Your child is scheduled for complex surgery that will require general anesthesia. When patients are under general anesthesia, they are unconscious and cannot feel pain or any other sensation. Complex surgeries include:

• Major operations in the chest and abdomen such as removal of tumors, operations of the gastrointestinal and genitourinary system, repair of an abnormally depressed chest (pectus excavatum) and minimally invasive (laparoscopic) surgery for gastric bypass
• Reconstructive surgery of the head and face
• Operations on the brain and the spinal cord

Being sure that your child's health at the time of surgery is in the best possible condition is very important to lessen any risks from anesthesia. The anesthesia team will carefully manage your child’s medical problems, ensure a safe anesthetic, replace fluids and blood as needed and provide good pain control.

Before the Operation

Before surgery, you will meet your child's anesthesiologist. You will be asked questions about your child's medical history, allergies, current medications, previous anesthetic experiences and current health status. The anesthesiologist will examine your child's airway, heart and lungs.

To reduce anxiety, a sedative may be given by mouth or by intravenous line 10 or 15 minutes before surgery if the anesthesiologist deems it safe and appropriate. This helps to relax your child, eases the process of separating from you and often provides amnesia so your child does not remember leaving you and coming to the operating room.

During the Operation

To begin general anesthesia, medication is given either intravenously (IV) or by having your child breathe anesthetic gas through a mask. The airway is often kept open with a breathing tube. The anesthetic includes inhaled and intravenous medications including pain medication and medication to prevent nausea and vomiting.

Anesthesia professionals will monitor your child closely during surgery. Routine monitors will check on the heart's electrical activity, blood pressure, oxygen levels in the blood and breathing (measuring inhaled oxygen and exhaled carbon dioxide concentrations). In addition, the anesthesiologist may use arterial and central lines to monitor continuous blood pressure and central venous pressure. An arterial line is like a regular IV, but is placed in an artery rather than a vein. Similarly, a central line may be used to monitor central venous pressure.

To manage pain, the anesthesiologist may place an epidural catheter. This thin tubing, placed in the epidural space along the spinal column, allows the physician to give pain medication continually. Pain also may be controlled by giving opioid medications such as morphine or fentanyl through the IV. Transfusion of blood and blood products may be required to replace blood lost during surgery.

After the Operation

After major operations, patients may be cared for in the Pediatric Intensive Care Unit (PICU). The breathing tube may be kept in place for a period of time after surgery to help your child breathe. Pain may be managed by a computerized pump, called patient controlled analgesia (PCA) or, in younger children, nurse / parent controlled analgesia (NCA).