Pediatric Anesthesiology: Guidelines and FAQs

The Division of Pediatric Anesthesiology at Stony Brook University Hospital provides anesthesia services at the main hospital and at the ambulatory surgery center. A team consisting of our anesthesiologist working with residents and certified nurse anesthetists will care for your child.

Many parents find their doctors through recommendations from their primary doctors or through family and friends. You do have a choice within our team, but you must make that choice known in advance. Most of the patients are satisfied with whom they are assigned. Should you have a preference, every effort will be made to honor that request.

There are four main categories of anesthesia; general, regional, monitored anesthesia care and local anesthesia. Regardless of the category of anesthesia your child may receive, special anesthetic agents and techniques will be used to provide a safe and speedy recovery.

1. General Anesthesia: The child is not conscious and has complete loss of sensation. This technique involves inducing sleep of the whole body and the brain.
2. Regional Anesthesia: A local anesthetic is injected by the anesthesiologist to provide numbness and loss of sensation to a region of the body. This could include spinal anesthesia, epidural anesthesia, upper and lower blocks. Additional intravenous medication may be given to make the child comfortable and drowsy.
3. Monitored Anesthesia Care: During this type of anesthesia, the surgeon usually injects local anesthetic to the site of surgery to provide numbness and loss of sensation. The anesthesiologist then supplements this with intravenous medication to make the child comfortable and drowsy.
4. Local Anesthesia: Local anesthetic is injected by the surgeon to provide numbness and loss of sensation to a small area. This technique is rarely performed in the pediatric group.

We sometimes offer a combination of these modalities of anesthesia. The reasonable choices available for the surgery will be discussed with the anesthesiologist beforehand.

Yes, in certain situations. Some operations can be performed using a choice of different anesthetic types. Your anesthesiologist will discuss available options with you after reviewing your child’s medical history. Your preference will be discussed so that the most appropriate anesthetic plan is made.

We now realize that many children need less sedation when calm, assured and confident parents help them through the stress of a procedure or hospitalization. In spite of parents' reassurances, however, some children still may require medicine to calm them before a procedure. This medication may be given by mouth or injection. The time and type of such premedication will vary and will be determined by the anesthesiologist.

No procedure is without some degree of risk, which your anesthesiologist will discuss with you prior to the procedure. Fortunately, serious and major complications such as strokes and deaths from general (or other types of) anesthesia are very rare today, despite the fact that more procedures are being performed on sicker and younger patients than in the past. In the last 10 years, the estimated numbers of deaths attributed to anesthesia (for all types of surgical procedures) have dropped significantly to 1 in 250,000. Serious complications such as strokes and prolonged periods of mechanical ventilation have also declined over the past few decades.

The increased safety of general anesthesia is due to many factors, including safer drugs, more extensive training of anesthesiologists and national standards of care. However, minor side effects may occur, such as nausea and vomiting, sore throat, dizziness, tiredness, headache and pain.

You will receive separate bills for different professional services. Stony Brook Anesthesiology, P.C. participates in most health plans. If you have any financial concerns, you may call our anesthesia office, Tel- (631) 444-2975.

There will be circumstances where it is appropriate for a parent to come into the operating room. Studies and experience show that this decision needs to be individualized and discussed between you and your anesthesiologist. There are many situations where other choices are better and possibly even safer. Please do not hesitate to discuss your options.

The reason for fasting prior to surgery is to reduce the risks of aspirating gastric contents during the surgery. This complication, although rare, is very serious and parents need to strictly follow our recommendations. This has nothing to do with nausea and vomiting after the surgery.  We have very clear policies as to specific ages and time periods before surgery when the child must refrain from eating and/or drinking. These are all based on safety standards. We believe that the fasting time should be as short as possible before the surgery.

Generally, we request that you give most medications on the morning of surgery. This should be discussed with your surgeon who will contact us with any questions, and refer you for a preoperative consultation if necessary. 
Medication may be taken with a sip of water on the day of surgery. Please bring in all medications with you on the day of surgery. Some medications will be stopped for the surgery, particularly diabetes medication and blood thinners (rarely seen in the pediatric group). You should bring these medications with you the day of surgery. Please call us with any questions you may have.

The Division of Pediatric Anesthesiology at Stony Brook University Hospital provides anesthesia services at the main hospital and at the ambulatory surgery center. A team consisting of our anesthesiologist working with residents and certified nurse anesthetists will care for your child.

You probably will not get to know your child's anesthesiologist as well as the cardiologist and/or cardiac surgeon. Nonetheless, the anesthesiologist plays many important roles in your child's care before, during and after the surgery or procedure.

Specifically, the anesthesiologist:

1. Continually monitors vital functions such as breathing, heart rate and rhythm, blood pressure, body temperature, oxygen saturation, fluid and blood needs, and makes medical decisions as necessary.
2. Ensures the child's safety during surgery by using anesthetics and techniques, which are tailored to the specific medical condition.
3. Provides consultation on many aspects of medical care, including pain management, medications and airway management.

A pediatric anesthesiologist is a physician who has completed medical school, at least four years of medical training (a year of internship and three years in an anesthesiology residency program), and usually at least one year of a pediatric anesthesia fellowship program. During this period of education and training, the pediatric anesthesiologists become very knowledgeable about many areas of medicine, including cardiology, pediatrics, critical care and pharmacology. The anesthesiologist’s education does not end with the completion of fellowship training, however. Because the field of pediatric cardiac anesthesiology is constantly evolving and expanding, pediatric anesthesiologists continually update their knowledge and skills through regular participation in educational courses and symposia, earning continuing medical education credits as appropriate or required.

The preoperative interview has two important purposes:

1. The first one is to provide the anesthesiologist with essential information about health history so he or she can properly plan and manage the anesthesia and care during and following the surgery or procedure.
2. The second purpose of the interview is to give you an opportunity to ask questions and voice any concerns you may have.

The anesthesiologist will want to make sure that your child is in the best possible physical condition before surgery. You will be asked important questions about your child's general health, including whether he or she has allergies or asthma, whether there has been any family history of difficulties with anesthesia and what your child's experiences have been with previous anesthetics. During this evaluation, the anesthesiologist will explain the planned anesthetic procedure. The discussion may include whether or not your child will receive anything for sedation before surgery, how the anesthetic will be initiated and maintained, and other pertinent anesthetic details. This is the best time for you and your child to ask questions and express any concerns to the anesthesiologist.

You will also be asked about allergies. Sometimes children react to certain medications in odd ways that are not truly allergic reactions but are "labeled" as such.

When you report that your child is allergic to a medication, you will be asked to describe the reaction so that we can determine if there is a true allergy. It is unusual for children to be allergic to anesthetic drugs. The most commonly encountered allergies are to antibiotics, such as penicillin or amoxicillin.

Sometimes significant illnesses may cause problems during some types of surgery and anesthesia. For this reason, the anesthesiologist may feel it is best to postpone surgery. Remember, your child's safety is our first priority.

We now realize that many children need less sedation when calm. Our child-centered approach in concert with assured and confident parents help many children through the stress of a procedure or hospitalization. However, some children still may require medicine to calm them before surgery. This medication may be given by mouth or injection. The time before surgery that such premedication is given will vary. The anesthesiologist will determine the type of medicine used, if any, during the preoperative visit.

Anesthetic agents can be started in several ways. Most commonly in adults, anesthesia is started by an intravenous injection so the patient becomes unconscious rapidly. This is also a method that can be used for children. Another method of beginning anesthesia is to let your child breathe anesthetic agents until losing consciousness. This is called a mask or inhalational induction. With this approach, your child will be asked to breathe through a "space mask" quietly, and no needle sticks will be performed until after your child is sound asleep. The choice of which method to begin anesthesia will be made by the anesthesiologist based on many factors.

After inducing general anesthesia, the child will be unconscious during the operation. Be assured that throughout the entire operation, the anesthesiologist continually monitors and adjusts the level of anesthesia. Even when sedation is used, there might be some recollection of the operating suite.

Your child may receive a blood transfusion. At present, blood supply is extremely safe, but the risk is not zero. If you have any specific concerns about this issue, discuss them with the team. Complications include risk for infection and other reactions.

No surgical procedure is without some degree of risk, which your surgeon will discuss with you prior to the operation. Fortunately, serious complications such as strokes and deaths from general (or other types of) anesthesia are very rare today, despite the fact that at this time, more cardiac surgeries are being performed on younger and sicker patients.

In the last decade, the estimated numbers of deaths attributed to anesthesia (for all types of surgical procedures) have dropped significantly. Serious complications such as strokes and prolonged periods of mechanical ventilation have also declined over the past few decades. The increased safety of general anesthesia is due to many factors, including safer drugs, more extensive training of anesthesiologists, and national standards of care that reflect current best practices.

Side effects from general anesthesia may occur, but the vast majority are not serious, do not last long and are treatable. Side effects may include sore throat, headache, back pain and/or fatigue. Some patients experience nausea or vomiting, but this occurs less frequently than in the past.

This depends on many factors, including the type of surgery, so there is no single answer to that question. Most likely, the child will be awakening in the Pediatric Cardiac Intensive Care Unit.

Some discomfort after a major surgical procedure is to be expected. But strong, effective painkilling drugs are routinely provided to cardiac surgical patients so they can be as comfortable as possible. Patients and families should be reassured to know that the Pediatric Intensive Care Unit staff members are very aware of the importance of effective pain management and very experienced at managing children's pain.

You probably will not get to know your child's anesthesiologist as well as the primary service physicians. Nonetheless, the anesthesiologist will play many important roles in your child's care before, during and after the MRI procedure.

Specifically, the anesthesiologist:

1. Continually monitors the vital functions such as breathing, heart rate and rhythm, blood pressure, oxygen saturation, and fluid and blood needs, and makes medical decisions.
2. Ensures the child's safety during the procedure by using anesthetics and techniques, tailored to the specific medical condition.
3. Manages pain during the immediate post-procedure period to make the child as comfortable as possible.
4. Provides consultation on many aspects of medical care, including medications and airway management.

The preoperative interview has two important purposes:

The first one is to provide the anesthesiologist with health history so he or she can properly plan and manage your anesthesia and care during and following the procedure.

The second purpose of the interview is to give you an opportunity to ask questions and voice any concerns you may have.

The anesthesiologist will want to make sure that your child is in the best possible physical condition before the procedure. You will be asked about your child's general health, whether there has been any family history of difficulties with anesthesia and what your child's experiences have been with previous anesthetics. During this evaluation, the anesthesiologist will explain the planned anesthetic procedures. The discussion may include whether or not your child will receive anything for sedation before the procedure, and how the anesthetic will be initiated and maintained. This is the best time for you and your child to ask questions and express any concerns to the anesthesiologist.

You will also be asked about allergies. Sometimes children react to certain medications in odd ways that are not truly allergic reactions but are "labeled" as such. When you report that your child is allergic to a medication, you will be asked to describe the reaction so that we can determine if there is a true allergy. It is unusual for children to be allergic to anesthetic drugs or to the MRI contrast agent (injected during the study). The most commonly encountered allergies are to antibiotics such as penicillin or amoxicillin.

Sometimes minor illnesses such as sniffles and colds may cause problems during some types of surgery and anesthesia. For this reason, the anesthesiologist may feel it is best to postpone the procedure. Remember, your child's safety is our first priority.

We now realize that many children need less sedation when calm, assured and confident parents help them through the stress of a procedure or hospitalization. In spite of parents' reassurances, however, some children still may require medicine to calm them before a procedure. This medication may be given by mouth or injection. The time and type of such premedication will vary and will be determined by the anesthesiologist.

Anesthetic agents can be started in several ways. Most commonly in adults, anesthesia is started by an intravenous injection so the patient becomes unconscious rapidly. This is also a method that can be used for children. Another method of beginning anesthesia is to let your child breathe anesthetic agents until losing consciousness. This is called a mask or inhalational induction. With this approach, your child will be asked to breathe through a "space mask" quietly, and no needle sticks will be performed until after your child is sound asleep. The choice of which method to begin anesthesia will be made by the anesthesiologist based on many factors.

After inducing general anesthesia, the child will not be conscious (aware) during the entire procedure. Be assured that throughout the entire study, the anesthesiologist continually monitors and adjusts the level of anesthesia. Even when sedation is used, there might be some recollection of the MRI suite after the study is over.

No procedure is without some degree of risk, which your anesthesiologist will discuss with you prior to the MRI study. Fortunately, serious complications such as strokes and deaths from general (or other types of) anesthesia are very rare today, despite the fact that more procedures are being performed on sicker and younger patients than in the past. In the last 10 years, the estimated numbers of deaths attributed to anesthesia (for all types of surgical procedures) have dropped significantly to 1 in 250,000. Serious complications such as strokes and prolonged periods of mechanical ventilation have also declined over the past few decades. The increased safety of general anesthesia is due to many factors, including safer drugs, more extensive training of anesthesiologists and national standards of care.

Side effects from general anesthesia may occur, but the vast majority are not serious, do not last long and are treatable. Side effects may include sore throat, headache, back pain and/or fatigue. Some patients experience nausea or vomiting, but this occurs less frequently than in the past.

This depends on many factors, so there is no single answer to that question. Most likely, the child will be awakening in the MRI area immediately after the procedure.