Counting Sheep: Anaesthesia for Children
If your child needs to come for a procedure under anaesthesia, this section has more detailed information for both you and your child.
There is a lot of information and to make it easier to digest, we have created a short parent’s video to prepare you for what to expect. We are both parents and understand that your child having a procedure in theatre can cause stress and anxiety to you. Please feel free to contact us should you wish to discuss anything to do with the anaesthetic.
What is anaesthesia?
General anaesthesia ensures that your child is unconscious, free of pain during their procedure and will have no memory the procedure. The medication used to start and continue the anaesthetic may be given through a mask (as a gas) or through a drip as an injection. It will usually be possible for you to choose how the anaesthetic will be given, but in some cases, there are important medical reasons for using a certain method. In some cases, your anaesthesiologist may also recommend a nerve block to avoid pain associated with a procedure.
Your anaesthesiologist will discuss these options with you during the preoperative consultation. It would be helpful if you could please complete the medical history questionnaire before your child comes to the hospital.
What to tell your child
Parents have an important role in preparing children to make their visit to the hospital as positive as possible. We believe that children should be told as much as possible about what is going to happen to them in a non-threatening way. To assist you in preparing your child for their experience, we have made a short children’s video for them to watch.
On the day of Procedure
We understanding that keeping your child from eating and drinking can be extremely difficult. However, it is extremely important to stick to the fasting instructions to keep your child safe under anaesthesia.
- If your child’s procedure has been booked on a morning list, please do not let them eat anything after midnight the night before, although they may drink water or clear apple juice (e.g.: Liquifruit apple juice) until 05:00am on the morning of their operation.
- If they have been booked for an afternoon list, please do not let them eat anything after 07:00am on the morning of the procedure, although they can drink water or clear apple juice until 10:00am.
- Infants may have formula milk until 6 hours before their operation, breast milk until 4 hours before their operation and water until 2 hours before their operation.
These instructions are important. If there is food or liquid in your child’s stomach during anaesthesia, it could come up into their throat and damage their lungs. If you are unsure when your child needs to stop eating or drinking, please use our fasting calculator.
Once your child has been admitted to the hospital ward, your anaesthesiologist will come to see them with you in for the preanaesthetic consultation.
This will entail your anaesthesiologist asking some questions and confirming the history which you have submitted in the medical history questionnaire.
They will examine you child and then, together with you, will formulate a plan for the anaesthetic.
Sometimes, your anaesthesiologist may prescribe some medication to be given to your child before they come to theatre. This may be medication for pain, to make your child more relaxed or numbing cream to decrease pain should a drip need to be inserted whilst your child is awake.
Children are often reassured by having a primary caregiver stay with them until they are under anaesthesia. However, if you are showing signs of being anxious, this may upset your child even more. It is important, therefore, to remain as calm as possible. You may carry your child, lie in the hospital bed next to them or walk next to them as is most comfortable for you and your child.
Your child is also welcome to bring a favourite toy or blanket to theatre with them, and may even play games or watch a program on a smart phone should this relax them.
Occasionally, staying with your child is not a good idea, for example, with very small babies, children coming for emergency surgery or parents who are extremely anxious. In this case, we may request that you do not accompany your child into theatre. We understand that being separated from your child is very stressful, but we hope that you will respect our decision in such a case. Please remember that your child’s safety is of the utmost importance to us.
If you do stay with your child, in the theatre a monitor will be placed on their finger, ear or toe. It does not hurt the child at all. If the anaesthesiologist is using gas to start the anaesthetic, they may play a game to get your child used to the mask. Once the child is used to the mask, it will be held in front of their face. Whilst this does not hurt the child, some children find it uncomfortable and may become upset. Anaesthetic gas is given through the mask and the child will go to sleep. Please do not be alarmed if your child twitches, wriggles, rolls their eyes, breathes noisily or suddenly goes limp. This is just how they go to sleep under anaesthesia.
Once your child is asleep, we will help you to place them gently on the theatre bed. You are welcome to give them a kiss goodnight and then you will be accompanied out to the waiting area.
Whilst the procedure is being performed, the anaesthesiologist will remain with your child at all times. It is likely that a “drip” will be placed once your child is asleep (if not already done so) to allow for various medications and fluid to be given. In most cases, a small tube will be placed in the child’s throat to help them to breathe. This tube will be removed before the child wakes up, but they may experience a sore throat after the procedure, this usually resolves without any specific treatment within a day.
After the procedure, your child will be taken to the recovery room. Here, they are monitored intensively by a highly trained nursing sister to ensure that they recover well after the anaesthetic, that any pain or nausea can be treated and that the surgical site is not bleeding. Once the child has recovered sufficiently, you will be allowed to join them again. Please do not be alarmed if your child is disorientated, feel dizzy or have blurred vision. These are all temporary effects after anaesthesia and will wear off. Once the child has recovered sufficiently, you will both return to the ward. In the ward, your child will have something to drink and eat and their drip will be removed as soon as they are sufficiently awake and depending upon the type of surgery.
Depending upon the type of procedure, your child may feel some pain afterwards. Your anaesthesiologist will use various types of medications to control the pain. Some of the medications used for pain relief may have side effects, and this may limit the amount of medication your child will safely be able to have. As anaesthesiologists we carefully balance potential side effects with optimal pain relief. Your anaesthesiologist will work with you and your child to ensure the best possible pain relief.
When your child is discharged, you will be given full instructions on what pain medications to give and how to give them. If your child has had a nerve block as part of their management, you will also receive discharge instructions for peripheral nerve blocks. Whilst your child will be fully awake by the time they are discharged, please be aware that general anaesthesia can impair their judgement for 24 hours. During this time, please do not let them engage in dangerous activities and contact your anaesthetist or hospital if there are concerns.
Whilst modern anaesthesia is extremely safe, there are rare complications which may still be experienced. Even though the utmost care will be taken during the anaesthetic management of your child, no guarantees can be given of a completely complication-free anaesthetic.
Please refer to our anaesthetic information pages for a list of possible complications.
Anaesthetic options for your operation
Nature of General Anaesthesia
General anaesthesia is often used for many types of operations. Your anaesthesiologist will give you medication either through a drip or via a mask. This medication will cause you to lose consciousness (go to “sleep”) so you will not be aware of the surgical procedure being performed. A tube may be placed in your throat to help you breathe. This tube will be removed as you wake up and you will probably not remember it, but your throat may be painful after the procedure. Whilst you are asleep, the anaesthesiologist will remain with you at all times to monitor your heart rate, blood pressure, breathing and other vital signs to ensure they are normal and remain steady. As part of the general anaesthetic, your anaesthesiologist will ensure that you are given pain medication as required. Once your surgery is complete, your anaesthesiologist will reverse the anaesthetic medication and you will wake up.
What if I do not want a general anaesthetic?
If you do not want to have a general anaesthetic, your anaesthesiologist can discuss with you other choices for anaesthesia and pain relief after the operation, as well as their potential side effects.
Potential Complications of General Anaesthesia
Modern anaesthesia is extremely safe and your well being is our top priority. However, even in the very best hands, very rarely complications may occur. Whilst our intention is not to frighten you, as part of responsible practice, we are obliged to inform you about these possible risks. If you are particularly concerned about any of these complications, please feel free to contact us before your procedure.
Nature of Spinal and Epidural Anaesthesia
Spinal and epidural anaesthesia may be used for surgical procedures from the chest down. They are commonly used for Caesarian Section and for orthopaedic surgery. In theatre, you will be asked to sit or lie on your side. Your anaesthesiologist will clean your back thoroughly and then place clean sheets over you. A first injection of local anaesthetic will be given to numb the skin – this injection may burn for a short while. You will then be asked to bend you back forwards (like an “angry cat”) and the spinal or epidural injection will be performed. Here, local anaesthetic and other medications are injected close the nerves coming out of your back. As it starts taking effect, you will start noticing a warm and heavy sensation in the part of your body being targeted. Both legs may start to feel heavy and may be impossible to move them. You may still feel touch and movement, but you will have no pain once the spinal or epidural has taken effect. Depending on what medications are given, this may last several hours. The spinal or epidural may be used alone or may be used in combination with a general anaesthetic or conscious sedation. In the case of an epidural, a small plastic tube may be left in your back so that local anaesthetic and other medication may be infused for the days following your surgery to assist with you pain control.
What if I do not want a spinal or epidural anaesthetic?
If you do not want to have a spinal or epidural anaesthetic, your anaesthesiologist can discuss with you other choices for anaesthesia and pain relief after the operation, as well as their potential side effects.
Potential Complications of Spinal and Epidural Anaesthesia
Modern anaesthesia is extremely safe and your well being is our top priority. However, even in the best hands, very rarely complications may occur. Whilst our intention is not to frighten you, as part of responsible practice, we are obliged to inform you about these possible risks. If you are particularly concerned about any of these complications, please feel free to contact us before your procedure.
Nature of Regional Anaesthesia
As part of your anaesthetic management for your operation, your anaesthesiologist may suggest using a technique called a “nerve block”. Medication called local anaesthetic is injected around a nerve to the area of your operation, making that part of the body numb.
Benefits of a nerve block
Nerve blocks have many benefits including:
- Better pain relief after your surgery, especially in the first few days after surgery
- Less need for strong pain-relieving drugs such as opioids (e.g.: morphine)
- Fewer opioid-related side effects (e.g. nausea, vomiting, drowsiness, constipation, urinary retention and itching)
- Shorter recovery time after your surgery
- Possibly earlier hospital discharge
- Extremely safe procedure
How the nerve block is performed
Your anaesthesiologist has been trained to perform safe and effective nerve blocks. The nerve block may be performed while you are awake, sedated or under anaesthesia. If you are awake while the block is being performed, you may feel some discomfort as the needle is introduced. Let your anaesthesiologist know if you have excessive pain or strange feelings shooting through the part of your body being blocked.
The block may be performed using:
- nerve stimulator (your muscles will twitch slightly) and/ or
- ultrasound guidance (nerve and needle are visualized, allowing a faster, more comfortable and safer nerve block)
After surgery
A “single shot” block can give pain relief for up to 24 hours. Sometimes a very narrow plastic tube called a “catheter” can be left in place to allow local anaesthetic to be administered continuously for a few days after surgery to assist with pain relief. Whilst your limb is numb, it is important to protect it from extreme hot or cold, pressure or awkward positions which may injure you without your knowledge. If you have weak or numb leg, only walk when there is somebody to assist you to make sure that you do not fall. If your limb is still numb after 72 hours (3 days) please contact your anaesthesiologist. You will be given clear instructions for discharged with a nerve block.
As the block starts wearing off, you may feel pins-and-needles in the affected area. Be sure to take some pain medication before the block wears off totally to prevent the pain coming back suddenly. Your anaesthetist will discuss with you what pain medication to take.
Do I need to do anything with the pain catheter?
If you are going to have a catheter, your anaesthetist will explain what to expect and how to manage your catheter in your preoperative consultation and you will be given clear instructions for discharge with a nerve catheter.
It is important to be careful that the catheter is not pulled out since this may decrease its efficacy. If you notice redness, swelling or pain at the catheter insertion site, please make the ward staff or anaesthetist aware of this immediately since it may indicate the beginning of an infection.
What if I am still in pain?
Occasionally, a nerve block may not take away all of your pain. If your pain is not well controlled, you will be offered alternative pain medication that your doctors have prescribed.
What if I do not want a nerve block?
If you do not want to have a nerve block, you will be informed about your other choices for anaesthesia and pain relief after the operation, as well as their potential side effects.
Potential Complications of Regional Anaesthesia
Modern anaesthesia is extremely safe and your well being is our top priority. However, even in the very best hands, very rarely complications may occur. Whilst our intention is not to frighten you, as part of responsible practice, we are obliged to inform you about these possible risks. If you are particularly concerned about any of these complications, please feel free to contact us before your procedure.
Nature of Conscious Sedation
Conscious sedation aims to keep you relaxed and comfortable during your surgical procedure but you will not be totally unconscious. You may be aware of what is happening, or may sleep through the procedure depending upon the depth of the sedation. Your anaesthesiologist will give you some medication through a drip to make you feel relaxed and drowsy. If the procedure is likely to be painful, the sedation will be used with medication to prevent the pain. Your anaesthesiologist will remain with you throughout the procedure to ensure that your blood pressure, breathing, and other vital signs remain steady throughout. The sedation wears off quickly and so is useful for short, uncomplicated procedures. However, please remember that your judgement may be impaired for up to 24 hours and you are advised not to engage in any dangerous activities (including driving) or taking care of small children during this period.
What if I do not want to have conscious sedation?
If you do not want to have conscious sedation, your anaesthesiologist can discuss with you other choices for anaesthesia, as well as their potential side effects.
Potential Complications of Conscious sedation
Modern sedation is extremely safe and your well being is our top priority. However, even in the best hands, very rarely complications may occur. Whilst our intention is not to frighten you, as part of responsible practice, we are obliged to inform you about these possible risks. If you are particularly concerned about any of these complications, please feel free to contact us before your procedure.
Billing Policy
Fees charged by anaesthesiologists fall within the guidelines of the Health Professions Council of South Africa (HPCSA). Included in the anaesthesiologist’s fee are:
- the pre-anaesthetic consultation
- anaesthetic care from when you enter the operating theatre until you are able to be left in the care of a nurse in the recovery room
- specific procedures to enhance safety and provide postoperative pain relief
Factors which can influence the fee that is charged include:
- the duration of your procedure
- if your procedure is an emergency
- if specialised techniques are used to manage your postoperative pain
- if your anaesthesiologist continues your care in the Intensive Care Unit
- if your child is less than 1 year of age
- if you are older than 70
- if your body mass index is more than 35
Gwen, André and Nadine each have their own separate practice, our billing policies are aligned. Our standard billing rate is Discovery Classic, and we are contracted in with specific medical aids.
If you would like to request a cost estimate for your anaesthetic bill, please fill in our cost estimate request form. The proportion of the anaesthetic account which will be covered by your health funder will depend upon what medical aid and what plan you are on. Whilst the guarantor remains responsible for settlement of the account, regardless of what portion is paid by your medical funder, we also understand that times are difficult for many of our patients.
Should you be unable to pay a copayment because of financial hardship, please contact us to request the deferral of payment or make an arrangement to remit payment on a monthly basis at an agreed rate.
Informed Consent
As Anaesthesiologists we are required by the HPCSA (Health Professions Council of South Africa) to keep detailed records about our patients and their procedures. These records contain information of a personal nature. The use and processing of this information falls under the Protection of Personal Information (POPI) Act. View the PDF
To ensure that we are fully compliant with both HPCSA regulations and POPI act, part of the consent (view consent form) which you will be asked to sign includes a POPI agreement which enables us to use your information to provide the best quality anaesthetic care.
The parts of the consent pertaining to POPI have been reproduced below for your information where you will be asked to give consent for:
- Your medical records being kept and transferred in digital format.
- Your personal information is stored in a secure location and is accessible to third parties only with signed confidentiality clauses as part of their employment agreements/ contracts.
- Your personal information collected in terms of this consent to be utilised for healthcare of the patient, billing and collection of debt as well as processing of queries, complaints or compliments and may be forwarded to the relevant health care professionals or organisations as required by law.
- Sharing of information on your account information with your medical funder, with other credit grantors and with the credit bureau.
- Your personal and clinical information to be shared with other persons or institutions (e.g.: medical scheme) if this is necessary to serve a legitimate purpose within the ordinary course and scope of the anaesthesiologist’s duties, provided such disclosure is in the patient’s interests.
- The release of any clinical information, including the patient’s HIV status, to any other member of the medical/ paramedical profession responsible for your safety and treatment.
- The processing of your health and personal information in order to provide you with proper treatment, care and/or for the administration of the institution or professional practice concerned. This consent would extend to responsible parties acting as service providers to the institution or the professional practice concerned.
- The sharing of patient, guardian and guarantor information with the South African Society of Anaesthesiologists CEO and its Private Practice Business and Regulation Business units in the event of a complaint (which information will be kept confidential within the SASA CEO, Private Practice and Regulation Business Units).
- Communication with your family/ nominated others with respect to your medical care and medical account.
- Anonymous data of a clinical (including anonymised ultrasound images) and practice management nature to be collected and used in published or unpublished research, clinical audits, quality control, teaching and training.
We may use your anonymous data of a clinical and practice management nature to be collected and used in published or unpublished research, clinical audits, quality control, teaching and training. This could include anonymised ultrasound images. Whilst your data will assist with research, it will be impossible to trace any data or images to you and confidentiality will be maintained.
Should we require the use of anonymised photographs, we shall contact you for express written permission before using photographs for any research, publications, presentations, teaching or training. Any images will be used only in accordance with international standards for patient confidentiality and you will have the option to opt out at any time.
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We are fully qualified doctors with years of training exclusively in the practice of anaesthesia, intensive care and pain management, resuscitation and advanced life support.
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044 630 0660
info@synceruscare.co.za
Postnet Suite 204
Private bag x 6590
George
6530