Coming for an Anaesthetic- Paediatrics

What to expect

Your child will be looked after by an anaesthetist. They are a specialist doctor that will care for your child during the operation/ procedure, keeping your child asleep and providing pain relief.

You will get the chance to speak to the anaesthetist before the operation, however this leaflet should help prepare you and your child for what will happen.

Preparing your child

It is important that you speak to your child about their operation before they come into hospital. This helps them feel more prepared and will give them a chance to talk through any worries they may have. Exactly what and when you tell them will depend on the age of your child.  If your child is over the age of 4 years, it is worthwhile starting to prepare them a week before their procedure. Under 4’s should be told a couple of days beforehand and again on the day.

Encourage your child to talk about the operation and ask questions. You should let your child know that the anaesthetic will stop them feeling pain during the procedure and that they will be asleep for the entire time. 

Pre-Assessment

Once your child is booked in for their operation you will be referred to the paediatric pre-assessment service by your doctor.

The pre-assessment nurses will contact you to complete all of the hospital admission paperwork and ask about any medical conditions your child has or things they see other professionals for.

It is vital you keep all of your pre-assessment appointments or your child may not be able to come for their operation. These appointments can be face to face or over the telephone. They will also confirm all of your admission arrangements.

Sometimes the pre assessment nurses or your doctor will ask that you attend a Consultant anaesthetist Preoperative clinic for a further review. If you need to do this we will let you know. This appointment would be in addition to your pre assessment nurse appointment.

Consent

Before your child has an operation, you will be asked to sign a form on their behalf agreeing to treatment. We only do what it says on the form unless your child is in immediate danger.

If you have any questions or do not understand or want to know more, for example:

• Why the treatment would be good for your child?

• What sort of things the treatment will involve?
  
• Are there alternative treatments?
  
• What are the risks of having the procedure?
  
• What might happen if you decide not to have the treatment for your child?

The person taking consent from you will be able to answer all of these questions or will find you somebody who can.

If you need time to think about your decision please say so.

Sometimes your child can consent for themselves. If your child is 16-18 years old and can understand what the procedure is and the risk and benefits of this, they can give consent in the same way as an adult. However, you may be involved if your child disagrees or does not understand the need for treatment.

In order to consent for a child or young person you must have parental responsibility. To avoid us having to postpone your child’s treatment it is important that someone with parental responsibility attends hospital with the child. If this is not possible please let us know.

If you are not sure who has parental responsibility for your child, please just ask. We are happy to help.

If your child is unwell before their anaesthetic

Our priority is to keep your child safe. There are times when it is not safe for your child to have an anaesthetic.

If your child is unwell in the run-up to their operation or procedure, you should contact us as soon as possible.

Children and Young Person’s Elective and Investigations Unit

Telephone: 01642 383470

OR

• Children’s Ward

Telephone: 01642 382715

This will allow us to make a decision about your child coming in and avoid the inconvenience of you making arrangements which you later need to cancel.

Please call for advice if your child has: 

• Coughs, cold, fever (temperature), diarrhoea, vomiting or ear infection during the week before admission.

• Hand, foot and mouth or scarlet fever during the two weeks before admission.
  

• Chickenpox, chest infection, antibiotics from GP for cough or tonsillitis during the six weeks before admission.

• Any symptoms of Coronavirus (Covid-19) or close contact with someone who has this virus.

• Any hospital admission in the 6 weeks before their admission.

If you are not sure, please just contact us. In some cases you may still be asked to come in for a review; so that we can assess your child and decide if it is safe to go ahead.

Anxiety

It is normal for children to be worried about coming for an operation. You may also be worried. We are here to help.

If you feel that your child is particularly worried or you think they will refuse an anaesthetic please let us know as soon as possible, ideally when you meet our pre assessment team. There are lots of resources available to help you and your child and for those who are very anxious we can even organise visits to the hospital in advance of surgery or special anaesthetic plans.

Even with excellent preparation, some children may require a sedative premedication to reduce anxiety. This is usually given as a liquid, but can very occasionally be given as an injection or tablet. If we think this will help your child this will be discussed at the Preoperative clinic or by the anaesthetist on the day of surgery.

We suggest all families download our ‘Little Journey’ app from Google Play or the Apple Store. This is free.

When requested type in the name of the hospital you are visiting e.g. The University Hospital of North tees and Hartlepool and then select the pathway most appropriate to your child.

There are pathways for day case patients and those who will stay with us overnight. The app is also set up for different ages of children. You are welcome to look at all of the pathways and explore the 360 degree hospital photographs.

The app also contains games and other informative articles for you to read. Some parents find it helpful to look at the app themselves first so that they can select the most appropriate settings for their child.
There is no limit to how many times you can access the app.

On the day of the operation/procedure

For morning surgery:

• You should give your child a glass of water or dilute squash (no milk or fizzy drinks) before you leave home to come to hospital on the day of their operation.

• Your child can have breast milk up to four hours before their anaesthetic (until 5am).

• You child can eat and have cow’s milk, plant milks etc. up to 6 hours before they come in for their anaesthetic. (Until 2am).  Do not give your child milk after 2am.

For afternoon surgery:

• Please give your child breakfast before 7am and encourage them to sip water or dilute juice (no milk or fizzy drinks) until you leave home to come to the hospital. They should not have cow’s milk or plant milks (it is classed as food) or food after 7am.

• If your child is breast fed they can have breastmilk until 9am, after this they can have water until 11am.

• If your child needs thickeners (e.g. Carobel) in fluids this counts as food and so they cannot have this in the 6 hours before surgery. If this is likely to be a problem please let us know.

• Do not allow your child to chew chewing gum or have any sweets on the day of their operation.

Your child can still clean their teeth on the day of surgery.

It is advisable that your child wears loose, comfortable clothing when they come to hospital.

When you arrive

When you come to the hospital on the day of the operation your child will be admitted by one of the nursing staff.  You will be seen by an anaesthetist, who will discuss the anaesthetic plan.

The surgical team will also come and see you to answer any final questions. Very occasionally, if there are concerns on the day of the operation, we may need to delay or cancel what has been planned. This could be due to your child being unwell, new information that becomes available or an emergency on the day.  All efforts are made to avoid this from happening.

Pregnancy Tests

It is important that we know whether there is any possibility that your child may be pregnant so that we can keep them safe during their procedure. We therefore ask young people about their periods and as needed request a urine sample for testing. If you have concerns about this please speak to our nursing staff.

The anaesthetic

Your child will generally go off to sleep by one of two ways:

• By breathing in the anaesthetic gas
  
• By medications given through a cannula (small plastic tube).

If your child has a cannula inserted they will normally have ‘numbing cream’ put onto their hands to numb the skin.

This works well for most children. The medications used to go to sleep work very quickly however, children can be wriggly as it starts to take effect, so do not be alarmed. This is usually the quickest way to go off to sleep.

If your child goes to sleep with the anaesthetic gas, the anaesthetist will use a clear face mask or their hand to direct the gas to your child’s nose and mouth. It takes a few minutes to go to sleep and your child will likely become wriggly as it takes effect – this is normal.

Even if your child goes to sleep with the gas, they may have ‘numbing cream’ put on their hands and then a cannula put in while they are asleep to allow medications and fluids to be given during and after the operation.

The option that is best for your child will be discussed with you by the anaesthetist. You and your child may be able to choose which they would prefer, but sometimes this is not possible.

Can I stay with my child?

You are welcome to come into the anaesthetic room whilst your child is going off to sleep, however, if you do not wish to do so that is absolutely fine. 

Generally, only one parent can accompany their child in the anaesthetic room. If you require an interpreter we will generally invite them to come to the anaesthetic room with you so that you and your child can fully understand what is going on.

Siblings are not allowed to come into the anaesthetic room with you and your child. You should make arrangements so that they are not brought into hospital. 

Once your child is asleep you will be asked to leave the anaesthetic room. 

Very occasionally, it is not possible to accompany your child but if this is the case, it will be explained to you.

After the operation

Your child will be looked after in the recovery area by a specialist member of the nursing team. You will be able to see your child once they are safely awake. Most children do not remember their time in recovery as they still have anaesthetic drugs in their system.

After a period in recovery your child will return to their bed on the ward or day unit where they will be monitored.

After their anaesthetic your child may be sleepy or sometimes upset as they feel strange and do not fully understand why. Do not worry about this. As the anaesthetic drugs wear off they will gradually return to their normal self.
You will be allowed to eat/ drink once the nurses think you are okay.

Their cannula from theatre will remain in place until the nursing staff feel that they are awake, comfortable and not being sick. If your child likes particular foods you are welcome to bring them to the hospital for after the operation.

We offer toys and activities on the day unit but your child is welcome to bring their favourite toy or a tablet/games console if this will help them when they are with us.

Most children will be able to go home a few hours after their operation.
If your child needs to stay in overnight, one adult is allowed to stay with them on the ward. You will usually know in advance if your child is likely to stay in hospital, however sometimes this is decided on the day if they need monitoring for a slightly longer period of time.

It is always advisable to bring some essential things should you have to stay overnight with your child, particularly if you live any distance from the hospital.

Pain relief

Most children will receive medicines to reduce pain before the operation, usually paracetamol and ibuprofen. Although the hospital provides both of these medications, if your child will only take particular brands or flavours it can be useful if you bring these on the day for us to use.

Whilst asleep, your child will receive more medications to manage pain. Sometimes this will include local anaesthetic injections to numb the nerves supplying the area being operated on.

If you struggle to manage your child’s pain at home normally or if they have pain which limits their activities, please let us know so that we can put a special plan in place for them before the day of surgery.

Side effects

The most common unwanted effects following an anaesthetic are feeling sick or vomiting and a sore throat. Most children recover quickly, however some require medications to help. Feeling tired and dizzy will gradually wear off.  Some children will be more disorientated than others, but again this will wear off in time.

It is quite common for your child’s sleep or behaviour to be a little difficult after they have been in hospital. This can last for a few weeks.

Problems associated with anaesthesia are uncommon in otherwise healthy children. These can include a minor cut to the lip, damage to teeth, reactions to medications and breathing difficulties during or after an anaesthetic. 

The most serious complications associated with having an anaesthetic are very rare but include severe allergic reactions, injury to nerves and the risk of death or disability (such as stroke, deafness or blindness).

If there are any specific potential complications for your child, or we feel they are higher risk for complications, this will be discussed with you before your child has their anaesthetic.

Post-operative confusion

It is common for children and young people to be confused in the first hour after their anaesthetic. You may hear this called Sevoflurane delirium. This is most common in younger children who will often become quite upset. Your child will not generally remember this and will settle down once the anaesthetic drugs have come out of their system. It is often more distressing for the parents to witness than the child to experience.

Going home

When you go home the staff at the hospital are always available for advice if you need it. Please do not worry about calling us for help.

It is advisable to have both Paracetamol and Ibuprofen (if your child can take this) available at home in case your child needs these after their operation.

Most children do not need any more than these simple pain killers to manage their pain, particularly if they are given regularly. If any stronger painkillers are needed, we will provide these.

The anaesthetic may remain in your child’s system for up to 24 hours and you should keep an extra eye on them during this time, as they may be more prone to accidental injury.

I have questions

We want you to have all of the information you need to make the right decisions about your child’s anaesthetic. If you have any questions at any time please just ask.

You can also find more information on the website for the Royal College of Anaesthetists if you go to:  https://www.rcoa.ac.uk/patient-information

Useful links

• Information for children, parents and carers
• Risk of Anasthesia
• Information for children and young people

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]