Anesthesia in children

Before the anesthesia

Before each procedure, there is a precise anamnesis of the entire medically relevant history of the child to be treated. This is important as it may be necessary to reschedule the surgery. Parents, as well as the child to be treated, will be informed about all risks in good time before the operation and have the opportunity to ask questions about the exact procedure of the operation and the anesthesia.

Depending on the age, there are different times for which the child to be treated must be sober. For all children older than six months, no food, including sweetened drinks, should be consumed at least about six hours before the operation.
The time for infants under 6 months is four hours before the procedure. Unsweetened liquids should be avoided by any age group at least two hours before surgery. A sedative will be given about 60 minutes before the procedure, which will relax the child and make them a little sleepy.
Shortly before the operation, either skin-numbing plasters (EMLA plasters) or a spray are applied to the arm, which make the catheter as painless as possible. In children who do not allow the insertion of a catheter, the anesthesia can usually also be induced by inhalation using anesthetic gas before the intravenous access is established.

During anesthesia

The child is positioned in the operating room and the monitoring devices are attached. These devices monitor the child's blood pressure, pulse and breathing at all times.
Then the anesthesia is initiated. Depending on whether an intravenous access could be established, the induction takes place with drugs, which are administered via the vascular system, or inhalation with anesthetic gases.
The maintenance of general anesthesia usually takes place according to the balanced model of general anesthesia. This means that anesthetic gas is mixed into the breath and medication is administered intravenously using syringe pumps.

After anesthesia

After the procedure, the child comes to the so-called Recovery room. The respiratory and heart functions continue to be checked there and the patient waits under medical supervision until the anesthetics wear off.
Only when the treated child is completely sensible again and can orientate himself can he either go to the ward or go home for outpatient interventions. In any case, it should be in the first 24 hours after surgery one good care of the child be guaranteed. Depending on the location of the operation, in most cases you can eat and drink again shortly after the operation.

Side effects

Like most medical interventions and drugs, general anesthesia is not always free from side effects. The duration of the side effects of anesthesia can vary. In the last few decades, however, a lot has happened in the development of new drugs for anesthesia and in the precise monitoring of patients during the procedure. Despite everything, side effects occur with general anesthesia, but in most cases they do not leave any permanent damage and heal without damage.

Read more on the topic: Fear of anesthesia / general anesthesia

The side effects that occur occasionally, in about 1 in 10 to 1 in 100 cases, include:

• Nausea and vomiting after anesthesia. This nausea can be attributed to the anesthetic gases used during the operation. To prevent this side effect, the anesthetic gas can be dispensed with and the anesthesia can be carried out solely with intravenously administered medication.
• Bruising from storage or blood vessel punctures. These harmless bruises will resolve on their own in a few days and will heal safely.
• Pain in the throat area, which is often associated with difficulty swallowing and a changed voice. This effect is caused by intubation during surgery. The vocal cords and throat area are irritated by the intubation tube. As a rule, the side effects caused by intubation will pass within a few hours or days.
• The whole body may also shake in the recovery room due to a drop in body temperature and the anesthetics used during the operation. In such cases, the children can be warmed with blankets.
• In children it can happen that they generally feel very uncomfortable after an operation and that they express this discomfort by screaming, crying or restlessness in the recovery room. However, after being transferred to the ward, the feeling should pass quickly.
  The following side effects may occur between 1 in 100 and 1 in 1000 cases:
• An allergic reaction to agents used during the operation may manifest as itching or reddish swelling after the procedure. To prevent this, anti-allergic agents can be used before the operation.
• Infections can occur at the puncture site of the catheter, as well as tooth damage that requires dental treatment. In addition, in some cases there are temporary movement restrictions, which are due to the pressure during storage. In most cases, however, these paralyzes are short-lived and regenerate after a few days.
• The very rare side effects of general anesthesia in children, i.e. in less than one case in 1000 treatments, include severe allergic reactions, voice disorders, permanent paralysis, as well as the so-called awareness phenomenon, in which the patient regains consciousness during the operation and sometimes even pain feels. This phenomenon occurs more frequently in children, as they break down the anesthetic agents used more quickly and the exact dosage of the agents is more difficult.
• Serious side effects such as cardiovascular arrest, sepsis, organ damage, thrombosis, heavy bleeding and respiratory arrest occur in less than one in 10,000 cases.
• Another dreaded side effect during general anesthesia, which can arise primarily from the anesthetic gases used, is so-called malignant hyperthermia. Hereditary predisposition can promote the occurrence of this dangerous metabolic imbalance, which is associated with a sharp rise in body temperature. However, with the introduction of modern medication, the mortality rate from malignant hyperthermia has dropped significantly in recent years.

How dangerous is general anesthesia in children

The decision to have a medical procedure that requires general anesthesia is never made lightly, especially in children. Despite modern technology and extensive medical experience, surgery and the necessary general anesthesia involve surgery always risks. Interventions at risk are not performed in children if an operation is possible at a later date.

The individual risk with general anesthesia always depends on the present Comorbidities, the general health status as well as the Duration the anesthesia. The risk of dying or permanent damage from serious complications during general anesthesia increases significantly with the so-called ASA Score.
This value is calculated from the existing comorbidities that a person has. If there are relevant accompanying illnesses, the value increases and that Risk of anesthesia clearly.

Overall, general anesthesia can still be used as a low risk classify. Some surgical interventions are only made possible by means of anesthesia and by closely monitoring the child while unconscious, dangerous complications can be recognized and eliminated.

Compared to operations on older people, children tolerate the anesthesia and the stress they are exposed to as a result of the operation very well. Serious comorbidities are less common in children, and their general condition is usually very good. The complications, however, are due to their still weak infants Immune system more often, which is why some operations have to be postponed to a later date.

Current situation

Because of experimental experiments, which were mainly carried out in animal models, the voices have lately been louder, suspecting possible brain cell damage in children, which is supposed to be caused by anesthesia.
Due to the neurotoxicity of the anesthetics, the anesthesia obtained is intended to limit the ability of children to learn. Once this relationship was discovered in the animal model, a number of studies were started to examine children who received anesthesia early in their life. To this end, studies were carried out in the USA and in Europe.

The results of these studies, which were only completed and published some time ago, turned out to be very different:

Studies from Denmark and the Netherlands could not find a connection between anesthesia and changes in the children's brains or behavior. Only one study from the USA, which retrospectively examined children who were given anesthesia more than once before the age of 4, was actually able to establish a connection between learning difficulties and the anesthesia received.

Even after evaluating all studies, a clear result is unclear. It is not considered certain whether the learning disorder that occurred in the children was actually caused by the anesthesia or rather by the operation (s) and the respective illness itself.
In general, however, there is no alternative to general anesthesia for many operations. Only in rare cases can it be recommended to postpone surgery to a later date in order to avoid surgery during the development of the brain. Most surgeries on children are important and must be done at the appropriate time.

Anesthesia at the dentist

Dental interventions are often painful and fearful, especially for children.
In order to create the best possible treatment conditions, sedation (anesthesia) become necessary. The child is given a sedative but can continue to breathe.
One way of sedating children at the dentist is to administer the sedative midazolam (Dormicum). The drug's effects peak around 20 minutes after administration. It has a strong anti-anxiety, calming effect and makes you a little tired.

It also has the effect that the children no longer remember the period of treatment. During the entire period, the child is awake and responsive, but there is constant monitoring. After the procedure, the child should stay in the dental practice with their parents until the medication is broken down.
Another way to sedate children during dental surgery is nitrous oxide. Here, too, the child is constantly awake and responsive.

The child is put on a nasal mask through which they inhale a gas mixture of oxygen and nitrous oxide. The laughing gas has a calming and anxiety-relieving effect. It relieves pain and makes the child feel euphoric and lose track of time. As a result, the use of an anesthetic injection, for example, is much more accepted.

Read more on the topic: Local anesthesia at the dentist
You can find more detailed information about sedation in our relevant article: Sedation - Everything You Should Know

Cost of anesthesia at the dentist

At the dentist, most minor procedures are performed under local anesthesia (local anesthesia). However, since many children are very afraid of the treatment and the younger children often cannot keep still long enough, dentists like to use general anesthesia.

As a rule, health insurance companies cover the costs if the children are under 12 years old and the need for anesthesia can be justified medically. However, the conditions for reimbursement vary depending on the health insurance company. If in doubt, the dentist should ask the health insurance company for a cost estimate.

Anesthesia with a cold

Whether a child is suitable for anesthesia on the day of the operation is up to the anesthetist to decide.
He decides this on the one hand on the basis of his own examination results, on the other hand he includes the results of a previous examination by the pediatrician.

This examination serves to identify previous illnesses and to be able to assess the physical condition of the child. The pediatrician will then state in writing to what extent the child is generally capable of anesthesia. In order to enable the anesthetist to make an assessment, it is of great importance to him, such as any change in the child's health fever, to cough or cold to communicate.

If the child has a cold, it must be weighed whether it is capable of anesthesia. The problem is that a cold, an upper respiratory infection, can lead to serious complications, especially in very young children Bronchospasm and Laryngospasm, can lead. This is a spasmodic contraction of the bronchi or larynx (larynx) which can block the airways.
This can be caused by Irritation of the airways which are carried out in connection with the anesthesia. The airways can still be overly sensitive for up to ten days after an infection has passed.

In most cases, these complications can be treated successfully. Nevertheless, careful consideration must be given to the risk of carrying out a Surgery for a cold is received.
Urgent interventions are usually carried out anyway. In the case of non-urgent interventions, the operations are in most cases postponed for at least two weeks to be on the safe side. It is always important that the parents contact the surgeon and the anesthetist as early as possible in order to clarify to what extent they assess the current infection as a danger for the operation and, if necessary, to postpone the appointment.

It should be noted, however, that not every easy cold, like a runny nose, is an inevitable hindrance to performing an operation. In ear, nose and throat medicine, for example, many interventions in children are used to reduce the number of frequent infections.

General anesthesia at the dentist

In some cases, children may need to be given general anesthesia.
This is usually done by an anesthetist. First of all, there is a preliminary examination by the pediatrician as well as an informative discussion by an anesthetist.

On the day of the treatment by the dentist, the child must be sober, which means that they must not have eaten anything six hours before the procedure and nothing four hours before the procedure.
The teeth should also not be brushed beforehand. At the dentist, the child is first given an anxiolytic calming juice. Then the anesthesia is initiated with a special mask. The child falls asleep after a few minutes, and only then do the parents have to leave the treatment room.

The dentist will now perform the procedure. The child is monitored by the anesthetist during the entire period. The child is then monitored in the recovery room until it is well rested.
As a rule, parents are allowed to go back to their child immediately after treatment. When the child is completely awake again and the anesthetist gives their consent, they can go home.

Find out more at: General anesthesia at the dentist

Anesthesia for polyp surgery

Polyps are the so-called pharyngeal tonsils. The removal of the polyps is now an absolute routine procedure, but the operation is not uncomplicated and is therefore always performed under general anesthesia.

The anesthesia consists of a sleeping pill that switches off consciousness. In addition, a pain reliever and a drug that relaxes the muscles are given. Because of the muscle relaxation, the affected person cannot breathe alone. Instead, a so-called tube (a tube that goes through the mouth into the windpipe) is used for ventilation.

Sleep disorder after anesthesia

Sleep disorders after general anesthesia are observed again and again in children. They can appear in the first few days after surgery and go away within a week. However, many also report longer-lasting episodes with sleep disorders.

A concrete connection with the anesthesia is not known. It is much more assumed that the children will wake up again with pain after the operation, and they will also notice a change in the operated area. This may create a fear of waking up with these feelings again. Usually, a lot of patience and positive encouragement help until the sleep disorders subside after a few days to weeks.

Fever after anesthesia

Fever after anesthesia can have different causes. Postoperative (occurring after the operation) tremors are particularly well known.

However, this is not because the affected child has a fever. Rather, it lost body heat during the operation and has to regain it through the tremor. An actual increase in body temperature to over 38 ° C usually indicates an infection.

This can be caused by wound infections or inflammation, for example at the puncture site of the Braunule (the “needle” through which infusions are given) and should be carefully monitored. Antipyretic agents and medication (e.g. antibiotics), depending on the cause, can counteract the fever.

Please also read the article: Fever after surgery

Nausea and vomiting after anesthesia

About 30% of people experience one-time nausea and vomiting after general anesthesia. This is not just the case with children, but applies to all age groups.

Nausea is particularly common in people who have been anesthetized by an inhalation anesthetic (anesthetic given in the air).

Other groups of people who are particularly susceptible to so-called "postoperative nausea and vomiting" (nausea and vomiting after the operation) for short PONV are girls and women as well as people who suffer from dizziness or travel sickness.

Usually, a single dose of an anti-emetic (anti-nausea and vomiting medicine) solves the problem.