Not all children need tests or operations under a general anaesthetic, but some do. If your child needs an anaesthetic during their time at Great Ormond Street Hospital (GOSH), here's what you need to know about it.
What is a general anaesthetic?
A general anaesthetic ensures that your child is fully asleep and free from any sensation during a test or operation. It consists of a combination of medications given either as a gas to breathe or as an injection. General anaesthetics are only given by anaesthetists.
Anaesthetists are specialist doctors who look after children before, during and after a test or operation. Their role is to ensure that children are 'asleep' and safe throughout the test or operation and wake up comfortably at the end.
Why do I need to see an anaesthetist beforehand?
An anaesthetist will see you on the ward to assess your child's general health and to discuss the anaesthetic. For practical reasons, this may not be your child's anaesthetist, but if you want to meet them before your child goes to the operating theatre, please ask your nurse.
The anaesthetist will ask you if your child has had an anaesthetic previously and whether he or she has any allergies. They will also discuss options for anaesthesia and pain relief medication, and whether your child would benefit from taking a pre-medication (pre-med) which can help ease anxiety.
Why should my child not eat or drink before having an anaesthetic?
It is important that your child's stomach is as empty as possible as this reduces the risk of vomiting during and after the test or operation. Your admission letter or the nurses on the ward will discuss with you the time when your child should have their last food and drink before the test or operation.
What happens next?
Your child will either have an anaesthetic gas to breathe or an injection. When you meet the anaesthetist, they will tell you and your child the options for the anaesthetic.
The anaesthetist will closely monitor your child's blood pressure, pulse, temperature and breathing throughout the test or operation, ensuring that they are safe and fully asleep.
When the test or operation is finished, your child will be transferred to the recovery room. This is a large room in the operating theatre suite where your child wakes up from the anaesthetic. A nurse closely looks after each child until they are fully awake and comfortable enough to return to the ward.
Will I be able to stay?
Both parents are very welcome to come to the anaesthetic room and you will be able to stay until your child is asleep. Once they are asleep, you will return to the ward with the ward nurse.
How safe is anaesthesia and are there any after-effects?
The degree of risk will depend on your child’s medical condition and the nature of surgery for which anaesthesia is being provided. You will be able to discuss this with an anaesthetist before surgery but the following is a general overview of side effects and potential complications of anaesthesia.
Most children recover quickly and are soon back to their usual activities after an anaesthetic. Some children may get side effects - however, these are usually mild. Headaches, nausea (feeling sick, sometimes with vomiting) and a sore throat are common but can usually be treated effectively.
Other side effects generally just need time to wear off and include tiredness, dizziness, and disorientation on waking, which can be distressing both for children and for their parents. Some children may also have disturbed sleep patterns for a few days after an operation.
More serious problems are uncommon but include a minor cut lip, damage to teeth, an allergic or other reaction to a drug, and breathing difficulties either during or after an anaesthetic. People often worry about the risk of awareness during anaesthesia but fortunately this is rare. When it does happen, it tends to be awareness of sounds only, and in children does not seem to be associated with subsequent psychological problems.
The most serious complications are usually very rare but include severe allergic reactions, nerve injury, and the risk of death or disability such as a stroke, deafness or blindness.
Risks cannot be removed completely but modern equipment, training and drugs have continued to make anaesthesia safer. An anaesthetist will be with your child throughout their anaesthetic to monitor their progress and to help them to wake up as comfortable as possible.
Other procedures that an anaesthetist may perform for your child – such as insertion of an arterial line, central venous line, or epidural – will have their own specific side effects and risks of complication. You will have a chance to discuss the plan for anaesthesia, its risks and how they relate to your child with an anaesthetist before surgery.
Do you have any concerns?
If you have any worries or concerns about the medical procedures your child will experience at GOSH, our ward staff are here to help reassure you. Please do ask them if there are any issues that you would like to discuss. Our play specialists are experts at conveying complicated or worrying ideas to young patients in an understandable way.