Anesthesia: Providing Comfort with Minimal Risks
When children are facing a complex surgery and daunting rehab, anesthesia is a common concern. Those precious moments before and after “going under” are very much front of mind for the anesthesiology team at Hospital for Special Surgery’s Lerner Children’s Pavilion. The specially trained doctors and nurses there understand that undergoing anesthesia can sometimes be a bit frightening whether you’re 5 or 55.
That’s why the team starts the conversation long before the child is in the hospital gown, says Kathryn DelPizzo, MD, a pediatric anesthesiologist at HSS. For example, there’s an explanatory video that educates patients and families about anesthesia, plus scores of articles and pamphlets that address commonly asked questions. Having this wealth of information at the ready makes sense. After all, though anesthesia is commonplace during certain procedures, the experience of “going under” is something many children can’t quite imagine.
Types of anesthesia
Anesthesia works in several different ways, but Dr. DelPizzo likes to say it activates receptors in the brain that affect sleep, memory, and attention. “It induces a sleepy state,” she adds. Just how “sleepy” a patient becomes depends on the type of anesthesia he or she receives.
General anesthesia puts the whole body to “sleep,” and the young patient is completely unconscious. The child won’t feel any pain, nor will he or she be able to recollect anything about the experience. Doctors and nurses monitor the young patient closely from start to finish to ensure he or she is comfortable and receiving the just-right amount of anesthesia, which is often administered through an IV. They may also insert a tube into the patient’s mouth and into the windpipe to help with breathing since anesthesia deeply relaxes both body and brain. After the surgery is complete and the child regains consciousness, he or she may feel groggy and nauseated as the medicine wears off.
Depending on the procedure, the anesthesiologist may opt to give the young patient a regional or local anesthesia. Regional anesthesia numbs a large area, like the waist down, for example, while local anesthesia is used for a much smaller area. In both cases, a numbing medicine, like Novocaine or an epidural, is administered to whatever part of the body the surgeon is fixing. Most of the time, the child can breathe on his or her own, and as Dr. DelPizzo explains, there is a lower risk of side effects like nausea and vomiting.
Minimizing the risks
Just how much anesthesia a young patient receives depends on a combination of factors, including weight, age, and medical conditions. To the surprise of many parents, children can have any type of anesthesia. Choosing which kind—general, regional, or local—boils down to the procedure involved. “Luckily for patients at HSS, orthopedic surgery lends itself well to regional anesthesia, even for kids,” Dr. DelPizzo says.
The hospital also has a directive in place to use regional or local anesthesia when possible and to determine the amount of anesthesia to limit the dose to exactly what is necessary. “This is proven to reduce the amount of anesthesia our patients need for surgery,” Dr. DelPizzo says.
With advances in monitoring, medications, and tools (like ultrasound), the overall risk of complications from anesthesia is lower than ever. Doctors and nurses can now monitor nearly every organ during an operation, and newer medicines exit the body faster and cause fewer side effects. Also, as Dr. DelPizzo points out, “because of all the preparation that we do at HSS as a peri-operative team, we can minimize risks.”