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.
Boris Yaguda, M.D.