At Arkansas Children’s, our pediatric anesthesiologists are faced with the challenge of providing anesthesia for infants and children. They are uniquely prepared to meet the physical, developmental, psychological and emotional needs of infants, children and adolescents who require anesthesia or sedation.

Our anesthesiologists possess special skills and experience to develop and implement an individualized plan for inducing, maintaining, monitoring and recovering a child from anesthesia, including provisions for pain management after the procedure. A wide array of up-to-date and special equipment is available to the anesthesiologist that frequently is not available in adult hospitals.

In addition to addressing the physical needs, the psychological needs of our patients are met throughout the anesthesia and surgery experience. We recognize that many factors will influence how children understand and react to the events of surgery, including their age, developmental status, previous experience and anxiety level. Efforts are made to prevent and reduce distress throughout the entire surgery or procedure experience.

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Medical Director

Care Provided

  • Administer anesthesia or deep sedation to infant, child and adolescent patients during surgical and diagnostic procedures
  • Anesthesia services provided in 14 full-service operating rooms (including two for cardiac surgery and one for burn), four additional procedure rooms in the surgical areas, two cardiac catheterization suites, three MRI rooms, two CT suites, one interventional radiology suite, one nuclear medicine suite and the off-campus UAMS Radiation Oncology Center
  • Pediatric anesthesia is precision anesthesiology with an array of equipment unavailable in the usual adult hospital situation
  • Includes ventilator needs, fluid replacement needs and temperature control
  • Faculty and staff are available for consultation 24 hours a day
  • Pediatric Pain Medicine Program provides comprehensive, interdisciplinary treatment for infants, children, and adolescents with acute and chronic pain conditions
  • Inpatient pain service treats acute pain secondary to surgery, trauma, burns, dressing changes, painful procedures, and chronic medical conditions
  • Treatments include patient-controlled analgesia, epidural infusions and other methods of analgesic delivery
  • Some recurrent pain conditions such as cancer and sickle cell may be managed on an outpatient basis
  • Behavioral and psychological interventions are implemented when appropriate in conjunction with pharmacologic treatments
  • Administer anesthesia for pediatric and adult patients in the Burn Clinic

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Parent Present Induction (PPI)

At Arkansas Children's our Parent Present Induction (PPI) program is used to reduce stress and anxiety in children who are going to receive an anesthetic. A parent who wishes to be present with the child when he or she goes to sleep (induction) may do so if the child meets certain criteria and the anesthesiologist agrees. Patients who are undergoing emergency surgery or who are extremely ill may not be eligible. In all cases the decision of the Anesthesiologist is final.

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.

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