Anesthesia in Children

When a child needs an operation, it usually worries the parents more than the child.

That is entirely natural. But one of the most important facts in paediatric anesthesia is this: children are not small adults.

It is not only their height and weight that differ. Their respiratory systems, circulation, metabolism, their response to the drugs we use, and even the way they perceive an operation are different from adults.

Paediatric anesthesia is therefore one of the areas of anesthesiology that requires specific knowledge and experience. The aim is not only to perform the operation safely, but to let the child get through the process with as little fear and stress as possible.

Why are children not small adults?

There is a phrase used often in medicine: "a child is not a small adult."

The reason is not only body size. For example:

• Their airways are narrower
• Their oxygen consumption is higher
• They lose body heat more quickly
• Their fluid balance can change faster
• Their response to drugs varies with age

Drug doses in children are therefore planned not by weight alone, but with their stage of development taken into account.

Why are children more frightened of surgery?

Adults can understand why an operation is being performed. For a child it is different.

A hospital room, the door of an operating theatre or a place full of strangers can be frightening.

Paediatric anesthesia therefore involves psychological preparation as well as medical preparation.

In many cases the most important factor shaping a child's anxiety is the behaviour of the parents. Young children in particular try to read the world through their parents' eyes. If the mother and father are very anxious, the child will be anxious too.

The first treatment in paediatric anesthesia is often to reduce the parents' anxiety.

How does anesthesia begin in children?

In adults anesthesia usually begins with drugs given through a vein. In children the situation can be different.

In younger age groups in particular, having a cannula placed can cause real fear. In many children anesthesia is therefore started with a mask.

Anesthetic gases delivered through the mask send the child to sleep within a short time, and the intravenous line is placed afterwards. This reduces the child's anxiety and makes the process more comfortable.

Is mask induction safe?

Yes. It has been used worldwide for many years, and it is one of the most common ways of starting anesthesia in preschool children.

The anesthesiologist determines the most appropriate method according to the child's age, weight and the planned operation.

What is monitored during anesthesia?

Safety is the highest priority in paediatric anesthesia. Throughout the operation the following are monitored continuously:

• Heart rhythm
• Oxygen level
• Breathing
• Blood pressure
• Body temperature
• Fluid balance

Modern monitoring systems allow these to be followed second by second.

How is pain controlled in children?

It is no longer acceptable for children to experience unnecessary pain after surgery. Pain treatment is therefore planned before the operation begins.

In some operations the following are used to give a more comfortable recovery:

• Regional anesthesia techniques
• Nerve blocks
• Long-acting analgesics

Why do children sometimes cry on waking?

This is one of the things that surprises parents most.

Some children experience brief restlessness after waking from anesthesia. In medicine this is called emergence agitation. The child may cry, react to their surroundings or be briefly disoriented.

It is usually temporary, and most children settle within a short time.

Does anesthesia affect brain development?

This has been among the most researched topics in recent years.

Large studies using modern anesthetic drugs have not produced strong evidence that anesthesia given for short, necessary surgical procedures harms children's neurological development.

Postponing a necessary operation solely out of this concern is therefore usually not the right approach.

How should parents prepare their child?

Being honest matters. Rather than pretending the operation will not happen, explain it in a way appropriate to the child's age — without going into frightening detail.

Most important of all is for parents to keep their own anxiety from reaching the child as far as they can.