Does anesthesia affect my child? This is a question asked by many parents of children who need to undergo surgical procedures. Let me use an analogy here. Anesthesia is like riding in a car. Under normal circumstances, riding in a car is not life-threatening, but in the event of a car accident or other unforeseen circumstances, it may be life-threatening. Anesthesia is the same. Normal anesthesia has no adverse effects, but in rare cases where there is an anesthesia accident, there can be adverse effects. After all, the risks of both anesthesia and car rides are objective. But there is no need to refuse to ride in an automobile for fear of a car accident. This is also true of “choking on the car”. Pediatric anesthesiology has long been developed as a specialized discipline, and only professionally trained and qualified pediatric anesthesiologists are able to select the best anesthetic methods and medications based on the psychological, physiological, and pharmacological characteristics of children of different ages, as well as the location and duration of the required surgery. The first step of pediatric anesthesia is hypnosis, i.e. basic anesthesia! Because it is impossible for children to cooperate with the surgery, detachment from relatives will make children cry and restless, even if the surgical site of local anesthesia is very good, there is no sense of pain children will still cry and struggle. Basic anesthesia is when the child enters the operating room and is first given medication through the already established IV access to put the child to sleep. Ideally, basic anesthesia should put the child to sleep, but with normal breathing and heartbeat. Because basic anesthesia is also the administration of medication through a vein to the entire body, some anesthesiologists also call it a “general anesthesia,” in the broadest sense of the word. But the basic anesthesia alone can not tolerate the pain of the operation, because the basic anesthetic is mainly sedative drugs, no or only very light analgesic effect, equivalent to we take sleeping pills to sleep more deeply, take the needle will wake up the same. Therefore, the second step of pediatric anesthesia must also be analgesic! At present, the commonly used analgesic methods are general anesthesia, regional nerve block anesthesia (local anesthesia) two ways. General anesthesia can be divided into inhalation anesthesia (we often say tracheal intubation or laryngeal mask general anesthesia, the patient’s breathing by the respiratory control), intravenous compound anesthesia (intravenous analgesics, the right amount of drugs, if you can give a short period of time analgesia, respiration will not stop only weakened, through the mask to give oxygen can maintain oxygen saturation) and a combination of the two venous + inhalation anesthesia in three ways. In the process of general anesthesia, if the oxygen supply is guaranteed, all vital indicators such as blood pressure, heart rate, oxygen saturation are in the normal range, does not affect the respiratory and circulatory functions, and will not cause cerebral hypoxia. Regional nerve block anesthesia is the injection of local anesthetic into the peripheral nerve trunk nearby, so that the area innervated by the nerve anesthesia. There are many ways to do this, such as the hand and upper extremity surgeries such as polydactyly, syndactyly, etc., which are often done in our department, the brachial plexus nerve block anesthesia is sometimes applied, so that the upper extremity and the hand that is operated on will have no sensation and no movement for several hours. For foot and lower extremity surgery, sacral anesthesia is used to anesthetize only the lower extremities. The effects of the above anesthesia methods are transient, when the drug is gradually metabolized in the body to reduce the concentration, the effect will disappear. In inhalational anesthetics, on the other hand, as soon as the supply is stopped, the drug is quickly eliminated from the exhaled gas, and the child awakens as the anesthesia becomes lighter. Children in the process of anesthesia awakening, may appear in a trance, irritable crying and sleepy phenomenon is normal, parents do not need to be too nervous, anesthesia completely metabolized after the child will return to normal. Some parents think that the general anesthesia after the child will be “stupid”, and therefore the need for general anesthesia for surgical concerns, which in fact does not have any scientific basis. My department has received a child, a child once did 6 times surgery general anesthesia, and then the academic performance has been very good, but also entered Tsinghua University. It should be said that any anesthesia, whether general anesthesia or basic anesthesia + local nerve block, if the operation goes smoothly, there is no hypoxia during the operation, especially oxygen saturation is always at 100% anesthesia, there is no adverse effect on the child’s body and intelligence. During surgery or anesthesia, if the brain cells are deprived of oxygen for any reason, and for more than 5-8 minutes, the brain cells will be damaged, which may lead to intellectual decline. Severe cerebral hypoxia can even lead to brain death (vegetative) or even death, which are all possible accidents during anesthesia. Pediatric organism is not well developed, and its tolerance to anesthetics is poorer than that of adults, so the chances of anesthesia accidents are much greater than that of adults. Basic anesthesia in pediatrics requires specialist knowledge and, especially important, clinical experience. The same pediatric patient of the same age and weight, given the same amount of medication, can respond differently. Some just happen to fall asleep smoothly, some children have their eyes open, while others may have fallen asleep too deeply and become respiratory deprived and require artificial respiratory assistance. Therefore, it is still not easy for anesthesiologists in general hospitals that do not specialize in anesthetizing pediatrics on a daily basis to get a good handle on this, especially in small infants. Pediatric regional nerve block is also not easy to master, pediatric anatomy and adults have great differences, in addition, infants and young children are obese, thick subcutaneous fat, to accurately hit the anesthetic to the skin across the deep nerve trunk around is not easy. Of course, for anesthesiologists in children’s specialty hospitals, it is not difficult to fight every day with rich experience. But for the general hospital anesthesiologists, because the hospital has a pediatric department, pediatric anesthesia qualification, but the operation of the small children, after all, the anesthesiologist occasionally play a nerve block is difficult to hit the right, not allowed to hit the surgery on the anesthesia, even if the use of basic anesthesia or the child will be moving around or even woke up crying, and finally had to be changed to general anesthesia. Therefore, many general hospital anesthesiologists meet pediatric simply on the general anesthesia, either tracheal intubation general anesthesia, or intravenous complex general anesthesia. With the rapid development of pediatric anesthesiology, anesthesia drugs are more and more safe and effective, anesthesia equipment and monitoring instruments are constantly updated, in children’s specialty hospitals, pediatric anesthesia accident rate has been very low. However, from the overall view of all hospitals in the country, pediatric anesthesia accidents still occur every year. If anesthesia drugs are improperly selected or overdosed, they may not only cause intraoperative respiratory depression and hypoxia, but also cause other damages to the children’s muscles, and anesthesia accidents may also occur in individual children with poor liver and kidney functions or idiopathic body types who cannot tolerate anesthesia drugs. Once an anesthesia accident occurs, the anesthesiologist of the children’s specialty hospital has a stronger ability to rescue than the general hospital, and the chances of successful timely rescue are greater. To ensure the safety of pediatric anesthesia, the need is not only advanced anesthesia equipment and monitoring facilities, and not send anesthesiologists to children’s hospitals to further study for a year and a half can be solved. Because, what is more important is the anesthesiologist’s rich clinical experience, there are things that cannot be learned from books. There is certainly no comparison between those who do pediatrics every day and those who do pediatrics occasionally. Therefore, parents are advised that when choosing a hospital to visit, it is best to go to a specialized children’s hospital, which is necessary to ensure the smooth operation of surgical anesthesia. Even in specialized children’s hospitals, safe anesthesia also requires the cooperation of parents. Pre-operative examinations need to be perfected to make sure that there is no abnormality before the operation, and the anesthesiologist before the operation also needs to ask the child about his previous history of anesthesia, allergy to medicines, surgical history, and whether he has had any discomfort such as colds and fevers in recent days, so as to assess and predict the safety of the anesthesia for the child. Parents also need to cooperate with the preoperative and postoperative care, in order to avoid vomiting during anesthesia due to stimulation of the child, resulting in choking due to obstruction of the respiratory tract by the vomitus. The child should not eat or drink for 6 hours before the surgery. Within 6 hours after the operation, the anesthesia has not been fully metabolized, in order to keep the airway open to avoid suffocation, the child can not sleep on a pillow, need to fasting and water.