General Anesthesia for Outpatients

What is General Anesthesia and will your child need it?

What should you do to prepare your child for General Anesthesia?

What should you do when you arrive?

What should you expect while your child is receiving General Anesthesia?

What should you expect after your child has received General Anesthesia?

What is General Anesthesia and will your child need it?

General anesthesia will be scheduled when it is considered the safest way to keep your child still and comfortable throughout his/her radiology procedure. Some children require general anesthesia instead of sedation due to their medical history or physical characteristics. On rare occasion, a child may be referred for general anesthesia by the sedation nurse practitioner/physician because he/she "failed sedation." This means that the child was not able to complete the test or procedure because the desired depth of sleep was not achieved, or the child did not tolerate the sedation medications. Your child's physician can request general anesthesia through the radiology scheduler at 215-590-7000.

What should you do to prepare your child for General Anesthesia?

Will your child need a pre–anesthesia evaluation (pre-visit)?

At The Children's Hospital of Philadelphia, a team of specially trained doctors and nurses provide all of the anesthesia care. The anesthesiologist will want to make sure that your child is in the best possible physical condition before the test or procedure, therefore, your child may need a pre-anesthesia evaluation (also called a pre-visit).

After your child's physician schedules the test/procedure, you will receive a call from the radiology scheduler to confirm the date and time of the test and the pre-visit appointments. The pre-visit appointment is located in the Anesthesia Resource Center (ARC) on the third floor of the Wood Building. An Anesthesia Nurse Practitioner will ask about your child's medical history and will examine your child. You are encouraged to ask questions and discuss your concerns about the anesthesia plan.

If your child has received general anesthesia at The Children's Hospital of Philadelphia within the last 12 months, he/she may not need a pre-visit. If this is the case, the Radiology Phone Triage Nurse will call within 30 days of your child's test or procedure date. This nurse will update your child's medical history and will give you information about when to arrive at the hospital, where to go for registration, and pre-anesthesia diet instructions.

Please remember that a parent or legal guardian needs to come with the child on the day of anesthesia. A legal guardian must bring a copy of the court issued guardianship papers or the procedure may be postponed or cancelled unnecessarily.

What can you feed your child prior to general anesthesia?

The Radiology Department follows the hospital's pre-anesthesia guidelines for eating and drinking. It is very important that you follow these instructions or your child's test may be delayed or rescheduled. Some tests require a special oral prep the night before the test. Please follow the diet/prep instructions you are given for your child's particular test. If in doubt, call the Radiology Department Phone Triage Nurse at 267-426-7985.

Diet guidelines prior to anesthesia or sedation:

No food, milk, drink, candy or gum after 11 p.m. the evening before the procedure, except:

Consoling a young child who is not allowed to eat is a challenge. Be vigilant that the child does not help himself to food or drink and keep him away from other children who are eating. A hungry child is very resourceful at finding things to eat (example: pieces of cereal under the car seat cushion), and a sympathetic brother or sister may be tempted to share food.

The entire process, from arrival through anesthesia and recovery, can be physically draining for any parent/caregiver. For your own well-being, we strongly encourage you to eat and drink prior to arrival. We do not allow food or eating in the radiology waiting rooms or patient care areas. The radiology staff will direct you to vending machines and/or cafeterias.

Can you give your child his/her morning medicines?

Unless otherwise instructed, you may give your child his/her morning prescription medications while he/she is still allowed to take clear liquids. Remember — DO NOT give your child medication with applesauce or pudding, as these are considered solid foods. You may use Jell-OTM as an alternative to applesauce or pudding. Medications that are due later in the day may be given after your child has completed the test/procedure and recovered from anesthesia. Please give your child his/her usual respiratory medication treatments the day before and morning of the test.

What should you do when you arrive?

Children who are scheduled for general anesthesia for a Magnetic Resonance Imaging (MRI) scan should arrive one hour before the test is scheduled. Once you arrive, the first thing that you need to do is register your child. The registration area for MRI scans is located near the bank of elevators on the 2nd floor of the Wood Building.

Children who are scheduled for general anesthesia for other radiology tests or procedures should report to the Day Surgery Pre-op Check-in Area on the 4th floor of the Main Building. You should arrive 90 minutes prior to the scheduled test time if your child did not have an anesthesia pre-visit. This extra time will allow for a brief physical exam and review of medical history.

Children who did have an anesthesia pre-visit should arrive one hour prior to scheduled test time.

What should you expect while your child is receiving General Anesthesia?

What should you expect after you complete registration?

You and your child will be greeted by a nurse and taken to an exam room. Here a nurse or medical technician will weigh your child and check your child's temperature, heart rate, blood pressure, and oxygen level, and your child will change into hospital pajamas. The nurse will listen to your child's breathing and get an update on his/her health status, including current medications, allergies, recent pain issues, and your child's last solid food and clear liquid intake.

In keeping with The Children's Hospital of Philadelphia policy, all female patients who have begun menstrual periods must have either a blood or urine pregnancy test before anesthesia is given. This is necessary to prevent the possibility of giving a general anesthetic to someone who is pregnant.

You and your child may return to the waiting area until it is time to move to the radiology test/procedure area and meet with the anesthesiologist. The anesthesiologist will discuss the anesthesia plan with you. You and your child are encouraged to ask questions and discuss any concerns. Most children will be given a medicine by mouth that can make them giggly, sleepy, and unsteady. Once this medicine is given, children are in danger of falling and may not walk around. You may stay with your child until the anesthesiologist directs you to the waiting room.

What should you expect during your child's test/procedure?

The radiology staff will direct you to the appropriate waiting area. The anesthesia staff will administer medications and monitor your child during the test/procedure. Once your child is finished, he/she will be moved to a recovery area.

What should you expect after your child has received General Anesthesia?

Where will your child recover after the test/procedure is completed?

If your child has completed a MRI scan, the anesthesiologist will decide if your child will recover in the MRI Department or be taken to the Post Anesthesia Care Unit (PACU) on the 4th floor of the Main Building. Children who have completed other radiology procedures will be taken directly to the PACU for recovery. We will make every effort to reunite you with your child as soon as possible. For safety reasons, only one adult is allowed in the PACU. Please make arrangements for the care of your other children so that you can be with your hospitalized child.

Your child may be receiving oxygen, have an IV, or may be attached to a monitor. A nurse will continue to monitor your child's heart rate, breathing, blood pressure, oxygen reading, and temperature regularly during recovery.

How long will it take for your child to wake up after anesthesia?

Each child wakes up differently. Some are wide awake in the recovery room; others are groggy for hours. You will be instructed NOT to wake your child if he/she is sleeping. Some children wake up very confused and agitated for ten minutes to one hour after the procedure.

Approximately one third of children, especially those under six, experience "emergence delirium." They appear to be awake, but are not really aware. During this time, the child may cry, thrash, and reach for the parent. Nothing seems to calm the child. It is upsetting to watch but usually goes away by itself. Your nurse will make sure that your child is safe. Sometimes, a quiet, dark room can help the child go back to sleep. Usually, it just takes time for the effects of anesthesia to wear off. Try to stay calm, speak softly, and comfort your child. He/she will not remember this excited state and often, will wake up feeling fine.

When can your child eat again and resume his/her home medications?

Once your child is awake and able, he/she may gradually resume feeding. Unless otherwise instructed, infants may receive their usual formula or breast-feeding. Children on special diets or tube feedings may resume their routine as tolerated. Anesthesia may cause nausea and vomiting so you are encouraged to avoid foods high in fat or protein until your child is completely back to normal. We also suggest that you avoid feeding your child on the car ride home. If your child has nausea or vomiting prior to discharge, intravenous (IV) fluids and medication may be given to help your child feel better. If your child has nausea or vomiting after leaving the hospital, call the phone number listed on your discharge instructions and the radiology or anesthesia staff will advise you.

Unless otherwise instructed, your child's home medication routine may be resumed. Children who are being admitted to the hospital following their test/procedure will have a diet plan and medications ordered once they are on the inpatient unit.

Are there any activity limitations after anesthesia?

It is very common for children to be wobbly and prone to falls for up to 24 hours after anesthesia, so activities that require coordination should be restricted. Infants and young children need extra head support when being held and children who are able to walk will need assistance from an adult to keep them from stumbling into the furniture or falling down stairs. Quiet activities are recommended at home until the child is back to normal. Children are generally able to return to school 24 hours following anesthesia. The radiology or anesthesia staff will be able to give your child a note for school and advise you if you have any specific questions or concerns.

What do you do if your child has a problem after discharge from the hospital?

You will be given written discharge instructions before you leave the hospital. The instruction sheet will give you the phone numbers that you may call if you have a question or problem at home. An anesthesia or radiology nurse will also call you the next day to see how your child is doing and ask about his/her anesthesia experience.

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