Pediatric Anesthesiology

There are many important things that the anesthesiologist must consider when deciding whether or not to offer PPI.

Below are some of the key points:

• How comfortable are you with the idea of watching your child "go under anesthesia?" Children respond directly to the emotions of their parents. If you do not feel that you can remain calm and relaxed during the induction process PPI is not the right choice for you.
• Do you have medical conditions that may interfere with your participation? Are you pregnant or allergic to latex products?
• How does your child cope with procedures when you are present? Some children cope better with procedures when their parent is present, others cope better when their parent is absent.

Before Starting Anesthesia (Induction)

The anesthesiologist must consider the condition of your child. The safety of your child is our first concern.

Remember your child must be NPO (no food or drink) for several hours before surgery as explained by your doctors and nurses.

• How old is the child? Children between the ages of 1 - 10 benefit the most from PPI; however, arrangements can be made for some older children and young adults.
• Does your child have a special airway, heart, or lung problem?

Starting Anesthesia (Induction)

Anesthesia induction can be started in a number of ways:

• Inhalation through mask
• Intravenous medicine (IV)
• Intra-muscular injection (IM)

Many children receive a special medicine before induction to help calm them. This "premed" or "goofy juice" is not always used, and with PPI may not be necessary because you will stay with your child until they are asleep. Most children who have a PPI will breathe medicine through a special mask; however, it is sometimes necessary to use one of the other two forms of induction (IV or IM).

What to Expect During Mask Induction

If you are able to come with your child for the induction, there are two stages of behavior you will see:

Stage One

During this stage the child is aware of what is happening around them. It is normal for children to become anxious during induction.

They may try to:

• Push the mask away
• Cough or gag
• Cry or scream
• Complain about the smell
• Breathe rapidly, irregularly, or say that he/she cannot breathe

Some children who experience these behaviors may require gentle restraint to complete the induction process.

Stage Two

In the second stage of the induction, children become unaware and are unlikely to remember the events that take place or their behaviors.

Your child may:

• Try to sit up or stand
• Appear combative with staff
• Say things you do not understand
• Have glassy, unfocused, or rolled back eyes
• Become very limp

The anesthesiologist will let you know when it is time for you to leave the induction or operating room. Your child may not appear to be asleep when you leave the room because his or her eyes may still be partially open. It is important for you to realize that your child is unaware of your presence or you are leaving at this point.

Ways to help your child during Parent Present Induction (PPI)

• You can do whatever you normally do at home when helping to soothe him/her
• Depending on your child's age, you may be able to hold or rock your child
• You can hold your child's hand
• You can caress your child's hair or face
• You can talk or sing to your child
• If comfortable doing so, you may be able to help hold the mask to his/her face
• Remember, it is important to remain calm

Important Things You Must Remember

• If you are asked to leave the room you must do so quickly and immediately. The medical staff must be able to focus their attention on your child.
• Once the anesthesia induction begins to take place, the procedures must continue. Therefore, if your child becomes upset or resists the mask, he/she may have to be gently restrained.
• You must be flexible! Your child's anesthetic induction plan may need to be changed.
• Your child may need an injection or to have an IV placed if the anesthesiologist feels it would be best at that time.
• If your child is given anesthetic through his or her IV, the medicine may sting a little as it is given.
• The child may need the anesthesiologist to help with his/her breathing. This is normal and is expected.
• Time may pass differently when you are in the induction room. What may seem like a very long period of time is likely only a few minutes.

Finally, we would like to remind you that we would never require you to choose PPI. We understand that this is an individual choice and if you do not feel comfortable or prepared to go back to the induction with your child we will not ask you to do so. Our caring staff is dedicated to providing your child with the highest quality of care whether or not you are present for your child's induction.

• Anesthesia: Medicine that causes the loss of feeling or awareness.
• Anesthesia Induction: Same as anesthesia
• Anesthesiologist: Doctor who provides the medicine for anesthesia and keeps your child asleep and safe during surgery.
• Anesthetic: Medicine to decrease pain.
• "Goofy juice": Medicine given before surgery to help calm and relax your child before surgery.
• Intramuscular "IM": Medicine given in the muscle with a needle.
• Intravenous "IV": A thin tube placed into a vein through which medicines are given.
• NPO: No food or drink before surgery.
• Parent Present Induction "PPI": Parent or caregiver is present when their child receives anesthesia.
• "Premed": Medicine given before surgery to help calm and relax your child before surgery.