Before anesthesia of a child: the importance of consultation

Anesthesia techniques, management of pain, presence and role of parents ... Your child must be anesthetized and you ask yourself lots of questions? Françoise Galland, Director of the Association Sparadrap, helps you to see more clearly and to approach this experience in a serene way.

Anesthesia of children: techniques

One million children aged 0 to 15 years are anesthetized in the United States each year. When parents and children are well informed, they live better this medical procedure. Follow the guide!

Children's anesthesia: management of postoperative pain

"The consultation of anesthesia is a key moment for the child and his parents," informs Françoise Galland. In the case of a scheduled operation, the consultation takes place one week before the latter in general. It allows anesthetist-resuscitator physician to ascertain the child's state of health in order to assess the possible risks of general anesthesia and to choose the type of anesthesia accordingly.

On the program: medical examination, reading the health record and clinical examination of the child. Some complementary examinations can sometimes be performed, such as a blood test, an x-ray, etc. They allow in particular to search for possible disorders of coagulation or signs of muscular diseases.

It is during this consultation that parents and children can ask all the questions they have in mind, "advises the director of Sparadrap, the objective to anticipate the progress of the anesthesia. Home, parents can be attentive to any signs of worry their child: nervousness, bad sleep ... and propose to him to answer his questions, for example by reading him the illustrated guide edited by the association, "says Françoise Galland.

The initiation of anesthesia, also called induction, can be done either in a special room (induction room) or directly in the operating room, both located within the operating room. If the anesthesia takes place in an induction room, parents can sometimes stay with their child until he is asleep. There are two techniques of induction of anesthesia: by inhalation, with the application of a mask and breathing of anesthetic vapors, or by intravenous injection through an infusion.

Does your child's anesthesia worry you more than the surgical procedure? "The mortality rate associated with anesthesia is extremely low," reassured Dr. Frédéric Lacroix, head of functional unit of pediatric anesthesia at La Timone children's hospital in Marseille.

At the end of the operation, the child, still asleep, is taken to the recovery room. It monitors its vital vital parameters (pulse rate, blood pressure, oxygen saturation, respiratory rate) and its pain score. Caregivers administer pain killers to prevent and treat post-operative pain. "Whatever the prescribed medication, the anti-pain treatment begins even though the surgery is not finished, so that it is perfectly effective when the child wakes up," explains Dr. Frédéric Lacroix. Depending on the type of surgery, more or less strong pain medications will be used (ranging from paracetamol to morphine derivatives in case of severe acute pain), for a few days after the operation.

The right medication supplement? The parents ! "Today, it is probably barely 20% (8% in 2003) of the care teams that systematically welcome parents in the recovery room," deplores Françoise Galland. Yet the presence of parents is very important. "They participate in the reassurance of the child, distract him and are his spokesmen, especially in case of unrelieved pain," she says.

If you are present, what can you do? "Reassure your child by saying that he is awake, that you are watching over him," advises the director of Sparadrap. "Ask him if he is well installed, if he is well relieved," she adds. If your child has trouble, report it to the medical staff, more potent medications can be given. Are all parameters good? The pain is relieved? Your child will be able to reach his room. Anesthesia is behind him ... and you!

The rating of pain in children

In order to be able to administer the appropriate medications, the child's pain must be assessed.

- In children under 5 years of age, the assessment is made by a score determined by observation of the behavior and the search for signs meaning the pain by the nursing staff, with the help of the parents. < Br>

- For older children, tools adapted to each age can be used

Sources

- Press kit, Better understanding of pediatric anesthesia, Sparadrap and B. Braun Foundation, June 2011 - Interview with Françoise Galland, February 2012

For your advice: Parent counseling: My child is going to be operated under general anesthesia For your child: the practical guide, "I will be operated on - Then we will fall asleep!" - The distraction of the children Of the care GALLAND Françoise, TRACOU Antoine DVD To you to play Association SPARADRAP 2011 - Link to the short film




Induction by inhalation is the most common use in children under 4 years of age. The reference gas today for this type of anesthesia is sevoflurane. His advantages? Good respiratory and cardiac tolerance that allows the use of high gas concentrations, allowing a smooth and rapid induction. This anesthetic, however, has limitations, especially in children with epilepsy, and may cause episodes of restlessness upon awakening.Intravenous induction is sometimes preferred by children between the ages of 6 and 15 who are apprehensive The mask. The most commonly used anesthetic is propofol. It has replaced thiopental, even if it remains recommended in the particular case of induction in a child with full stomach, in case of urgent intervention essential.