What Do You Need to Know About Anesthesia Before Heart Surgery?
An anesthesiologist is the doctor that gives medicines that cause a patient to be unaware, or "asleep" during surgery.
The anesthesiologist closely watches your child during surgery. They control breathing, and put in IVs, along with other things.
Anesthesiology is a big responsibility. We know that no two patients are the same. It is important that an anesthesia team member meet with your family before surgery. They will talk about the patient's health history, examine the patient, and review laboratory tests to make a good anesthetic plan (medicine to help the patient sleep and be pain free. The anesthesiologist can explain what to expect on the day of surgery. They can also talk about the medicines that will be given on surgery day.
Most of these meetings will occur in the Same Day Surgery area the day before surgery. This will be a busy day. You will meet with a cardiologist (heart doctor), a nurse practitioner and the anesthesia team member.
Your child may also have a chest X-ray, electrocardiogram (EKG), blood tests and an echocardiogram that day.
For patients needing cardiac catheterization or transesophageal echocardiograms (TEE), most visits will occur on surgery day.
Speaking With the Anesthesiologist
An anesthesia team member will begin by reviewing the patient's health and medicine history. Questions will focus on the heart. Other health issues will be addressed like:
- Respiratory problems such as asthma or sleep apnea
- Problems such as gastro-esophageal reflux or muscle disease
- A family history of anesthetic problems.
The anesthesia team member will ask if your child has an active or recent respiratory infection such as a cold or pneumonia.
Active respiratory infections can be a reason to delay the procedure until the infection is better. If your child is ill the day before or the day of the preoperative visit, call the Cardiothoracic Surgery office to talk about the problem. Rescheduling may save you a trip to the hospital.
You will also be asked about allergies and any family history of problems with anesthetics. Sometimes children react to certain medications in odd ways. This may not be a true allergic reactions but important in planning anesthesia.
If you report a medicine allergy, you will also be asked to describe the reaction. It is unusual for children to be allergic to anesthetic drugs. The most common allergies are to antibiotics such as penicillin or amoxicillin.
Knowledge of Family Health Problems
There are some families in which family members carry a gene that makes them more likely to have reactions to certain anesthetic drugs. The condition is known as malignant hyperthermia (MH).
Malignant hyperthermia is a hereditary condition. It is caused by an abnormality in muscle tissue. This condition is rare. If you know of anyone in the family who had a very high fever during or shortly after surgery, it is important to report this.
Any other unusual events during surgery involving a blood relative should also be reported.
Common Questions and Answers
The preoperative visit will give you the chance to talk about your child's anesthetic with the anesthesia team member. It is important to ask questions about all phases of the anesthetic process.
Many times parents think of questions after the preoperative visit. If this happens, write the questions down on paper. Bring them with you the day of surgery. We will be happy to answer them for you.
Can I be present as my child goes to sleep?
Unfortunately, no. This is for safety.
The child can be more closely monitored in the operating room as they go off to sleep. Before the start of anesthesia, most children have a blood pressure cuff, EKG (heart monitor) leads, and a pulse oximeter placed. These things help the anesthesia team keep a close eye on your child.
Preoperative sedation can help your child’s anxiety before anesthesia.
Why would I want my child to have extra medication before surgery?
Preoperative sedatives make the process of starting anesthesia (going to sleep) as smooth as possible for the child. It decreases the anxiety over separation from family members.
Whenever possible, we use liquid medicines taken by mouth. The most used medicine is called Versed®.
Preoperative medicines are given at a specific time so there is enough time for the medicine to take effect.
After getting Versed®, most children will not remember being taken to the operating room for surgery.
Some children will be fascinated by the whole process. They will not need a medicine before going to the operating room. These children are the exception. We expect most children over the age of one year to be nervous. They are not likely to be separated from their parents with a medicine to help.
Will my child experience awareness or pain during surgery?
There are two parts to pain. One is an awareness that something hurts. The other is the body's response. This includes increased heart rate and blood pressure and the release of chemicals that increase the breakdown of fats and protein.
The medicines used during anesthesia block the conscious awareness. This begins when a child gets Versed® before surgery. This drug reduces awareness. It blocks memory for events after the drug is given.
Medicines given for anesthesia also block awareness. They help the patient not remember things. The combination of inhaled (gas) anesthetics and Versed® is very powerful.
Your child may also get narcotic medicine as part of the anesthetic. These drugs block pain signals.
The inhaled anesthetics used help block the body's response to pain. We adjust the dose based on the child's needs.
How do you know how much anesthesia to give?
Each child has constantly monitored. The doctor watches their heart rate, blood pressure, exhaled carbon dioxide and blood oxygen saturation. We use this information, and the child's age and weight to know how much anesthetic to give each child.
The anesthetics we use have been studied. There are ranges of doses that are appropriate for children of ages and weights. We know all children are unique. All medications are adjusted to the needs of each child.
Will my child experience pain after surgery?
Everything is done to make sure children who have heart surgery are comfortable after surgery. Every surgery has some discomfort. The narcotic medicines during surgery will not wear off as soon as the surgery is completed. The pain-blocking effect will last for one or more hours after surgery.
Once the child is in the Cardiac Intensive Care Unit, the care team there will give additional pain medicine as needed.
Some children are placed on continuous infusions of pain medication. Many are sedated overnight.
Some children have the breathing tube taken out right after surgery or within the first several hours after surgery.
If they are old enough to give themselves pain medication, a patient-controlled analgesia (PCA) device may be used.
Children who are too young to use a PCA may be given intravenous (IV) pain medications. See post-operative pain control options.
Will my child need a blood transfusion during surgery?
Every effort is made to avoid a transfusion. It is needed at times for the child's safety. If a transfusion is needed, your child's blood will be matched to blood of a similar type to help prevent an allergic reaction.
Infants and children under about 20 pounds are most likely to need a transfusion.
Most infants do not have enough red cells (oxygen carrying cells of the blood) in their circulation to go on the heart-lung bypass machine safely unless red blood cells are added to the bypass pump. This means that they get a transfusion while on the bypass pump.
Every effort is made to minimize the exposure to extra units of blood. After bypass, special ways for concentrating blood are used to get a safe red blood count in each patient.
In some cases, it is needed to give other blood products such as platelets. Platelets help the blood form clots. Platelets are used up or damaged during heart-lung bypass.
