Preparing Your Child For Anesthesia
Your pediatric anesthesiologists have created this page to better assist parents on how to prepare their child for anesthesia, surgery, and procedures requiring anesthesia. If you received a text to this page, feel free to contact me anytime to discuss your child’s anesthetic that contributes to their anesthetic postoperative outcome.
Please follow these preanesthetic fasting and medication instructions carefully to avoid the cancellation of your procedure.
Specific preoperative notes to parents:
Teenagers: No solid food after 8 PM the night prior to their procedure.
Pregnancy Test Requirements Prior to Anesthesia – see below
Fasting Guidelines
> 8 Hours: If your child was prescribed a bowel preparation for a colonoscopy procedure, please follow your doctor’s instructions carefully.
For teenagers having a procedure under anesthesia, the best advice is no solid food after 8 PM and an early bedtime will help improve their postoperative comfort and outcome.
8 Hours: Solid high-fat food, fried food, meat (protein), non-clear liquids, chewing gum, or candy must be completed 8 hours before the scheduled arrival time.
6 Hours: Solid low-fat food, formula, liquid thickeners, milk or carbohydrates, and toothbrushing must be completed 6 hours before the scheduled arrival time.
4 Hours: Pure breast milk (without thickener or cereal) must be completed 4 hours before the scheduled arrival time
2 Hours: Clear liquids (water, Pedialyte®, or apple juice) are allowed 2 hours before the scheduled arrival time
Note: Contact your pediatric anesthesiologist for specific fasting instructions in children under the age of 6 years. Newborns and infants may require specific nutritional guidelines depending on the fasting time, health problems, and postoperative metabolic demands.
Prescription Medications
- Medications should be taken as prescribed with clear liquids at least 2 hours before a scheduled procedure
- Medications taken in foods (e.g. apple sauce) or any other nonclear liquid medication (antibiotic) should be taken prior to 6 hours before a scheduled procedure. Some medications may be taken with honey 2 hours prior
- Inhalers and Nebulizers: Begin treatment 2 days before the procedure even if they are not symptomatic
- Diabetics on Insulin: Using these guidelines, consult with your treating physician
- Do not take ibuprofen (Motrin, Advil) within 2 days of the procedure
- Acetaminophen (Tylenol) is allowed
- Please stop taking herbal medications and diet drugs at least one week prior to surgery
Pregnancy Test Requirements Prior to Anesthesia
Your anesthesia care team follows the healthcare facilities policy to keep your child as safe as possible prior to an anesthetic. An important step, i.e., a pregnancy test with the parent’s and/or patient’s consent will be done through a urine sample when your child checks in on the day of your anesthetic. All patients with reproductive capability under the age of 18 and who have started menstruating (having periods) require a pregnancy test. Many institutions require the tests on all female above the age of 10 years.
Please have your child refrain from urinating prior to their arrival, if possible.
In rare cases when your child cannot give a urine sample because they have urinated prior to arrival, you may also have the pregnancy test done through a blood sample. This could delay your planned procedure up to a few hours or possibly a cancellation if the facility lacks the capability to do blood pregnancy tests.
What Happens After I Get the Results?
- If the test is negative (-), your team will go ahead with the scheduled anesthetic and procedure.
- If the result is positive (+), the care team will share the result with you privately. They will also help you decide what to do next. Your care team understands that getting a positive pregnancy test result can be unexpected. This does not happen very often.
Disclaimer: This guideline is not intended to impose standards of care preventing selective variation in practice that is necessary to meet the unique needs of individual patients. The physician must consider each patient and family’s circumstance to make the ultimate judgment regarding the best care.
Preparing For Anesthesia
Eating, Drinking and Preadmission Instructions
You may hear “NPO” instructions, nil per os (NPO) is a medical instruction meaning to withhold oral food and liquids from a patient. The preoperative fast is an attempt to avoid regurgitation and possible lung aspiration of food and liquid from the child’s stomach during the induction of anesthesia.
Note to Parents
Please have a nourishing breakfast out of the site from your children prior to your arrival at the healthcare facility. Dizziness, lightheadedness, and fainting have occurred in parents when they have not prepared physically and emotionally for their child’s day of surgery.
Preanesthetic Fasting Guidelines for Elective Procedures
> 8 Hours: If your child was prescribed a bowel preparation for a procedure, please follow your doctor’s instructions carefully.
8 Hours: Solid high-fat food, fried food, meat (protein), non-clear liquids, chewing gum, candy must be completed 8 hours before the scheduled arrival time. Stop foods like meat, fried foods, fatty foods, cheese, cow’s milk, gelatin (Jell-O®) which contains protein, liquid thickeners, and gum or candy (procedures may start as early as 6 AM).
6 Hours: Solid low-fat food, formula, milk or carbohydrates, and toothbrushing must be completed 6 hours before the scheduled arrival time. Solid low-fat food includes breast milk with thickeners, infant formulas, nonhuman (cow’s) milk, yogurt, cereals, bread, Jell-O®, fruit, and fruit juice with pulp (orange juice).
4 Hours: Pure breast milk (without thickener or cereal) must be completed 4 hours before the scheduled arrival time.
2 Hours: Clear liquids are allowed 2 hours before the scheduled arrival time. Clear liquids include water, Pedialyte®, apple juice, Gatorade®, clear sodas, coffee or tea without dairy, energy drinks, and Popsicles® without dairy or food particles.
Does your child have gastrointestinal symptoms or a metabolic disorder?
Following the guidelines does not guarantee complete gastric emptying. Patients with gastroesophageal reflux disease, difficulty swallowing, other gastrointestinal motility, and metabolic disorders (e.g., diabetes mellitus) may increase the risk of regurgitation and pulmonary aspiration.
Note: Additional fasting time (e.g., 8 or more hours) may be needed for fried foods, fatty foods, or meat.
Is Coffee, Tea and Energy Drinks a Clear Liquid?
Caffeine Withdrawal Headaches After Anesthesia: The question posed is dairy-free coffee or tea a clear liquid allowed prior to anesthesia? Black coffee, tea, caffeinated energy drinks, and carbonated beverages are considered clear liquids. Patients, pediatric and adult, who have a high daily intake of caffeine may drink black coffee or other clear caffeinated beverages 4 hours before anesthesia to prevent the onset of caffeine withdrawal postoperative headache.
Oral Medications
Medications may be taken as prescribed with a sip of water up to two hours before a scheduled procedure unless otherwise directed. Consult your surgeon or anesthesiologist.
Prescription Medications
- Medications should be taken as prescribed with clear liquids at least 2 hours before a scheduled procedure
- Medications taken in foods (e.g. apple sauce) or any other nonclear liquid medication (e.g. antibiotics) should be taken prior to 6 hours before a scheduled procedure
- Inhalers and Nebulizers: Begin treatment 1-3 days before the procedure even if they are not symptomatic
- Diabetics on Insulin: Using these guidelines, consult with your treating physician
- Do not take ibuprofen (Motrin, Advil) within 2 days of the procedure
- Acetaminophen (Tylenol) is allowed
- Please stop taking herbal medications and diet drugs at least one week prior to surgery
Inhalers or Nebulizers for Asthma or Reactive Airway Disease (RAD)
Patients on prescribed inhalers or nebulizers should begin treatment 1- 3 days before the procedure even if they are not symptomatic.
If your child’s surgery has been canceled once before due to wheezing, it is recommended that you consult your pediatrician and consider a dose of steroids a few days prior to surgery.
Does your child have symptoms of wheezing (bronchospasm)?
Most patients with asthma complain more frequently about chest tightness (in combination with shortness of breath or cough) than wheezing. Thus, any patient with chronic or episodic respiratory symptoms or who presents with a history of asthma or other chronic airway diseases should consult their primary care physician a few days before their procedure.
Clothing
Please wear comfortable loose-fitting clothing, no metal or zippers, short sleeve shirt, and slip-on shoes, and avoid one-piece outfits on children.
Comfort and Warmth
Pack a favorite stuffed animal, toy, or book to comfort your child. Bring a blanket to keep your child warm.
Bed Wetting (Nocturnal Enuresis)
Pediatric patients may benefit from wearing pull-up diapers if they wear one while sleeping. Bring an extra set of clothes for children who are at risk for bed wetting. For infants, bring a small supply of diapers and bottles.
Go To Bed Early!
Some of the best advice is to have you, your child or teenager get a good night’s sleep, so they are well-rested on the day of their procedure. We recommend an early bedtime by 10 PM (especially teenagers) and turn off all lights and electronic devices.
Psychological Preparation
The research literature dealing with patient preparation for anesthesia and medical procedures suggests preparation for anesthesia is important for young people and their parents. Preparing your child for anesthesia and surgery has demonstrated to help your child feel less anxious, cope much better, and get through the recovery period faster. Research also shows that when both parents and kids know what to expect, children have less anxiety, earlier discharge, and less pain medication requirement.
The extensiveness and style of psychological preparation for children should be guided by each child’s age and developmental level. In general, specific discussion about the sedation and procedure has more relevance for children >2 years of age.
Psychological preparation for children should have at least three components:
- What will happen (where, how long it will last, and what will be done)
- How it will feel (pressure, temperature, and level of discomfort to be expected)
- Strategies to cope with the stressor (which may be related to the sedation technique and/or procedure)
Age-based Psychological Preparation
- Separation anxiety and behavior regression is more common in children between 6 months and 6 years
- School-aged children are concerned with the surgical procedure and awareness under anesthesia
- Adolescents fear the loss of control
Pediatric Anesthesia Emergence Delirium Behavior
You may have heard of or have experienced a child waking up “wild” from anesthesia. It is not unusual to see children awake from anesthesia with delirium and agitation. Pediatric anesthesia emergence delirium is most frequently observed in preschool-aged children and males are more affected than female patients. The delirium occurs around 15 minutes after a general gas anesthetic (sevoflurane) and usually resolves within 30 minutes.
- Lack of eye contact
- Kicking
- Head tilting
- Holding their head backward
- Inconsolability
Please do not be alarmed, emergence delirium does not cause any long-term side effects. The PACU nurses will not wait to reunite you with your child because it may require your help to keep your child from pulling out IV catheters, dressings, and to ensure that the child doesn’t injure himself on the bed or harm the surgical site.
Our Mission is to improve the medical well-being of infants, children, and adolescents by offering personalized and comprehensive medical care by the most experienced physician anesthesiologists in the community.
Parent Resources:
- SmartTots
- Anesthesia Patient Safety Foundation
- Society of Pediatric Anesthesia (SPA)
- The American Society of Anesthesiologists
- Maintenance of Certification in Anesthesia (MOCA)
VIDEO: How to Prepare Your Child for Anesthesia and Surgery
Coming soon!