The Department of Anesthesiology at the Children's Hospital of Michigan at the Detroit Medical Center is dedicated solely to the care of children. All of the anesthesiologists are board eligible or certified and have completed a fellowship in
pediatric anesthesiology. The nurse anesthetists have also completed advance training in pediatric anesthesiology. At the Children's Hospital of Michigan, anesthesia is provided for more than 15,000 procedures each year. These
include basic procedures such as ear tubes, eye muscles and the removing of tonsils as well as open-heart surgery, neurosurgery, transplant surgery, scoliosis repair and other complex surgeries.
The Department has its own pain service run by anesthesiologists that are available to assist with post-operative pain management 24 hours a day, 7 days a week. Children's Hospital of Michigan was the first hospital in the state to have a Pediatric Pain Medicine
Anesthesiologists on staff know the important role that the family plays in caring for a child who is having surgery. A pre-surgery program, Surgery Express, has been developed to familiarize the parents and child with the hospital experience. Patients
are invited to watch a video and tour the operating rooms in an effort to make the operative day less intimidating. In addition, parents are allowed to stay with their children until they are ready to go "to sleep". Whenever possible, a parent is
allowed to go to the operating room until his or her child is asleep. Ask your anesthesiologist about this option.
Anesthesia is a medicine that induces a sleep-like state. Either your child breathes it into their lungs while sleeping or it is given through their IV. The anesthesia helps your child fall into a deep, sleep-like state that protects your child from pain and makes sure they don’t remember the operation.
There are various forms of anesthesia. The type of anesthesia your child will receive will depend on the type of surgery and your child's medical condition. Your DMC Children’s Hospital of Michigan pediatric anesthesiologist will decide which anesthetic is best for your child and will explain why and what to expect as well as answering any questions you have. The different types of anesthesia include the following:
Local Anesthesia with Sedation - an anesthetic agent given to temporarily stop the sense of pain in a particular area of the body. For minor surgery, a local anesthetic can be administered via injection to the site. However, when a large area needs to be numbed, or if a local anesthetic injection will not penetrate deep enough, physicians may use regional anesthetics.
Regional Anesthesia - used to numb only the portion of the body which will receive the surgical procedure. Usually an injection of local anesthetic (numbing medicine) is given in the area of nerves that provide feeling to that part of the body. There are several forms of regional anesthetics, including spinal, caudal, and peripheral nerve blocks.
General Anesthesia - used to induce unconsciousness during surgery. The medication is either inhaled through the airway, or administered through an intravenous line (a thin plastic tube inserted into a vein, usually in the patient's forearm). A breathing tube may be inserted into the windpipe to maintain proper breathing during surgery. Once the surgery is complete, the anesthesiologist stops giving the anesthetic and the patient wakes up in the recovery room.
Once the surgery is complete, the anesthetic medication wears off, and the patient gradually wakes up while being supervised one on one by a specially-trained nurse in the post-anesthesia care unit (recovery room) . Complete recovery from anesthesia continues in the recovery room. Expect your child to be sleepy and to doze off often. Some children become very excited and confused when awakening from anesthesia. This reaction can be disturbing, but usually lasts only a brief time and can be treated effectively.
As a parent, you may want to be there during induction (beginning of anesthesia). Anesthesia induction is the two- to three-minute process at the beginning of administering anesthesia. It may be possible for you to be with your child during induction, thus please let the hospital staff know if you want to be present. Your child’s anesthesiologist will make the final decision if you can be present, based on the age of your child, previous health history and the length and type of procedure.
A pediatric anesthesiologist is an anesthesiologist who has either a special interest in children or has received special training in pediatrics. Most anesthesiologists will have attended four years of college, four years of medical school and an additional four years of internship and residency. Pediatric anesthesiologists may have also done a pediatrics residency or an additional pediatric anesthesiology fellowship. Pediatric anesthesiologists care for children of all ages from newborn to teenagers and are experienced in the special needs of children (and their families) at different ages. Their goal is to manage your child's anxiety before surgery, vital signs and overall well-being during surgery and to treat any pain or discomfort after surgery. It is also their goal to make you and your child's hospital experience as pleasant as possible.
Specially trained pediatric anesthesiologists help keep your child safe. You will meet your child's anesthesiologist prior to surgery. Children are not just “small adults” and react to anesthesia differently than adults. At the Children’s Hospital of Michigan, all anesthesiologists are specially trained in children’s anesthesia, ensuring your child receives the best care. Your anesthesiologist, will likely be assisted by specially trained anesthesia providers, which may include residents, fellows or certified nurse anesthetists. Your child will be monitored by these professionals the entire time they are under anesthesia, checking blood pressure, heartbeat and oxygen levels.
Side effects can include sleepiness, irritability, nausea, vomiting, sore throat and hoarseness. These side effects are usually self-limited and will typically go away within a few hours to a few days.
Reactions can happen but are extremely rare. The most severe—and the rarest—can be life threatening. Some of these risks include allergic reactions, awareness and heart problems. However, the Children’s Hospital of Michigan is one of the finest pediatric hospitals in the nation with every member of the anesthesia staff highly skilled in managing any risks or complications which may arise. Specially-trained pediatric anesthesiologists and nurse anesthetists have the expertise and experience to keep your child as safe as possible.
If your child eats or drinks too close to the time of the operation, the procedure will have to be rescheduled. It is important to follow your surgeon’s instructions—often referred to as “NPO guidelines”—regarding eating and drinking, even water, before the operation. Food or drink in your child’s stomach may be inhaled into the lungs during anesthesia induction, causing serious complications. These guidelines help minimize this risk. No eating, no drinking, no kidding!
In the past, children with colds had their anesthesia and surgery cancelled until they felt better. This practice was based on concerns that the anesthetic made the cold worse and increased the risk of complications during surgery. Nowadays, with much more knowledge about the effects of anesthesia on colds, it is much less common to cancel surgery for children due to colds.
An important role of the anesthesiologist is to ensure that your child breathes freely when asleep for surgery. This is more of a challenge when a child has a cold as they may have a lot of secretions and their air passages may be more sensitive. Sometimes this can result in coughing and spasm of the airways. Although these events, if they occur, are typically mild and easily treated, they can be troublesome.
The decision to cancel surgery for the child with a cold is based on a number of factors. Typically, children whose cold is limited to the nose and upper parts of the throat, whose secretions are clear, who do not have a fever, and who do not feel sleepy or lethargic can be safely anesthetized. Children who look sick, who have a fever (over 100°F) and have yellow or green secretions probably should have their surgery cancelled. Other factors may also be important including the urgency of the surgery. These decisions should be made in consultation with your anesthesiologist and surgeon who can determine whether cancellation of surgery is necessary.
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