When children need surgery, parents tend to focus on the procedure and the recovery. But there is another part of the process that parents should learn about: Anesthesia.
A pediatric anesthesiologist specializes in keeping children healthy and safe during surgery, monitoring vital signs and ensuring that patients remain unconscious throughout, says Dorothy Gaal, MD, a pediatric anesthesiologist who has been with Yale Medicine’s Pediatric Anesthesia Section since it was established in 1992.
She and her anesthesiologist colleagues communicate closely with surgeons and nurses about what is needed. “These are all standard things in our specialty,” Dr. Gaal says.
But a pediatric anesthesiologist’s work goes far beyond those primary medical responsibilities. In many ways the anesthesiologist is responsible for making the experience comfortable for patients and their families. Here is what parents can expect when their child undergoes a procedure that requires anesthesia.
Keeping kids at ease
From the start, Dr. Gaal makes sure the patient is at ease in ways big and small. “The environment—visually, auditory especially—is important during the initial encounter and the patient assessment and planning,” she says.
Well in advance of the surgery, Dr. Gaal and her colleagues try to relieve anxiety by making the child and his or her parents comfortable. Pediatric anesthesiologists focus on every detail, even what children look at in the operating room. “What the child and parent see needs to be as pleasant as possible,” Dr. Gaal says. She pays attention to the look and feel of the space, as well as the people who are in the room.
Usually, one parent is allowed to go into the operating room to be with the child as anesthesia gets started. This, says Dr. Gaal, helps “to decrease anxiety and separation concerns.”
Attention to every detail
Dr. Gaal sets the tone for the environment. Since vigilance about the patient’s vital signs is already part of her job, she makes sure to be closely attuned to even subtle cues about the child’s overall well-being. This level of engagement and alertness goes far beyond watching the monitors during surgery. Dr. Gaal also monitors the child’s facial expressions for signs of discomfort, noting that facial expressions, like grimaces or tearing, may indicate that a child is feeling pain.
Helping a child feel as comfortable as possible during a potentially frightening experience means being mindful of her own mannerisms, both while the child is awake and asleep. Dr. Gaal and other pediatric anesthesiologists even pay attention to details such as making the intravenous fluids apparatus and dressings child-friendly by using “colorful designs, sometimes even custom to their interest.” Says Dr. Gaal: “The children, even small ones, seem more accepting of their I.V. if it is pleasantly disguised.”
Different ways to deliver anesthesia
If a child’s anesthesia will be administered through a mask, as is sometimes the case, pediatric anesthesiologists use one that is pleasantly scented. If the anesthesia is delivered intravenously, the actual procedure is the same as for an adult—but the similarity ends there, Dr. Gaal says. “You don’t just scale down the anesthesia based on size,” she says.
Anesthesiologists take into account the different developmental and behavioral needs of children, customizing the drug delivery to account for a child’s respiratory capacity and brain development.
Dr. Gaal believes it is important for children to feel comfortable during the early stages of the procedure so, if possible, she lets them move around. “I’m pretty liberal with how children sit, lie, move in the operating room while they initially receive the anesthesia,” she explains. “Lying flat on their back staring at the ceiling doesn’t seem the most natural or comfortable.”
This focus on comfort is not only to make the child feel at ease during the operation; it is also key to the child’s lifelong health and well-being. Research shows that a frightening, painful experience with surgery can do lasting damage, Dr. Gaal notes. “It seems that painful procedures can have a lifelong impact. If a child is exposed to a painful procedure, there may be some imprinting and that exposure to such stimuli may require more pain medication in the future,” she says.
Tender care through recovery
After surgery, children typically spend a few hours in the post-operative recovery room, where their health is monitored closely while the effects of anesthesia wear off. Not just nurses but also the pediatric anesthesiologists stay engaged during this transition. Members of the team check vital signs, including the child’s respiration and circulation as she or he regains consciousness. The doctors and nurses make sure to provide relief from any side effects of anesthesia, such as nausea and body temperature changes.
They also pay attention to how a child looks, perhaps combing his or her hair and washing the child’s face—the sort of tender, attentive care helps parents feel secure about the child’s health and recovery.