Anesthesiologist Questions Anesthesia

How are children usually given anesthesia?

My son has a tonsillectomy scheduled for next week, and is going to be given anesthesia. He's petrified of needles, however, so I'm worried that he would get scared if the anesthesia is given in this way. Is anesthesia only given through an IV? Can I suggest it be given a different way?

3 Answers

Depending on the age, size, and cooperation of the child, in some instances anesthesia can be started by breathing anesthetic gas. in general this is not done for adults or larger or older (school age) children. The onset of the anesthesia state demonstrates a more rapid onset when started by an IV route, instead of an inhalation route. It is that state of being "in between" awake and aware vs. deeply asleep that is the more dangerous time in the administration of anesthesia and is generally referred to as "Stage 2". Anesthesiologists and Nurse Anesthetists know this is a more dangerous time, and prefer to get a patient through this as rapidly as possible. This is the primary reason administration of an IV drug is the preferred manner of beginning the anesthesia, as the patient can pass through stage 2 within a few seconds, instead of taking a few minutes to pass through this stage that occurs with anesthesia induction by inhalation of an anesthesia gas.

There are a few methods of inducing anesthesia:

1) Intravenous medications
2) Inhalational anesthetic gas
3) Intramuscular injection

All three of these methods can be preceded by oral medication used to relax a child and create an amnestic effect. However, this requires the cooperation of a child in ingesting such medication which is typically a liquid with a somewhat bitter taste. An alternative delivery is through a mist directed up a nostril and absorbed through mucosa, but the downside is a brief burning sensation that can be upsetting to a child.

In the appropriate situation, many providers will utilize a mask induction w/ an anesthetic has called sevoflurane. It does have a strong odor that can be described to a child as similar to nail polish, wet paint or even stinky feet (kids tend to laugh at that last one quelling the anxiety). This method requires roughly 10 deep breaths into a mask (you can expect amnesia after the 3rd/4th breath). It does not smell horrible but does not smell like roses either. This results in no “shots” while the child is still awake as IV insertion occurs after they are “asleep.”

An intramuscular injection is typically the least desirable method but utilized for a patient who can not tolerate any cooperation or is at risk of hurting themselves or someone involved in their care. It is quickly effective and renders a child “asleep” in 3-5 minutes.

Alternatively, a local anesthetic cream (“EMLA cream”) can be applied to a prospective IV site prior to insertion making the site numb and pain free to the needle.

Best of luck - and remember the surgery/anesthesia process is always worse for the parent than the child as anticipation is the hardest aspect. Do everything you can to help your child realize there is nothing to be afraid of and do your best not to show to much of your own anxiety as they look to you for how they should react to an unknown situation like surgery.

Best regards,

He will be given most likely oral medication to make him very relaxed. Then, in the operating room, he will go to sleep with a mask and only then will an IV typically be placed. Don't suggest any alternatives. The anesthesiologist knows what to do and it's done that way for a reason.

Boris Yaguda, M.D.