you child can be given to help them feel better.
The anaesthetist and your surgeon will give pain relief (analgesia) during your child’s surgery so it is working as your child wakes up.
It is helpful for you to share information about pain relief your child has had in the past – this helps doctors choose the medicines to keep your child comfortable. You may be asked:
- whether your child prefers tablets or syrups
- which pain relief medicines they have had, or have worked in the past
- if your child (or you) have had any side effects to pain relief medicines.
Pain relief can be given by mouth, through a tube into the stomach (nasogastric tube) or directly through a drip into a vein. This will depend on the type of surgery your child has had and how long they take to recover and stay in hospital.
After major surgery, your child will have pain relief given through a drip. Most patients have pain medicines for one to two weeks after major surgery. If your child is old enough, they may have pain relief medicine given by patient controlled analgesia (PCA) pump. A PCA has a button that your child can press when they are in pain. See our fact sheet Patient Controlled Analgesia.
If your child is taking strong pain relief medicines, nurses and doctors from the Children’s Pain Management Service (CPMS) will visit your child everyday while they are taking these medicines. They can help adjust pain relief medicines to keep your child as comfortable as possible.
Wound and drain care
Nurses will closely monitor your child’s surgical wound (cut) to make sure it doesn’t keep bleeding and will check the drains (and the fluid coming out of them). Your child’s surgeon will be told if there is too much bleeding, or if nurses are concerned for any other reason.
Some bruising around the wound or cut is normal and should heal as your child recovers. See our fact sheet Wound care.
Returning to usual activities
Your child will need rest and may not feel like doing very much or doing their usual activities. Many children will need some time at home from school or kindergarten. The amount of usual activity your child takes part in should be guided by how they feel. Your doctor will let you know how long your child will need to rest at home, and how long it might take for your child to return to their normal activities.
Key points to remember
- General anaesthesia or GA is a mixture of medicines given to your child to keep them asleep during surgery.
- Children can go to sleep for surgery by one of two ways – medicine can be given through a drip or gas can be breathed through a mask.
- You can stay with your child until they are asleep.
- Your child will be moved to recovery after surgery and nurses will call you so you can be with your child when they wake up.
- Nurses will monitor your child’s wound and provide medicines for pain and nausea and vomiting if required.
For more information
Common questions our doctors are asked
How do I teach my child to take tablets before their surgery?
Some medicines are available as liquids and tablets, or can be crushed and mixed with water. Some only come as a tablet. If your child can’t take tablets it can be helpful to teach them before their surgery, especially if they need to take these medicines once they go home. See our RCH brochure Teaching children how to swallow tablets and capsules for some useful tips.
Why does my child need a blood test to check their iron level before their surgery?
It can be a good idea for your child to have a blood test to check their blood count and iron levels before major surgery. This finds out if they need their iron stores topped up by tablet or infusion into the vein. It can reduce the need to have a blood transfusion during surgery. You can talk to your doctor before the surgery if you are concerned about your child’s iron levels.
Are there any helpful videos to prepare myself and my child?
The RCH has lots of resources that can help you and your child prepare for surgery. Watching videos on our Be Positive (B+) page with your child is a great way to show them what to expect. You can also visit our Comfort Kids page, which has helpful resources for both parents and children.
Will my child need a blood transfusion during their surgery?
During the surgery, your team may collect your child’s own blood (with a special machine called a ‘cell saver’) and give it back to them. Some children also have a blood bank transfusion under GA or after the surgery. The RCH team does not recommend directed donation where a family member donates blood for the child.
Developed by The Royal Children's Hospital Anaesthesia and Pain Management department. We acknowledge the input of RCH consumers and carers.
Developed October 2019.
This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.
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