Anesthesia for Complex Surgery

Your child is scheduled for complex surgery that will require general anesthesia. When patients are under general anesthesia, they are unconscious and cannot feel pain or any other sensation. Complex surgeries include:

  • Operations in the chest and abdomen such as removal of tumors, repair of an abnormally depressed chest (pectus excavatum) and minimally invasive (laparoscopic) surgery for gastric bypass
  • Reconstructive surgery of the head and face
  • Bladder enlargement (augmentation)

Your child's health at the time of surgery is very important to lessen any risks from anesthesia. The anesthesiologist will carefully manage heart, lung, and other organ problems, breathing difficulties, fluid and blood loss and pain.

Before surgery, you will meet your child's anesthesiologist. You will be asked questions about your child's medical history, allergies, current medications, previous anesthetic experiences and current health status. The anesthesiologist will examine your child's airway, heart and lungs.

To reduce anxiety, a sedative may be given by mouth or by intravenous line, 10 or 15 minutes before surgery if the anesthesiologist deems it safe and appropriate. This helps to relax your child, eases the process of separating from you and often provides amnesia so your child does not remember the experience.

General anesthesia is given either intravenously (IV) or by having your child breathe anesthetic gas through a mask. The airway is kept open with a breathing tube. The anesthetic includes inhaled drugs, muscle relaxants and pain medication.

Anesthesia professionals will monitor your child closely during surgery. Routine equipment will check on the heart's electrical activity, blood pressure, oxygen levels in the blood and breathing (measuring inhaled oxygen and exhaled carbon dioxide concentrations). In addition, the anesthesiologist may use arterial and central lines to monitor continuous blood pressure and central venous pressure. An arterial line is like a regular IV, but placed in an artery rather than a vein. Similarly, a central line may be used to monitor central venous pressure.

To manage pain, the anesthesiologist may place an epidural catheter after your child is asleep. This thin tubing, placed in a space between the bones of the spine and the spinal cord, allows the physician to give pain medication continually, when indicated. Pain also may be controlled by giving medications such as morphine or fentanyl through the IV. Transfusion of blood and blood products may be required to replace blood lost during surgery.

After the surgery, patients are often cared for in the Pediatric Intensive Care Unit (PICU). The breathing tube may be kept in place for a period of time after surgery to help your child breathe. Pain may be managed by a computerized pump, called Patient Controlled Analgesia (PCA) or, in younger children, Nurse / Parent Controlled Analgesia (NCA).

Last Updated 05/2014