Children are the future of our country and the heart and soul of their parents. Every parent wants their children to grow up healthy and healthy. However, some children are not so fortunate, due to one reason or another will be sick, and some need surgery, surgery will face the problem of anesthesia, but because the “procedure” of anesthesia is too professional, people do not know it, which makes parents very worried. What is anesthesia? What are the common methods of anesthesia for pediatric patients? Why are children not allowed to eat or drink before surgery? Does general anesthesia affect the child’s intelligence? What are the questions? Then let me give you the answer to eliminate your worries and concerns.
1. Why are children not allowed to eat or drink before surgery?
Many parents do not understand that they cannot eat or drink before surgery, fearing that they will aggravate their children, and some believe that they can only tolerate surgical anesthesia better if they eat well before surgery. Therefore, some parents often do not listen to the fasting time ordered by doctors and nurses and let their children eat before surgery, and as a result, they have to stop this surgery and do it again at a later date.
Preoperative fasting is an important part of preoperative preparation, which is mainly to prevent gastric contents from regurgitating during anesthesia or surgery and causing asphyxia or aspiration pneumonia, which can affect gas exchange in severe cases and endanger the child’s life. The incidence of aspiration in pediatric emergency surgery and adult emergency surgery has been reported to be 1/373 and 1/4544, respectively, and the incidence of aspiration is 10 times higher in neonates and infants than in children and 2 times higher in pediatric patients than in adults. Therefore, preoperative fasting is very necessary. However, fasting for too long to prevent malabsorption will not only cause thirst and hunger in children, but also cause unnecessary crying and irritability, and in severe cases, hypoglycemia or dehydration.
So when is it appropriate to start not eating and drinking before surgery? According to the specific situation of pediatric development in China, experts have developed a pediatric preoperative drinking and fasting time for reference.
Our pediatric preoperative fasting and drinking time recommendations (hours).
Type of intake
Fasting time
Clear beverage
2
Mother’s milk
4
Formula milk
6
Cow’s milk
6
Solid foods
8
2. Why should the anesthesiologist visit the child before surgery?
The purpose of the pre-anesthesia visit includes understanding the child’s medical history, conducting the necessary physical examination, checking the laboratory test results, etc., and then making a comprehensive assessment to provide the basis for a perfect anesthesia plan.
Pediatric anesthesia is mostly general anesthesia, and pediatric patients have a relatively large head and tongue, narrow nasal cavity, high laryngeal position, and easily loose teeth. Whether these children can receive anesthesia should be determined by their symptoms, whether they have other diseases, and the urgency of the surgery. If the child has a history of asthma, the usual drugs, including corticosteroids and β2 agonists, should be used until the day of surgery and be prepared for intraoperative resuscitation.
3. What is the purpose of preanesthetic drug administration?
The purpose of preanesthesia medication is to eliminate the anxiety of the child and parents, so that the child can be separated from the parents smoothly and avoid postoperative behavioral abnormalities due to the child’s fear.
The age-related emergency response of children to anesthesia and surgery: infants under 6 months of age are not yet able to develop fear of strangers, while children aged 1-3 years are the age group with the most perioperative psychological problems, mainly manifesting as anxiety, crying, fear of pain, fear of leaving the family, and possibly leading to prolonged abnormal behavior, which must be given sedative drugs to let the child sleep before entering the operating room for surgery These children must be sedated to put the child to sleep before entering the operating room for the procedure and then return to the parents when they wake up from the surgery.
Midazolam is currently the most widely used preoperative sedative for pediatric anesthesia, and its cis-amnesic effect can reduce the incidence of postoperative behavioral abnormalities in the pediatric population. It can be given orally (oral dose is 0.3-0.5 mg/kg) or intravenously, currently it is given intravenously in our hospital, and the intravenous dose is 0.1-0.2
mg/k g.
4. What is anesthesia? What are the common methods of anesthesia for pediatric patients?
Simply put, anesthesia is the use of drugs or other methods to temporarily render the patient unconscious, either as a whole or locally, in order to achieve painlessness. It helps to relieve the child’s pain during surgery, ensures the child’s safety, and creates good conditions for surgery.
Pediatric anesthesia methods include: general anesthesia and local anesthesia. General anesthesia includes intravenous anesthesia and inhalation anesthesia. Local anesthesia includes local infiltration anesthesia, regional block, and intravertebral anesthesia. Due to the uncooperative nature of pediatric patients, general anesthesia is mostly chosen for pediatric surgical procedures.
General anesthesia is an anesthetic method in which anesthetics are applied to the central nervous system (brain and spinal cord) so that it is suppressed and presents a loss of consciousness and no pain throughout the body. General anesthetics are divided into intravenous anesthetics and inhalation anesthetics, and inhalation anesthetics are called inhalation anesthesia when general anesthesia is achieved by inhalation through the respiratory tract, while intravenous anesthetics become intravenous anesthesia when general anesthesia is caused by intravenous or intramuscular injection. Whether it is intravenous or inhalation, there is anesthesia drugs into the body, and children with short surgery time generally come to be given intravenous drugs, mask to maintain respiration can be, if the time is long, if necessary, also need to be placed in the laryngeal mask or tracheal intubation.
Laryngeal mask placement for general anesthesia can maintain good ventilation and less irritation to the respiratory tract, mainly for: minor surgery without the risk of vomiting and reflux, such as hernia, syringomyelia; children with difficult airway; emergency resuscitation, etc.
Tracheal intubation general anesthesia is to place the tracheal tube into the trachea, which is more stimulating to the organism, but can meet the management of the airway for a long time or in different positions, and is most commonly used in pediatric anesthesia, especially for critically ill children, head, neck and chest surgery, as well as major abdominal surgery, prone and lateral surgery, tonsillectomy, intestinal resection anastomosis, etc.
6. Does general anesthesia have any effect on the child’s intelligence?
Before the child’s surgery, parents often have concerns about anesthesia, worrying about the effect of anesthesia on the child’s intelligence, especially if they choose general anesthesia. In fact, this concern is not necessary at all, because general anesthesia means that the central nervous system is anesthetized. After the child is anesthetized, he or she temporarily loses the response to painful stimuli, but still retains certain neurological reflexes and maintains normal vital signs, such as breathing, heartbeat, blood pressure, pulse and so on. The doctor will choose the appropriate dose. As the operation time progresses, the effect of anesthesia gradually decreases, and at the end of the operation, the effect of anesthesia disappears and the muscle resumes its normal work. The general anesthesia is basically excreted from the body 1-2 days after stopping the drug.
7. Can a child with only a mild cold have surgical anesthesia?
According to statistics, about 30% of children have a cold for a long period of time during the year. Sometimes, we have an appointment with the surgeon for this surgery, but the child develops cold symptoms before the surgery, so should we continue the surgery and will there be any risk of anesthesia?
These simple minor surgeries and colds may not be a big problem when viewed separately, but for anesthesiologists it is a matter of careful consideration.
First of all, the respiratory tract of children is more sensitive and therefore reacts to many stimuli quite strongly. In order to maintain the respiratory tract during general anesthesia, a laryngeal mask or endotracheal tube must be inserted, which can cause irritation to the trachea and surrounding mucous membranes during placement and can easily cause life-threatening conditions such as laryngospasm and bronchospasm. According to clinical literature, the chance of these complications during general anesthesia for children with colds is 5-10 times higher than for children without colds. Moreover, the younger the child with a cold is, the higher the risk of anesthesia. Therefore, it is recommended that once a fever or cold (temperature greater than 38 degrees, cough, runny nose) is detected, the routine surgery should be canceled. How long should the surgery be postponed? It is generally recommended that surgery can be scheduled again after 2 weeks of complete remission of cold symptoms without increasing the incidence of respiratory complications.
With the above explanation, I believe you already know about pediatric anesthesia and will not be overly worried as you were before. In order to reassure the parents and ensure the safety of the child, the anesthesiologist will care for the child as if it were his or her own, and will take extra care of it.