What types of anaesthesia are available for children undergoing eye surgery?
There are two main types of anaesthesia: local and general. Local anaesthesia consists of numbing the area to be operated on by applying or injecting anaesthetic agents. For example, dentists use local anaesthesia by injecting lidocaine into the area of the tooth to be operated on. The patient is still awake, able to move and is aware of the procedure. General anaesthesia puts the whole body to sleep and greatly reduces /eliminates the possibility of movement during the procedure. The patient is not aware of the procedure and feels no pain during the procedure.
Children will almost always need general anaesthesia to undergo surgery on or around the eyes. This is necessary so that the little patient is completely still and the operation can be performed safely and efficiently. General anaesthesia is sometimes required for a complete examination of a child who is extremely uncooperative, and the ophthalmologist cannot obtain crucial information in the practice.
Minor eyelid procedures can be performed under local anaesthesia, but this requires the patient to be calm and cooperative.
Administering anaesthesia to a child before surgery
How is anaesthesia administered to children?
General anaesthesia is usually administered to children in two stages. First, a relaxing medicine is given that causes the child to fall asleep. This medicine is usually given as a gas through a scented face mask. An intravenous line /central line (IV) is usually placed in a vein in the arm or leg after the child has fallen asleep with the help of the mask. Older children can be given line IV before falling asleep.
In short procedures, such as unclogging a tear duct, sometimes only a mask is needed to administer the anaesthesia and complete the procedure. However, for most eye procedures, a breathing tube or laryngeal mask (a special type of tube that can cause less irritation and reduce the sore throat after surgery) is placed in the trachea to allow the anaesthetist to control and support the child’s breathing while under anaesthesia. Tube inhaled anaesthetic agents and/or intravenous drugs maintain anaesthesia. The breathing tube is removed at the end of the operation before the little patient is completely awake. The intravenous line (central line) can be removed during the recovery period when the child drinks fluids and does not feel nauseous. The following figure is a photograph of an endotracheal tube.
How does anaesthetic “sleep” differ from normal sleep?
Anaesthetic “sleep” is quite different from normal sleep, because strong drugs act on every organ of the body. Achieving and maintaining the desired effect requires continuous monitoring and adjustment. Your anaesthesiologist has the experience and knowledge to decide which agents are best for your child and to administer them safely.
How should a child be prepared for surgery?
If your child is old enough to understand why he or she will be operated on, it is important to give him or her an explanation so that he or she can feel comfortable with the decision. If the child is very small, then it is useful for you to be calm and cheerful for him/her. If you have any questions, please ask any members of the hospital team for clarification. Staff, nurses and doctors will try to make the clinic experience a positive one.
Is a medical examination for children necessary before undergoing general anaesthesia?
Yes. Prior to surgery, a medical history and physical examination should be performed to ensure that your child is healthy enough to undergo anaesthesia and have any planned surgery. This will probably be checked by the child’s paediatrician and anaesthesiologist, but also by the ophthalmologist in relation to the results of the tests.
At Oftapro, children can be examined from the first days of life!
Can the predisposition to complications from anaesthesia be inherited?
Yes, there are certain reactions to anaesthesia that occur in the family, as well as hereditary medical conditions that can make the administration of anaesthesia more complex. Be sure to talk to your child’s anaesthesiologist about any known side effects of anaesthesia that have occurred in your child’s blood relatives. These complications can be severe, such as malignant hyperthermia, or less severe, such as nausea and vomiting. There are steps that can be taken and/or medications that can be administered to prevent or help treat these potential complications.
What can a child eat or drink before general anaesthesia?
Patients under general anaesthesia should not eat or drink anything for a certain period of time before surgery. This time interval can be of 4-8 hours, depending on the age of the patient and the type of food or liquid. The specific requirements for your child will be given to you directly by the clinic.
A completely empty stomach helps prevent lung aspiration. Lung aspiration occurs when the contents of the stomach are breathed into the lungs and can cause serious complications. Fasting can be difficult for anyone, especially children, but please note that this is required for the safety of the child.
The clinic staff will give you specific instructions on when your child should stop eating and drinking. Please follow them exactly as recommended to avoid delaying or cancelling the procedure.
Can a sedative be administered to soothe a child before surgery?
Depending on the operation your child has to undergo, this can be done. Many hospitals will provide a liquid sedative (syrup) to children before surgery to ease any restraint. A sedative comforts children while waiting for surgery, reduces anxiety as they move into the operating room, and helps them forget about the events immediately associated with their surgery.
Is general anaesthesia dangerous?
Patients are extensively monitored by the anaesthetist while falling asleep. Severe reactions to anaesthesia are extremely rare. All precautions shall be taken to ensure the safety of the child while he or she is sleeping.
What is a laryngeal airway mask?
A laryngeal airway mask (LAM) is a special breathing tube that is positioned above the vocal cords instead of passing through them, as an endotracheal tube does. This can reduce tracheal irritation during surgery and can reduce neck pain later LAMs are not appropriate in every case. Your ophthalmologist and anaesthetist will decide if this is right for your child and the operation.
Modern anaesthesia involves the introduction of a laryngeal mask that reduces airway irritation. In Oftapro Clinic, laryngeal masks have been used in short and medium-term interventions since 2004.
Can a parent be with the child while the anaesthesia is administered?
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Each hospital has its own policies regarding the possibility for the parents to be with the child when they wake up in the recovery room. In the OFTAPRO Clinic, a parent will accompany the child until the entrance to the operating room and will be with the child in the recovery room from the moment the anaesthesiologist considers that he/she can be brought to his/her parent from the wake-up room where he/she will be monitored after the end of the intervention for another period of time. The presence of the parent inside the operating room is not allowed.
What happens during recovery after general anaesthesia after surgery?
Once the surgery is complete, the anaesthesiologist will begin to wake the patient. This may take a few minutes or more. Once this can be done safely, the tube is removed and normal breathing is resumed. The child is then transferred from the operating room to the recovery room and in the next about an hour will continue to wake up gradually. During this time, children are often sleepy, irritable and confused. They will receive constant care from the staff. In the next few hours, the child will still be sleepy, sometimes naughty and may have a low tolerance for discomfort or pain. The use of mild painkillers is helpful when needed. Most children resume normal activities until the next day. Occasionally, a child will sleep for hours after a procedure, especially after a long operation or if pain relief medication is needed.
What are the side effects of anaesthesia?
Children may experience nausea or vomiting after eye surgery, especially when talking about a muscle surgery such as strabismus surgery. Therefore, nausea can last for hours, rarely being severe. Every effort must be made to reassure the child and make him/her comfortable. Sometimes it is necessary to keep the central line until the next day to allow the administration of an additional medication.
What are the risks of anaesthesia?
Serious complications of anaesthesia, such as brain damage or death, are exceptionally rare. In general, healthy children tolerate anaesthesia at least as well as adults.
Whenever possible, elective eye surgery should be avoided when the child is ill. Anaesthetists and surgeons should be informed of all medical conditions and all medications the child is taking. They MUST be informed of any anaesthetic problems the child or any blood relative has experienced, as there are some rare hereditary conditions that are associated with an increased risk.
Some studies have shown that patients under the age of 4 who receive anaesthesia may be at increased risk of long-term neurological effects and / or learning disabilities, especially if they already have pre-existing conditions. This is currently an active area of research as physicians and scientists work to learn more about how to safely provide anaesthesia to younger patients. These risks can be offset by the benefits of a medically necessary procedure. When surgery is needed to improve the child’s development, it is not advisable to delay it until after the age of four. Talk to your child’s doctor before the operation about the risks and benefits of surgery or an examination that requires general anaesthesia.
Although eye surgery is usually a routine, children are extensively monitored by the anaesthetist while they sleep. Severe reactions to anaesthesia are extremely rare. All precautions shall be taken to ensure the safety of children while they sleep. Please discuss all your questions with your child’s anaesthetist before the operation.
Can strabismus surgery be performed in children and adolescents with local or local anaesthesia?
In general, no. Rarely, in a selective group of exceptionally stoic adolescents and adults, strabismus surgery can be done with a local anaesthetic injection through the lower eyelid to numb the nerves around the eyeball. Unlike its use in adult cataract surgery, topical anaesthesia, consisting of ophthalmic drops numbing the surface of the eye, does not provide sufficient comfort to the patient to be used during ocular muscle surgery. The strabismus operation usually takes 30-40 minutes and can often be significantly longer. The patient should be completely still and comfortable during this period to avoid potentially serious complications that may result from unexpected sudden movements. Because it cannot be expected for most children to remain motionless for the time required to complete surgery, almost all children need general anaesthesia in order for the eye muscle surgery to be performed safely and comfortably.
Paediatric anaesthesia is generally a safe procedure. Complications can be minimized by following the rules and guidelines for general anaesthesia and postponing elective surgery if the child is ill. Modern anaesthesia allows surgery or examinations to be performed without pain or anxiety.