1 The Practice of Pediatric Anesthesia
Preoperative Evaluation and Management
Parents and Child
1. As your child is anesthetized, the eyes may roll up: “You might see your child’s eyes roll up and this is completely normal and happens to all of us when we fall asleep; it is just that we are not looking for it.”
2. “As people fall asleep they often make snoring noises and other noises from their throat; if your child does this it is completely normal.”
3. “As the anesthetic reaches the brain, the brain sometimes gets excited and causes movement of the arms and legs that are without purpose, or it may cause them to turn their head from side to side. This means the anesthetic is having its effect and even though your child appears to be partly awake, he (or she) has received enough anesthesia to ensure that he (or she) does not remember this.”
4. “If your child becomes frightened, we will increase the amount of the anesthesia medicine rapidly and calm your child as quickly as possible.”
5. If the child is to have an IV induction, then informing the parents that the child might suddenly look pale and that the start of anesthesia will be very rapid is also helpful so as to avoid confusion about what the parents will observe.
These preemptive explanations are important to undermine the parents’ anxiety at a time when you need to focus on the child. It is common for parents to decline to be present during induction once they hear these explanations. Finally, it is prudent to reassure the parents that for surgeries that are emetogenic and in children who have been or are prone to emesis, that appropriate prophylactic therapy will be administered before the child recovers. Similarly, explain to them that if pain is anticipated, it will be managed aggressively in the operating room and in the recovery room. Anesthesiologists can provide valuable assistance in this respect because of their knowledge of the pharmacology of sedative and opioid medications (see Chapter 6), as well as their ability to perform neuraxial and peripheral nerve blocks (see Chapters 41 to 43). The possible need for postoperative intensive care, including assisted ventilation, should be anticipated and fully discussed with the parents and child (if the child is of an appropriate age). If special monitoring is required in the operating room or postoperatively, this should be explained and the child assured that the IV catheters, airway devices, and all invasive monitoring devices will be placed after induction of anesthesia to avoid causing discomfort and will be removed as soon as the child’s postoperative condition permits.