More Information about Anesthesia Services

Your child’s anesthesia care team will include an attending anesthesiologist and either a nurse anesthetist, a pediatric anesthesia fellow or a senior anesthesia resident.

Your first contact with an anesthesia provider will typically take place on the day of surgery. Once you have been admitted and brought to a pre-operative holding room, the anesthesia team will meet with you and your child. The anesthesia team will have access to your medical records but will need to confirm some details. Afterward, we will talk about the anesthetic plan with you.

The plan for most patients – including those having procedures in the operating room, cardiac catheterization lab or MRI scanner – will include a general anesthetic. Your child will be asleep for the entire procedure. A small number of patients having catheterizations will not need general anesthesia.

There are two common ways of giving a child general anesthesia.

1. Most children will receive intravenous induction, also called an IV. A doctor injects the anesthetic into the bloodstream through an IV to cause your child to sleep.
2. The other way through inhalation by placing a mask on your child's face. As your child breathes, they will absorb the anesthetic into the blood, which will take it to the brain to cause sleep. We use this method with very young patients.

If your child is given an IV, we may provide a sedative dose in the holding room. If not, we can provide a sedative by mouth, nose or injection. This can help your child if they are anxious about being separated from you.

Once your child is relaxed, we take them to the operating room to place basic monitors, such as a blood pressure cuff and pulse oximeter. We then give your child anesthesia for the surgery. Anesthesia providers will supply breathing support, first through a face mask and then a breathing tube.

The team will place any intravenous catheters, arterial line catheters, central venous catheters, and a bladder catheter after the breathing tube. Your child will then be prepared for surgery.

Some procedures that take place in our cardiac catheterization laboratory do not require general anesthesia. This usually only happen with older patients, such as teenagers. In these cases, we use monitored anesthesia care (MAC).

The patient receives medications for sedation and relaxation through an IV, but not general anesthesia that causes sleep. The goal with MAC is to keep the patient comfortable and breathing on their own.

The cardiologist will use local anesthetics to numb any part of the body where a catheter will be placed or an incision made.

The advantages of MAC for the patient include less nausea, quicker recovery from sedation and avoidance of side effects such as sore throat or hoarseness from a breathing tube.

May I stay with my child while they go to sleep?

You may stay with your child in the holding area until it is time for your child’s surgery.

The start of anesthesia is a critical time. Because we want to ensure every team member’s attention is entirely on your child, we don't allow parents to be present in the OR or the MRI suite as we begin anesthesia.

Easing any anxiety your child may experience when separating from you is very important to us. Many children do very well with distraction when going to the OR (games, toys or watching a favorite TV show). We also offer the option of premedication in the holding room area (medication given to drink or as a nasal spray that helps alleviate anxiety). Your anesthesia team will discuss the best option for your child with you on the day of surgery.

Will my child have an IV placed while awake?

Most surgical procedures require placement of a peripheral intravenous catheter (IV). Your child will receive fluids and medication through the IV during the procedure. We place the IV either in the holding room or the operating room after your child goes to sleep by breathing anesthesia gas through a mask.

Your anesthesia team will discuss the safest option for your child based on your child’s age and medical concerns, = and the type of procedure they will receive.

My child has a cold or fever. Do we need to reschedule the surgery?

Surgery and anesthesia are stressful for your child. Ideally, we proceed with any elective (non-urgent) surgery at a time when your child is not ill. Especially over the winter months, many children experience upper respiratory infections. This may increase the risk of complications during the anesthetic.

If your child’s symptoms are very mild (for example only a clear runny nose or a mild cough), we will likely proceed. If your child has more severe symptoms such as fever, productive cough, yellow or green secretions, lethargy or decreased appetite, we recommend postponing your child’s elective surgery for at least four weeks.

Not every fever requires your child’s surgery to be postponed. Ideally your child's temperature should be normal for at least 48 hours prior to elective surgery. If your child only has a low-grade fever due to teething or an ear infection, for example, we will likely be able to proceed with your child’s surgery even if the fever occurred within 48 hours prior to surgery. Your anesthesia team will evaluate your child in the holding area on the day of surgery to determine if it is safe to proceed.

If you are unsure if you need to reschedule your child’s surgery, call the PATCH clinic at (615) 936-1840. We are happy to discuss your child’s symptoms with you.

If a fever is due to a current upper respiratory infection, the flu, strep throat or a urinary tract infection, call the PATCH clinic.

My child has a chronic illness with specific anesthetic considerations. How can I get in touch with my anesthesia team before the surgery?

Some chronic conditions require special precautions during anesthesia. Specialists (for example, your child’s neurologist or geneticist) may have given you specific instructions for your anesthesia team. If you have not been referred to the PATCH clinic prior to your child’s procedure, or would like to discuss specific anesthetic concerns, call the PATCH clinic at (615) 936-1840 to schedule a pre-anesthetic appointment.

Can my child have his or her usual morning medication on the morning of surgery?

This depends on the type of medication your child is taking.

We encourage you to give your child his or her usual morning doses of medications for seizure, acid reflux, ADHD, allergies or heart conditions (for example: Sildenafil, Digoxin, Lasix), as well as prednisone and asthma inhalers.

Some medications may need to be held. These include ibuprofen; blood thinners like aspirin, warfarin and lovenox; and certain blood pressure medications. 

Your child must not have any solid food for six hours prior to surgery. This is important if your child usually takes medication with apple sauce, pudding or other solid foods. If the medication is due under six hours prior to arrival time, consider giving the medication with gelatin instead of solid food. This is considered a clear food and can be given up to two hours prior to surgery.

Call us at (615) 936-1840 for help. We are happy to go over your child’s medications with you and develop a plan for your child’s day of surgery based on arrival time and NPO requirements.

Why do we have to arrive two hours before my child’s surgery?

Preparing your child for a surgical procedure includes several steps. You will first go through registration. Then we will bring you to the holding room area where you will meet several members of your health care team. A nurse will confirm the procedure your child is scheduled for and go over your child’s health history, medications and allergies.

You will also meet several members of your anesthesia team. The first team member will be a preanesthetic testing nurse practitioner who will ask questions to ensure your child receives the right anesthetic. After that, you will meet the anesthesia providers who will be in the OR with your child. They will discuss the anesthetic plan with you, including how your child will go to sleep, what type of anesthesia your child will receive and what to expect after the anesthetic. Ask the team any questions you may have at that time.

Your surgical team will go over the surgical consent with you.

Finally, you might meet one of our child life specialists who can help ease any anxiety your child may experience.

What type of anesthesia will my child receive?

This depends on the surgical procedure and your child’s health history. Your anesthesiologist will discuss anesthetic options with you and determine the best one for your child.

I am a foster parent or legal guardian. What documentation do I need to provide?

Bring any documents you have outlining legal guardianship or custody on the day of surgery. We will scan a copy of the documents to add to your child's electronic chart for future visits.

If you are a foster parent and DCS signs medical consents, please let your DCS caseworker know the date and time of surgery. The surgical and anesthesia teams will contact the DCS nurse for consent on the day of surgery.

My child is scheduled for a sedated MRI or CT. What type of anesthesia will my child receive?

The type of sedation or anesthesia depends on the imaging study and your child’s medical history.

Some CT scans are very short and can be done with mild sedation. This means your child will not be completely asleep. Other CT scans require a general anesthetic. This means your child will be completely asleep. Most CT scans only take a few minutes to complete.

Most MRIs that require sedation are done under light general anesthesia. Your child will be completely asleep for the MRI. Most MRI scans last from one to three hours.