Preassessment

In adult anaesthesia we preassess patients either by asking them to visit the hospital or complete a questionnaire. Although some hospitals do this with children, it has little benefit for most patients and may even reinforce negative fears. Your surgeon will have given me information about your child’s operation. Please look at the following questions. If any of them apply to your child, please email me at [email protected] with as many details as you can:

• Has your child or any other relative ever had a problem with an anaesthetic?
• Was your child more than 6 weeks premature or did he/she need ventilation at birth?
• Has your child any cardiac (heart) problems?
• Has your child any congenital illnesses?Has your child suffered from asthma requiring an emergency admission to A and E?
• Has your child had any serious infectious diseases including hepatitis, TB or HIV?
• Has your child had any other medical diagnoses requiring seeing a consultant?
• Has your child any mental health issues?
• Is your child on regular drugs/Does your child have any allergies to drugs or latex?

Preparing your child for anaesthesia

I strongly recommend that you explain to your child that they are going to have an operation. The amount of detail will depend on your child’s age and maturity, so for example a five-year-old having dental restorations could be told that they were going to come into hospital, go to sleep, have their teeth mended and then go home. If you do not explain what is happening to your child, he or she will be confused and frightened and the patient journey will be considerably more difficult for them. Children are not frightened of anaesthesia unless they have had a frightening time or been hurt with a previous anaesthetic. Most of my children who need repeat anaesthetics see it is as a game and something to look forward to.

I like to treat older children as adults. Having grown up children myself I appreciate that they rapidly become friends as opposed to dependents even though they may still need guidance! That is why children at 16 have full autonomy to consent to operations and children younger than this can provide their own consent if they understand about the operation. If your child is old enough therefore please ask them to read through the adult section of my website and encourage them to email me with questions themselves if they wish to.

The Harley Street Clinic has excellent play leaders and dedicated nurses who are more than happy to show your child around the hospital in advance. Please do not hesitate to ask if you think this would be helpful although do not think it is essential as I appreciate you and your child may both live busy lives.

The day of the operation

There is little need for special preparation. For larger operations your surgeon or I may ask for some blood tests but we do not do tests for the majority of operations. Please make sure you arrive at the hospital in good time, normally at least two hours before the operation. Nobody likes to be kept waiting but it is very important that we have time to undertake an anaesthetic consultation and to admit your child ensuring everything is prepared. The hospital ward has a play area and every room has a television. Please bring in a favourite toy and an iPad but please try to keep the amount of luggage to a minimum.

Your child can eat food until six hours before the operation. There is no need to introduce a light diet or to exclude any specific foods and I would strongly recommend you do not do so. Your child can now drink until one hour before the operation which in practical terms means until you arrive at the hospital. Drinks include anything but pure milk, orange juice with particles in or yoghurt and smoothies. If your child is hungry they are welcome to have apple juice which is full of sugar and eliminates hunger. Children should not be allowed to be nil by mouth for longer than this as it is both unpleasant and leads to dehydration. Finally, if you are breastfeeding, this can continue until four hours before the anaesthetic

The time of the operation

One of the biggest issues we face in a paediatric hospital is requests for children to be operated on first thing in the morning.

This is often due to misunderstandings about eating and drinking and I hope the previous section is helpful. The timing of the operation relies on many different factors including the different staff, equipment and the demands of other operations.

If you have a specific reason why an operation needs to be at a certain time on a certain day please email me directly and I will do my best to help you. However no paediatric hospital can survive if operations can only occur first thing in the morning.

Coming into hospital

The hospital will ask you to confirm your details with the accounts department and you will then be shown to your child’s room. Your child is free to use the playroom and their television; the ward is secure so your child is safe. I will undertake a consultation when we will go through your child’s medical history and I will undertake an examination and explain everything to both you and your child. We normally apply local anaesthetic cream to the back of the hands. The nurses will take some observations and for some operations we will ask your child to undress. For other operations your child will be able to leave on their clothes.

The nurses will bring you to the anaesthetic room. It is very important that only one parent comes to the anaesthetic room. I need to get your child’s attention and concentration and if both parents are present your child will see me as the outsider and this will make it more difficult for him or her. Equally, if both parents come down to the operating theatre door and one is then stopped, your child will think that that parent has done something wrong and be frightened. Most children are used to going out of the house with one parent and leaving the other parent in the house. To your child their bedroom will be their home. We will recheck your child’s details in the anaesthetic room before starting the anaesthetic. We do not normally apply monitoring to young children. The usual start of an anaesthetic consists of putting a small plastic cannula in the back of the hand where the skin has been numbed with local anaesthetic. This is quicker and less frightening than using a mask. However I do not have multiple attempts and if there are no obvious veins or it is difficult we will use a mask to start the anaesthetic.

When your child is asleep I will ask you to leave the anaesthetic room with the nurse. You are welcome to give your child a kiss but I do need to keep your child safe and undertake a number of different things quite quickly so it is important for you to leave when asked.

We will call you to recovery as your child is regaining consciousness. Some parents are keen to be in the recovery room before the child is fully conscious but this is not always practical nor indeed a good idea. Be assured that your child is being well looked after by my recovery staff and I will also be in the theatre suite.

The recovery staff will make sure your child is comfortable and stable before allowing him or her to go back to the ward. Some children suffer from recovery delirium and this particularly applies to children having ENT procedures and dental operations. Recovery delirium is where the child is not aware of their surroundings but may cry or be restless. There are drugs we can use but it normally resolves very quickly and the child has no recall so do not be distressed. Children are rarely sick and pain can be well controlled.

If your child has been admitted as a day case, they will be able to go home quite quickly. For many operations such as MRI scans and dental operations they do not need to eat or drink nor pass urine. I will discuss this with you at the preoperative consultation. Your child must go straight home by car or taxi and not go out until the following day. Most children can go to school the day after an anaesthetic.

Children having day case procedures rarely need strong pain killers. I would recommend you have a supply of paracetamol and I profile at home as the hospital will charge a much higher fee than your local pharmacist and this will not be covered by your insurance company.