Consequences of general anesthesia in children. Why is general anesthesia dangerous for a child? Is it possible to prevent complications?

Very often, anesthesia scares people even more than the operation itself. The unknown, possible unpleasant sensations when falling asleep and waking up, and numerous conversations about the harmful effects of anesthesia are scary. Especially if all this concerns your child. What is modern anesthesia? And how safe is it for the child’s body?

In most cases, all we know about anesthesia is that the operation under its influence is painless. But in life it may happen that this knowledge is not enough, for example, if the issue of surgery for your child is decided. What do you need to know about anesthesia?

Anesthesia, or general anesthesia, is a time-limited medicinal effect on the body, in which the patient is in an unconscious state when painkillers are administered to him, with the subsequent restoration of consciousness, without pain in the area of ​​​​the operation. Anesthesia may include administering artificial respiration to the patient, ensuring muscle relaxation, placing IVs to maintain a constant internal environment of the body with the help of infusion solutions, control and compensation of blood loss, antibiotic prophylaxis, prevention of postoperative nausea and vomiting, and so on. All actions are aimed at ensuring that the patient undergoes surgery and “wake up” after the operation without experiencing a state of discomfort.

Types of anesthesia

Depending on the method of administration, anesthesia can be inhalational, intravenous and intramuscular. The choice of anesthesia method lies with the anesthesiologist and depends on the patient’s condition, on the type of surgical intervention, on the qualifications of the anesthesiologist and surgeon, etc., because different general anesthesia may be prescribed for the same operation. The anesthesiologist can mix different types of anesthesia, achieving the ideal combination for a given patient.

Anesthesia is conventionally divided into “small” and “large”; it all depends on the quantity and combination of drugs from different groups.

“Small” anesthesia includes inhalation (hardware-mask) anesthesia and intramuscular anesthesia. With machine-mask anesthesia, the child receives an anesthetic drug in the form of an inhalation mixture while breathing independently. Painkillers introduced into the body by inhalation are called inhalational anesthetics (Ftorotan, Isoflurane, Sevoflurane). This type of general anesthesia is used for low-traumatic, short-term operations and manipulations, as well as for various types of studies when a short-term switching off of the child’s consciousness is necessary. Currently, inhalation anesthesia is most often combined with local (regional) anesthesia, since it is not effective enough as mononarcosis. Intramuscular anesthesia is now practically not used and is becoming a thing of the past, since the anesthesiologist absolutely cannot control the effect on the patient’s body of this type of anesthesia. In addition, the drug, which is mainly used for intramuscular anesthesia - Ketamine - according to the latest data, is not so harmless for the patient: it turns off long-term memory for a long period (almost six months), interfering with full-fledged memory.

“Major” anesthesia is a multicomponent pharmacological effect on the body. Includes the use of medicinal groups such as narcotic analgesics (not to be confused with drugs), muscle relaxants (drugs that temporarily relax skeletal muscles), sleeping pills, local anesthetics, a complex of infusion solutions and, if necessary, blood products. Medicines are administered both intravenously and by inhalation through the lungs. The patient undergoes artificial pulmonary ventilation (ALV) during the operation.

Are there any contraindications?

There are no contraindications to anesthesia, except for the refusal of the patient or his relatives to undergo anesthesia. However, many surgical interventions can be performed without anesthesia, under local anesthesia (pain relief). But when we talk about the patient’s comfortable condition during surgery, when it is important to avoid psycho-emotional and physical stress, anesthesia is necessary, that is, the knowledge and skills of an anesthesiologist are needed. And it is not at all necessary that anesthesia in children is used only during operations. Anesthesia may be required for a variety of diagnostic and therapeutic procedures, where it is necessary to remove anxiety, turn off consciousness, to enable the child not to remember unpleasant sensations, the absence of parents, a long forced position, a dentist with shiny instruments and a drill. Wherever a child needs peace of mind, an anesthesiologist is needed - a doctor whose task is to protect the patient from operational stress.

Before a planned operation, it is important to take into account the following point: if a child has a concomitant pathology, then it is desirable that the disease is not exacerbated. If a child has been ill with an acute respiratory viral infection (ARVI), then the recovery period is at least two weeks, and it is advisable not to carry out planned operations during this period of time, since the risk of postoperative complications significantly increases and breathing problems may arise during the operation, because a respiratory infection primarily affects the respiratory tract.

Before the operation, the anesthesiologist will definitely talk with you about abstract topics: where the child was born, how he was born, whether vaccinations were given and when, how he grew, how he developed, what illnesses he had, whether he has any diseases, examine the child, get acquainted with the medical history, and carefully study all the tests. . He will tell you what will happen to your child before the operation, during the operation and in the immediate postoperative period.

Some terminology

Premedication- psycho-emotional and medicinal preparation of the patient for the upcoming operation, begins several days before surgery and ends immediately before the operation. The main goal of remedication is to relieve fear, reduce the risk of developing allergic reactions, prepare the body for upcoming stress, and calm the child. Medicines can be administered orally in the form of syrup, as a nasal spray, intramuscularly, intravenously, and also in the form of microenemas.

Vein catheterization- placement of a catheter in a peripheral or central vein for repeated administration of intravenous medications during surgery. This manipulation is performed before surgery.

Artificial pulmonary ventilation (ALV)- a method of delivering oxygen to the lungs and further to all tissues of the body using an artificial ventilation device. During surgery, they temporarily relax the skeletal muscles, which is necessary for intubation. Intubation- insertion of an incubation tube into the lumen of the trachea for artificial ventilation of the lungs during surgery. This manipulation by the anesthesiologist is aimed at ensuring the delivery of oxygen to the lungs and protecting the patient's airways.

Infusion therapy- intravenous administration of sterile solutions to maintain a constant water-electrolyte balance in the body, the volume of circulating blood through the vessels, to reduce the consequences of surgical blood loss.

Transfusion therapy- intravenous administration of drugs made from the patient’s blood or donor’s blood (erythrocyte mass, fresh frozen plasma, etc.) to compensate for irreplaceable blood loss. Transfusion therapy is an operation for the forced introduction of foreign matter into the body; it is used according to strict health conditions.

Regional (local) anesthesia- a method of anesthetizing a specific area of ​​the body by applying a solution of local anesthetic (painkiller) to large nerve trunks. One of the options for regional anesthesia is epidural anesthesia, when a local anesthetic solution is injected into the paravertebral space. This is one of the most technically difficult manipulations in anesthesiology. The simplest and most well-known local anesthetics are Novocaine and Lidocaine, and the modern, safe and longest-acting one is Ropivacaine.

Preparing the child for anesthesia

The most important thing is the emotional sphere. It is not always necessary to tell your child about the upcoming operation. The exception is when the disease interferes with the child and he consciously wants to get rid of it.

The most unpleasant thing for parents is the hunger pause, i.e. six hours before anesthesia, you cannot feed the child; four hours before, you cannot even give him water, and by water we mean a clear, non-carbonated liquid without odor or taste. a child who is on can be fed for the last time four hours before anesthesia, and for a child who is on, this period is extended to six hours. A fasting pause will allow you to avoid such complications during the onset of anesthesia as aspiration, i.e. entry of stomach contents into the respiratory tract (this will be discussed later).

Should I do an enema before surgery or not? The patient's intestines must be emptied before the operation so that during the operation under the influence of anesthesia there is no involuntary passage of stool. Moreover, this condition must be observed during operations on the intestines. Usually, three days before surgery, the patient is prescribed a diet that excludes meat products and foods containing plant fiber, sometimes a laxative is added to this the day before the operation. In this case, an enema is not needed unless the surgeon requires it.

The anesthesiologist has many devices in his arsenal to distract the child’s attention from the upcoming anesthesia. These include breathing bags with images of different animals, and face masks with the smell of strawberries and oranges, these are ECG electrodes with images of cute faces of your favorite animals - that is, everything for a child to fall asleep comfortably. But still, parents should stay next to the child until he falls asleep. And the baby should wake up next to his parents (if the child is not transferred to the intensive care unit after the operation).

During surgery

After the child has fallen asleep, the anesthesia deepens to the so-called “surgical stage”, at which point the surgeon begins the operation. At the end of the operation, the “strength” of anesthesia decreases and the child wakes up.

What happens to the child during the operation? He sleeps without experiencing any sensations, particularly pain. The child's condition is assessed clinically by the anesthesiologist - by looking at the skin, visible mucous membranes, eyes, he listens to the child's lungs and heartbeat, monitoring (observation) of the work of all vital organs and systems is used, and, if necessary, rapid laboratory tests are performed. Modern monitoring equipment allows you to monitor heart rate, blood pressure, respiratory rate, the content of oxygen, carbon dioxide, inhalational anesthetics in the inhaled and exhaled air, oxygen saturation in the blood as a percentage, the degree of depth of sleep and the degree of pain relief, the level of muscle relaxation, the ability to conduct a pain impulse along the nerve trunk and much, much more. The anesthesiologist carries out infusion and, if necessary, transfusion therapy; in addition to drugs for anesthesia, antibacterial, hemostatic, and antiemetic drugs are administered.

Coming out of anesthesia

The period of recovery from anesthesia lasts no more than 1.5-2 hours while the drugs administered for anesthesia are in effect (not to be confused with the postoperative period, which lasts 7-10 days). Modern drugs can reduce the period of recovery from anesthesia to 15-20 minutes, however, according to established tradition, the child must be under the supervision of an anesthesiologist for 2 hours after anesthesia. This period may be complicated by dizziness, nausea and vomiting, and pain in the area of ​​the postoperative wound. In children of the first year of life, the usual pattern of sleep and wakefulness may be disrupted, which is restored within 1-2 weeks.

The tactics of modern anesthesiology and surgery dictate early activation of the patient after surgery: get out of bed as early as possible, start drinking and eating as early as possible - within an hour after a short, low-traumatic, uncomplicated operation and within three to four hours after a more serious operation. If a child is transferred to the intensive care unit after surgery, then the resuscitator takes over further monitoring of the child’s condition, and here continuity in the transfer of the patient from doctor to doctor is important.

How and with what to relieve pain after surgery? In our country, painkillers are prescribed by the attending surgeon. These can be narcotic analgesics (Promedol), non-narcotic analgesics (Tramal, Moradol, Analgin, Baralgin), non-steroidal anti-inflammatory drugs (Ketorol, Ketorolac, Ibuprofen) and antipyretic drugs (Panadol, Nurofen).

Possible complications

Modern anesthesiology seeks to minimize its pharmacological aggression by reducing the duration of action of drugs, their quantity, removing the drug from the body almost unchanged (Sevoflurane) or completely destroying it with enzymes of the body itself (Remifentanil). But, unfortunately, the risk still remains. Although it is minimal, complications are still possible.

The inevitable question is: what complications can arise during anesthesia and what consequences can they lead to?

Anaphylactic shock is an allergic reaction to the administration of drugs for anesthesia, to the transfusion of blood products, to the administration of antibiotics, etc. The most formidable and unpredictable complication, which can develop instantly, can occur in response to the administration of any drug in any person. Occurs with a frequency of 1 in 10,000 anesthesia. It is characterized by a sharp decrease in blood pressure, disruption of the cardiovascular and respiratory systems. The consequences can be the most fatal. Unfortunately, this complication can only be avoided if the patient or his immediate family previously had a similar reaction to this drug and is simply excluded from anesthesia. Anaphylactic reactions are difficult and difficult to treat; they are based on hormonal drugs (for example, Adrenaline, Prednisolone, Dexamethasone).

Another dangerous complication that is almost impossible to prevent and prevent is malignant hyperthermia - a condition in which, in response to the administration of inhalational anesthetics and muscle relaxants, body temperature increases significantly (up to 43 ° C). Most often this is a congenital predisposition. The consolation is that the development of malignant hyperthermia is an extremely rare situation, 1 in 100,000 general anesthetics.

Aspiration is the entry of stomach contents into the respiratory tract. The development of this complication is most often possible during emergency operations, if little time has passed since the patient’s last meal and the stomach has not been completely emptied. In children, aspiration can occur during hardware-mask anesthesia with passive flow of stomach contents into the oral cavity. This complication threatens the development of severe bilateral pneumonia and burns of the respiratory tract with the acidic contents of the stomach.

Respiratory failure is a pathological condition that develops when the delivery of oxygen to the lungs and gas exchange in the lungs are disrupted, in which the maintenance of normal blood gas composition is not ensured. Modern monitoring equipment and careful observation help to avoid or timely diagnose this complication.

Cardiovascular failure is a pathological condition in which the heart is unable to provide adequate blood supply to organs. As an independent complication in children, it is extremely rare, most often as a result of other complications, such as anaphylactic shock, massive blood loss, and insufficient pain relief. A complex of resuscitation measures is carried out followed by long-term rehabilitation.

Mechanical damage is a complication that can occur during procedures performed by an anesthesiologist, be it tracheal intubation, venous catheterization, placement of a gastric tube or urinary catheter. A more experienced anesthesiologist will experience fewer of these complications.

Modern anesthesia drugs have undergone numerous preclinical and clinical trials, first in adult patients. And only after several years of safe use are they allowed in pediatric practice. The main feature of modern drugs for anesthesia is the absence of adverse reactions, rapid elimination from the body, and predictable duration of action from the administered dose. Based on this, anesthesia is safe, has no long-term consequences and can be repeated several times.

Without a doubt, the anesthesiologist has a huge responsibility for the patient's life. Together with the surgeon, he strives to help your child cope with the disease, sometimes being solely responsible for preserving life.

Overall, a good informational article; it’s a shame that hospitals don’t provide such detailed information. My daughter was given about 10 anesthesia in the first 9 months of her life. There was a long anesthesia at the age of 3 days, then a lot of mass and intramuscular ones. Thank God there were no complications. Now she is 3 years old, develops normally, reads poetry, counts to 10. But it’s still scary how all these anesthesia affected the child’s mental state. Almost nothing is said about this anywhere. As they say, “saving the main thing, don’t bother with the little things.”
I made a proposal to our doctors to provide a certificate of all manipulations on children, so that parents could calmly read and understand, otherwise everything is on the go, fleeting phrases. Thank you for the article.

I myself underwent anesthesia twice and both times I had the feeling that I was very cold, I woke up and started chattering my teeth, and even a severe allergy began in the form of hives, the spots then grew larger and merged into a single whole (as I understand it, swelling began). For some reason, the article does not say about such reactions of the body, maybe it’s individual. And it took several months for my head to get better, my memory noticeably decreased. How does this affect children and if a child has neurological problems, what are the consequences of anesthesia for such children?

My child has undergone three anesthesia and I really want to know how this will affect his development and psyche. But no one can answer this question for me. I was hoping to find out in this article. But only general phrases that there is nothing harmful in anesthesia. But in general, the article is useful for general development and for parents.

A note on "conduct". Why is this article placed in the "Car" section? Of course, some connection can be traced, but after an “encounter” with a car, preparing for anesthesia for three days is usually quite problematic;-(

For some reason, the article, and indeed most materials on this topic, do not talk about the effect of anesthesia on the human psyche, and especially on a child. Many people say that anesthesia is not only about “falling and waking up”, but rather unpleasant “glitches” - flying along the corridor, different voices, the feeling of dying, etc. And an anesthetist friend said that these side effects do not occur when using the latest generation drugs, for example, Recofol.

Anesthesia is the artificial introduction of a person into deep sleep using special drugs. Reversible inhibition of the central nervous system occurs with loss of consciousness, relaxation of skeletal muscles and partial loss of reflexes. Such anesthesia allows you to safely and effectively perform an operation of any complexity, but every patient should be aware of the possible complications and consequences.

Technique for mask anesthesia for adults and children

Anesthesia can be administered intravenously, intramuscularly or inhalation. The mechanism of action of the latter method is to inhale gaseous substances (ether, fluorothane, pentran, nitrous oxide). It can be performed by the endotracheal or endobronchial method (when substances are delivered directly into the respiratory tract through a tube), or as mask anesthesia (involves inhaling a mixture of gases through a special mask).

The combination of anesthetics is selected by the anesthesiologist individually depending on the patient’s condition and the type of medical procedure. Their main goal is to minimize the body’s negative reaction to aggressive medical manipulation. Anesthesia should not only induce sleep, but also reduce the severity of the body's automatic reactions and relax the muscles.

After taking a comfortable position, the doctor brings a face mask to the patient’s face. After about a minute, the substances begin to act.

Advice: In the intermediate stages of falling asleep, the child may become disoriented, try to sit up, breathe rapidly or wheeze. This is considered a normal reaction of the body to immersion in anesthesia.

In pediatric dentistry, mask anesthesia is often used for long-term medical procedures, because it causes a quick effect and is easily regulated (the child will wake up only after the supply of the gas-narcotic mixture is stopped). For most often I use substances such as fluorothane and nitrous oxide, which enter the lungs through inhalation. for children it is preferable only in some cases: large and complex operations, plastic surgery of the lower jaw, interventions on it.

Contraindications and possible complications

Indications for the use of this type of pediatric anesthesia include therapeutic and diagnostic manipulations in ENT practice, as well as those that require disruption of tissue integrity (biopsy, puncture), endoscopic examinations of the gastrointestinal tract, operations on the abdominal organs, and suturing wounds. In dentistry, it is used only for indications: the child’s inadequacy due to fear, a large amount of work.

The reasons for searching for an alternative option are considered to be the refusal of the parents, the need for a major operation, complications from mask anesthesia in the past, and the serious condition of the child.

Indications for mask anesthesia in adult patients include the presence of trauma, including burns, myocardial infarction, and the need for transport immobilization.

Contraindications for adults:

The most common complications of anesthesia, including during dental procedures, are respiratory failure (hypoventilation), vomiting, regurgitation of gastric contents - passive entry of masses into the esophagus, oral cavity, anaphylaxis (allergic reaction), hypotension (lowering blood pressure). But any body system can fail.

Problems with the respiratory system:

• suffocation due to oxygen starvation, obstruction of the airway;
• tongue retraction (can also occur after surgery);
• laryngospasm due to closure of the vocal cords;
• bronchospasm (air cannot escape through the narrowed passage of the alveoli).

To prevent and minimize, use a supply of humidified oxygen and strictly adhere to anesthesia technology.

Circulatory problems:

• disturbance of heart rhythm, blood pressure;
• increased bleeding;
• heart failure.

Most complications in children occur during the awakening stage, disrupting vital functions. Most often they manifest themselves in the form of depression of consciousness, breathing, and blood circulation due to the residual effect of narcotic substances, metabolic disorders, and a decrease in circulating blood volume.

Advice: Before starting general anesthesia for a child, the dentist must conduct a general, biochemical blood test, a test for coagulation and platelets, blood group and Rh, as well as a urine, stool, ECG test and obtain a pediatrician’s opinion on the state of health and the absence of contraindications.

To prevent problems from arising, immediately after emerging from anesthesia, the patient should periodically take deep breaths and exhales, move his legs and arms.

Consequences of mask anesthesia

In the scientific press, publications by practicing physicians about the effect of mask anesthesia on the cognitive system, especially in children, are increasingly appearing. Some patients suffer from impaired memory, thinking, and concentration. In young patients, neuralgic abnormalities and changes in behavior are diagnosed. But if anesthesia is performed by a qualified doctor with full compliance with technology, the risk of serious complications is minimal.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

Yesterday we started talking about anesthesia for a child and its types. While general issues have been covered, there are still some important points that parents need to know. First of all, we need to talk about the presence of contraindications.

Possible contraindications.

In general, there are no absolute contraindications to anesthesia, as to the procedure in general. In case of emergency, it is used even if there are contraindications under normal conditions. There may be contraindications to certain types of drugs for anesthesia, then they are replaced with drugs of a similar effect, but of a different chemical group.

However, it is always worth remembering that anesthesia is a medical procedure that requires the consent of the patient himself, and in the case of children, the consent of their parents or legal representatives (guardians). In the case of children, the indications for anesthesia can be significantly expanded. Of course, some of the child’s operations can be performed under local anesthesia (local anesthesia or, as it is called, “freezing”). But, during many of these operations, the child experiences a strong psycho-emotional load - he sees blood, instruments, experiences severe stress and fear, cries, and must be restrained by force. Therefore, for the comfort of the child himself and more active elimination of problems, general anesthesia of short-term or longer duration is used.

Anesthesia in children is used not only during operations; often in pediatric practice, the indications for it are greatly expanded due to the characteristics of the child’s body and its psychological characteristics. Often, general anesthesia is used for children during medical procedures or diagnostic tests, in cases where the child needs immobility and complete calm. Anesthesia can be used in cases where it is necessary to turn off consciousness or turn off the memory of unpleasant impressions, manipulations, scary procedures without mom or dad nearby, if it is necessary to be in a forced position for a long time.

Thus, anesthesia is used today in dentists’ offices if children are afraid of the drill or they need quick and fairly extensive treatment. Anesthesia is used for long-term studies, when everything needs to be examined closely, and the child will not be able to lie still - for example, during a CT or MRI. The main task for anesthesiologists is to protect the child from stress as a result of painful manipulations or operations.

Conducting anesthesia.

During emergency operations, anesthesia is carried out as quickly and actively as possible in order to begin the necessary operation - then it is carried out according to the situation. But during planned operations, it is possible to prepare in order to minimize possible complications. If a child has chronic diseases, operations and manipulations under anesthesia are performed only in the remission stage. If a child becomes ill with an acute infection, he is also not subject to planned operations until he has fully recovered and all vital signs have returned to normal. With the development of acute infections, anesthesia is associated with a greater than usual risk of complications as a result of respiratory failure while under anesthesia.

Before the operation begins, anesthesiologists always come to the patient’s room to talk with the child and parents, ask many questions and clarify information about the baby. It is necessary to find out when and where the child was born, how the birth took place, whether there were any complications, what vaccinations were given, how the child grew and developed, what and when he was sick with. It is especially important to find out in detail from parents whether they are allergic to certain groups of medications, as well as allergies to any other substances. The doctor will carefully examine the child, study the medical history and indications for surgery, and carefully study test data. After all these questions and conversations, the doctor will talk about the planned anesthesia and preoperative preparation, the need for special procedures and manipulations.

Methods of preparation for anesthesia.

Anesthesia is a special procedure that requires careful and special preparation before it begins. During the preparatory phase, it is important to set the child in a positive mood if the child knows about the need for surgery and what will happen. For some children, especially at an early age, it is sometimes better not to talk about the operation in advance, so as not to frighten the child ahead of time. However, if a child is suffering due to his illness, when he consciously wants to be cured faster or have surgery, then a story about anesthesia and surgery will be useful.

Preparing for surgery and anesthesia with young children can be challenging in terms of fasting and staying hydrated prior to surgery. On average, it is recommended not to feed a child for about six hours; for infants, this period is reduced to four hours. Three to four hours before the onset of anesthesia, you should also refuse to drink; you cannot drink any liquids, even water - this is a necessary precaution in case regurgitation occurs when entering or exiting anesthesia - the backflow of stomach contents into the esophagus and oral cavity. cavity. If the stomach is empty, the risk of this is much less; if there is content in the stomach, the risk of it entering the oral cavity and from there into the lungs increases.

The second necessary measure in the preparatory period is an enema - it is necessary to empty the intestines of stool and gases so that involuntary bowel movements do not occur during the operation due to muscle relaxation. The intestines are especially strictly prepared for the operation; three days before the operation, meat dishes and fiber are excluded from the children's diet; the day before the operation and in the morning, several cleansing enemas and laxatives can be used. This is necessary to empty the intestines of contents as much as possible and reduce the risk of infection of the abdominal cavity and prevent complications.

Before the introduction of anesthesia, it is recommended that one of the parents or loved ones stay next to the baby until he switches off and goes to sleep. To administer anesthesia, doctors use special masks and child-type bags. When the baby wakes up, it is also advisable to have one of your relatives nearby.

How is the operation going?

After the child falls asleep under the influence of medications, anesthesiologists add drugs until the necessary muscle relaxation and pain relief are achieved, and surgeons begin the operation. As the operation is completed, the doctor reduces the concentration of substances in the air or in the dropper, then the child comes to his senses.
Under the influence of anesthesia, the child’s consciousness turns off, pain is not felt, and the doctor evaluates the child’s condition based on the monitor data and external signs, listening to the heart and lungs. The monitors display blood pressure and pulse, blood oxygen saturation and some other vital signs.

Coming out of anesthesia.

On average, the duration of the process of recovery from anesthesia depends on the type of drug and the rate of its removal from the blood. On average, modern drugs for pediatric anesthesia take about two hours to completely release, but with the help of modern treatment methods it is possible to speed up the time of removal of solutions to half an hour. However, during the first two hours of recovery from anesthesia, the child will be under the tireless supervision of an anesthesiologist. At this time, there may be attacks of dizziness, nausea with vomiting, and pain in the area of ​​the surgical wound. In children at an early age, especially in the first year of life, their daily routine may be disrupted due to anesthesia.

After surgery, today they try to activate patients within the first day after anesthesia. He is allowed to move, get up and eat, if the volume of the operation was small - after a couple of hours, if the volume of the intervention was significant - after three to four hours as his condition and appetite normalize. If after surgery the child requires resuscitation care, he is transferred to the intensive care unit, where he is observed and managed together with a resuscitator. After surgery, if necessary, the child may be given non-narcotic pain medications.

Could there be complications?

Despite all the efforts of doctors, sometimes complications can still arise that are minimized. Complications are caused by the influence of medications, disruption of tissue integrity and other manipulations. First of all, when any substance is administered, allergic reactions, including anaphylactic shock, are rare but may occur. To prevent them, the doctor before the operation will find out in detail from the parents everything about the child, especially cases of allergies and shock in the family. In rare cases, the temperature may rise during the administration of anesthesia - then antipyretic therapy is necessary.
However, doctors try to predict all possible complications in advance and prevent all possible problems and disorders.

My daughter has an inguinal hernia. We were diagnosed almost from birth, but the hernia did not bother us at all. Now the child is 2.6 years old, and the doctor is already insisting on surgery. I am very worried about general anesthesia. I'm worried how my daughter will cope with it. Tell us... I’m very worried... What are the consequences of anesthesia for a child at this age? I read that general anesthesia affects a child’s intelligence and brain function (especially in young children under 4 years old) and that negative consequences may remain. Maybe we should wait a little longer with the operation?

• Irina, Moscow
• January 16, 2018, 11:18

Currently, general anesthesia does not involve much risk if the treatment is carried out in a specialized institution equipped with the necessary equipment and in the presence of an anesthesiologist-resuscitator. Of course, the tolerability of anesthesia depends on the individual characteristics of the child and his somatic status. But I cannot say that general anesthesia increases the risk of developing intellectual problems and affects brain function, as well as the fact that a child’s reaction to anesthesia will change after 4 years. Modern drugs for anesthesia have low toxicity, are hypoallergenic, are quickly eliminated from the body, and allow anesthesia to be administered with minimal consequences.

If you choose the right drug and its dosage, taking into account the upcoming surgical intervention, the current state of the baby’s health and other important factors, the risks of negative consequences are practically eliminated.

In our clinic, in addition to traditional clinical assessment of the depth and adequacy of anesthesia, we use hardware control of anesthesia depth using BIS monitoring. This system measures the functional activity of the patient's brain (using the EEG method), allowing the anesthesiologist to more accurately manage anesthesia. Focusing on monitoring indicators, we are able to use anesthetics more rationally (usually by reducing the dose), prevent excessive dosage of the drug and achieve a smoother recovery of the patient from anesthesia. The method is harmless, has no contraindications, and can be performed on children of any age (including newborns).

BIS monitoring is widely used in the USA, Western Europe and is already included in the standard of mandatory intraoperative monitoring in a number of foreign countries. In Russia, unfortunately, only some medical institutions have this equipment.

An anesthesiologist administers anesthesia to a child

It has been observed that children aged 9 months to 7 years experience the process of separation from their parents very painfully. That is why in Western clinics, as well as in some modern Russian hospitals, the anesthesiologist offers parents the opportunity to stay with their child until he immediately falls asleep from anesthetic drugs. The feeling of closeness from mom or dad is very important for a child. Your presence in the operating room is an important part of the anesthesia process., since your presence with your child has a calming effect and convinces him that everything will be fine.

If the anesthesiologist allowed you to stay with the child until he falls asleep from anesthesia, then the following information will be useful to you.

Being in the preoperative or operating room (the room where anesthesia or anesthesia will be performed) requires strict adherence to the rules of sterility, so be prepared for the fact that before entering the operating room you will be asked to change into sterile hospital clothes.

Before anesthesia begins, it will often be more comfortable if the child sits on your lap. If your child is very small (infancy) or, on the contrary, older than 3 years, then it will be optimal if he lies on the bed. The anesthesiologist will advise you about the best position for the baby.

Beginning of anesthesia. A child inhales an anesthetic drug through a face mask

After the child is placed in a comfortable position, the anesthesiologist will bring a special mask to his face, through which a gaseous mixture with an anesthesia-inducing drug will be supplied. Modern children's face masks are very convenient and comfortable, they fit softly to the face, are made of transparent material, and often have a pleasant fruity smell (although it does not always cover the smell of anesthesia medicine).

When your child breathes through the mask, some anesthesia gas may pass by the mask. If you are in the first three months of pregnancy, then it is best for you to avoid contact with any medications. Although it has not been proven that there is any negative impact of anesthesia gas on the course of pregnancy, it would still be reasonable if it is not you, but someone else from your family who stays in the operating room with the baby.

The time required for a child to fall asleep is approximately one minute. This is much more than what is usually shown to us in films, where the introduction of anesthesia takes only a few seconds. Often in the intermediate stages of falling asleep (the anesthesia "arousal" stage), your child may become disoriented, start talking excitedly, squirming, and even try to sit or stand. His eyes may look away, his breathing may become shallow or irregular, and he may begin to snore. All these phenomena are completely normal manifestations of the process of immersion in anesthesia. You do not need to worry about this; besides, after anesthesia and surgery, your child will not remember these events. You can help your child and the anesthesiologist by remaining calm and gently restraining your child's hands from the face mask if necessary. After a minute, your child will become quiet and fall into a state of deep sleep (anesthesia). The anesthetist will inform you of this and ask you to return outside the operating room again.

If at any point during the process of falling asleep and induction of anesthesia, an unexpected situation arises, the anesthesiologist may ask you to leave the operating room immediately. We, anesthesiologists, greatly value your presence in the operating room with your child, and we are the ones who allow you to be in the operating room next to your child. To ensure maximum safety for your child, the anesthesiologist needs to focus all his attention, knowledge and experience on the unexpected situation, so your continued presence in the operating room can only harm your child.

Older children, as well as those with certain health problems, fall asleep very quickly and comfortably from intravenous administration. The medication is injected through a special thin tube (intravenous catheter) inserted into one of the veins of the hand, forearm or elbow. For painless installation of an intravenous catheter, a special local anesthetic gel is first applied to the skin area.