No Aspirin for Children

By Jessica Kell, MD

Some surgeries might be called “minor,” but there is no such thing as minor anesthesia when it comes to children. Kids are not small adults. That’s why it takes pediatric specialists to ensure the comfort and safety of infants, children and teens before, during and after surgery.

Pediatric anesthesiologists and nurse anesthetists have special training that focuses on the differences between adults and children. And they have special credentials for the job. They treat only infants, children and teens every day, so they are uniquely familiar with the physiology and emotional responses of children from tiny infants to teens. The physical differences between children and adults are significant.

Children’s airways are smaller and shaped differently from adults. Younger patients may have vocal cord spasms and other breathing problems more often than adults do during anesthesia. Pediatric providers know how to keep these “itchy” airways calmer and act quickly if problems occur.

Inserting an IV line into a small child’s thread-thin veins, especially if complications arise or special medicines are needed, can be a challenge. Pediatric specialists successfully perform these interventions many times a day in even tiny infants.

In most cases, patients can be asleep or drowsy before IV lines are placed or blood is drawn. This allows them to avoid the pain and common fear of seeing needles and tubes.

The anesthetic medication requirement for infants, children and adolescents varies greatly, so it is imperative to give and monitor the concentrations of drugs carefully. To be absolutely safe, pediatric doctors and nurses have certification in pediatric-specific cardiopulmonary resuscitation if the need arises.

Infants and small children often have greater and faster body temperature changes during surgery and anesthesia. CHKD’s operating rooms are warm and have special beds and blankets to keep patients comfortable.

Outpatient Surgery at CHKD

In CHKD’s pediatric setting, every person the child comes in contact with is specially trained and enjoys caring for children and teens. Nurses and doctors pay particular attention to the patient’s emotions and work hard to soothe worries of children and their parents.

Before and after surgery, the goal of nurses and doctors is to make the experience as pleasant as possible for the child and family. Eliminating fear becomes job-one for the entire surgical staff. So preparation begins long before the child is brought to the OR.

Patients are given a choice of the “flavor” they’ll find in their surgery mask when they get to the OR. The most popular candy-flavored anesthesia is bubblegum, with strawberry, watermelon, root beer and cotton candy close behind. To get patients accustomed to the notion of a mask being put on their face, nurses may play games, allowing them to try the flavors in a practice mask without anesthesia. Some patients feel better after sipping a cherry-flavored sleepy medicine too.

Before surgery children wait in a big play area that has a special place just for teens. For the trip to the OR, the child may have a choice of riding in a wagon or peddle car.

When the surgery is over, parents are brought to the post-anesthesia area as the child awakens. The treat of a flavored slush drink or ice pop is a welcome part of this period, especially to the patient who has not eaten for hours. And parents and children alike are grateful for time spent cuddling in the rocking chairs as the patient recovers for the trip home.

From beginning to end, the experience focuses on safety with the least possible pain and anxiety, and it hardly ever resembles the experience a patient might expect in an adult facility.

By Dr. Kell is one of 13 certified pediatric anesthesiologists with Children’s Specialty Group PLLC, who practice exclusively at CHKD and its outpatient surgery centers. She is medical director of anesthesia/surgical services for CHKD’s Health and Surgery Center at Princess Anne, opening next fall.