Stony Brook University Hospital Department of Anesthesiology

Division of Pediatric Anesthesia

PEDIATRIC ANESTHESIA FOR CARDIAC PROCEDURE

• Who will provide anesthesia?
• The division of pediatric anesthesiology at Stony Brook University Hospital provides anesthesia services at the main hospital and at the ambulatory surgery center. A team consisting of our anesthesiologist working with residents and certified nurse anesthetist will care for your child.
• What role does the pediatric anesthesiologist have in my child's care?
• You probably will not get to know your child's anesthesiologist as well as the cardiologist and/or cardiac surgeon.  Nonetheless, the anesthesiologist plays many important roles in your child's care before, during, and after the surgery or procedure.
  Specifically, the anesthesiologist:
  1. Continually monitors the vital functions such as breathing, heart rate and rhythm, blood pressure, body temperature, oxygen saturation, fluid and blood needs and makes medical decisions as necessary.
  2. Ensures the child's safety during surgery by using anesthetics and techniques, which are tailored to the specific medical condition.
  3. Provides consultation on many aspects of the medical care, including pain management, medications, and airway management.
• What is the education and training of a pediatric cardiac anesthesiologist?
• A pediatric anesthesiologist is a physician who has completed medical school, at least four years of medical training (a year of internship and three years in an anesthesiology residency program), and usually at least one year of a pediatric anesthesia fellowship program. During this period of education and training the pediatric anesthesiologists becomes very knowledgeable about many areas of medicine, including cardiology, pediatrics, critical care, and pharmacology. The anesthesiologist’s education does not end with the completion of fellowship training, however. Because the field of pediatric cardiac anesthesiology is constantly evolving and expanding, pediatric anesthesiologists continually update their knowledge and skills through regular participation in educational courses and symposia, earning continuing medical education credits as appropriate or required.
• Why is there a preoperative interview and what does it consist of?
• The preoperative interview has two important purposes:
  The first one is to provide the anesthesiologist with essential information about health history so he or she can properly plan and manage the anesthesia and care during and following the surgery or procedure.
  The second purpose of the interview is to give you an opportunity to ask questions and voice any concerns you may have.
• What will the anesthesiologist need to know?
• The anesthesiologist will want to make sure that your child is in the best possible physical condition before surgery. You will be asked important questions about your child's general health, including whether he or she has allergies or asthma, whether there has been any family history of difficulties with anesthesia and what your child's experiences have been with previous anesthetics. During this evaluation, the anesthesiologist will explain the planned anesthetic procedure. The discussion may include whether or not your child will receive anything for sedation before surgery, how the anesthetic will be initiated and maintained, and other pertinent anesthetic details. This is the best time for you and your child to ask questions and express any concerns to the anesthesiologist.
  You will also be asked about allergies. Sometimes children react to certain medications in odd ways that are not truly allergic reactions but are "labeled" as such.
  When you report that your child is allergic to a medication, you will be asked to describe the reaction so that we can determine if there is a true allergy. It is unusual for children to be allergic to anesthetic drugs. The most commonly encountered allergies are to antibiotics such as penicillin or amoxicillin.
  Sometimes significant illnesses may cause problems during some types of surgery and anesthesia. For this reason, the anesthesiologist may feel it is best to postpone surgery. Remember, your child's safety is our first priority.
• Will my child receive any medication before surgery?
• We now realize that many children need less sedation when calm. Assured and confident parents help them through the stress of a procedure or hospitalization. In spite of parents' reassurances, however, some children still may require medicine to calm them before surgery. This medication may be given by mouth or injection. The time before surgery that such premedication is given will vary. The anesthesiologist will determine the type of medicine used, if any, during the preoperative visit.
• How will my child be given anesthesia?
• Anesthetic agents can be started in several ways. Most commonly in adults, anesthesia is started by an intravenous injection so the patient becomes unconscious rapidly. This is also a method that can be used for children. Another method of beginning anesthesia is to let your child breathe anesthetic agents until losing consciousness. This is called a mask or inhalational induction. With this approach, your child will be asked to breathe through a "space mask" quietly, and no needle sticks will be performed until after your child is sound asleep. The choice of which method to begin anesthesia will be made by the anesthesiologist based on many factors.
• Will my child be asleep during the entire operation?
• After inducing general anesthesia, the child will be unconscious during the operation. Be assured that throughout the entire operation, the anesthesiologist continually monitors and adjusts the level of anesthesia.
  Even when sedation is used, there might be some recollection of the operating suite.
• Will my child receive blood transfusion?
• He or she may. At present, blood supply is extremely safe, but the risk is not zero. If you have any specific concerns about this issue, discuss them with the team. Complications include risk for infection and other reactions.
• What are the risks of general anesthesia?
• No cardiac surgical procedure is without some degree of risk, which your surgeon will discuss with you prior the operation. Fortunately, serious complications such as strokes and deaths from general (or other types of) anesthesia are very rare today, despite the fact that at this time, more cardiac surgery is being performed on younger and sicker patients.
  In the last decade, the estimated numbers of deaths attributed to anesthesia (for all types of surgical procedures) have dropped significantly. Serious complications such as strokes and prolong periods of mechanical ventilation, have also declined over the past few decades. The increased safety of general anesthesia is due to many factors, including: safer drugs, more extensive training of anesthesiologists, and national standards of care that reflect current best practices.
• What are the side effects of general anesthesia?
• Side effects from general anesthesia may occur, but the vast majority are not serious, do not last long, and are treatable. Side effects may include sore throat, headache, back pain, and/or fatigue. Some patients experience nausea or vomiting, but this occurs less frequently than in the past.
• When and where will my child wake up after the operation?
• This depends on many factors, including the type of surgery, so there is no single answer to that question. Most likely, the child will be awakening in the Pediatric Cardiac Intensive Care Unit.
• Pain after the operation?
• Some discomfort after a major surgical procedure is to be expected. But strong, effective painkilling drugs are routinely provided to cardiac surgical patients so they can be as comfortable as possible. Patients and families should be reassured to know that the Pediatric Intensive Care Unit staff members are very aware of the importance of effective pain management and very experienced at managing children's pain.