Join Dr. Koushik Herle, Consultant - Paediatric and Neonatal Surgeon, and Dr. Ravindra M N, Consultant and Head of ...

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Paediatric Anaesthesia I Dr. Koushik Herle - Dr. Ravindra M N I MHSR

so the most common and a general question that they ask is is anesthesia safe yes a vment yes there is no doubt that anesthesia is safe I gone other the days with basic anesthesia equipment now everything is computerized uh is there any lower age limit can anesthesia be given to neonates and incense yes very much we can um do surgeries right from the time the baby is born uh what are the precautions to follow before anesthesia yeah the most important uh thing in terms of uh the anesthesia point of view is the fasting status what about pain yeah this is uh a topic which we give lot of importance to so we do take care right from the time the child is anesthetized uh to make sure that the child is comfortable when the when he or she wakes up [Music] [Music] hello everyone I'm Dr Kik I'm consultant pediatric surgeon and a pediatric urologist at manipal hospital sjur road with me today I have Dr ravindra hello sir hi uh he is the head of the Department of anesthesia uh whenever a parent comes to meet more than the surgical aspect the first and the foremost question that they ask is is anesthesia safe for a child so they have a lot of of queries regarding the safety and how an anesthesia is administered to a child so to clarify all the doubts today I have with me the authority of anastesia Dr rindra the head of department at manipal hospital sarjapur road so I'll be asking him a few questions which the parents commonly do ask me and he'll be clarifying all the queries thank you Dr Kosik for having me here happy to answer the questions thank you sir pleasure having you here thank you so I there are a few questions which parents commonly keep asking me uh from my side whatever I do tell uh if they hear it from you I think they'll be more assured so to clarify the doubts uh I think this session would be very useful so I'll directly jump into those questions and uh I think you'll be able to help us out so the most common and a general question that they ask is is Anastasia safe yes a v yes there is no doubt that nsia is safe over the period of years we have evolved in terms of safety in anesthesia we now have more computerized uh workstations I gone other days with basic anesthesia equipment now everything is computerized it is like a pilot's cockpit we can measure each and every parameter of the child uh be it a heart rate uh oxygen emission level how the patient is breathing is the child doing well in terms of blood pressure color everything can be monitored and also we can monitor the uh child's body temperature even uh and also uh in terms of the drugs we use over the period of years we have uh more evolved modern um anesthesia medicines with very minimal side effects and even the side effects are um very much manageable and Toler uh like you said even I keep giving the same example of a aeroplane like an flight has to have a lot of safety checklist because a pilot has a lot of responsibility of carrying the passengers from one destination to another so like the right like rightly that you said it's definitely uh a pilot's cockpit yes so next question is uh does anesthesia cause neurological damage yeah I can answer these U this question in two parts uh a lot of people uh are scared of anesthesia because of few uh incident of brain damage or anesthesia related complications which have occurred uh and for obvious reasons since the child is involved it is an emotional issue and the Press also have highlighted this um in the newspapers so when I speak to the parents most of the times they refer to these articles in magazines uh and other forms of media um so uh like I told you even if in again I'll go back to the analogy of aircrafts if there is an air crash it definitely makes big news because it is not expected we do thorough checks before during and even after the procedure as well so there's nothing to fear in in those terms and there is one more reason why a lot of parents are worried one is uh refering to an American study uh Food and Drug Administration also has highlighted the fact that there could be some neurological damage uh in terms of anesthesia Administration um most of these studies are done in animals and um there is so far nothing in the literature which proves that there is any uh damage if at all during anesthesia the only thing uh which we are also concerned is when the child has to have repeated episodes of anesthesia so that will maybe maybe there will be um some effects regarding that but that is true in terms of any kind of medicines which they receive not specifically to C correct so to answer your question it does not cause any neurological damage like when we uh go for X-rays one of an x-ray or one C occasionally done doesn't cause much of a radiation exposure any person who has to undergo repeated X-rays and repeated radiation is what is risky same holds good for anesthesia also like one of surgery which is the most likely scenario in most of our pediatric surgery cases will not have a lasting neurological damage at all agree with you completely yes yes uh is there any lower age limit can anesthesia be given to neonates and inference yes very much uh again referring back to the advances made in uh anesthesia technology and medicines we can um do surgeries right from the time the baby is born um and there is no upper limit um at all the only limiting factor is the condition of the baby the uh the health of the baby and what condition the baby is when they reach to the hospital so that actually dictates um how safe the anesthesia is for that particular child yes yes uh moving on uh how is anesthesia given are there injections done before the child sleeps how is the child put to sleep yeah so we do make changes uh for um children because they are obviously very afraid of needles so while we have a pre-anesthesia check up we uh try to talk to the child all the fears of the parents uh even before the anesthesia is administered we have a preia checkup room where we we would try to meet the children or if they're already admitted we do a pre-operative visit uh in the ward where we explain everything in detail and so the what we generally try to do if possible we give them some syrups which can make them drowsy and it makes it easier for the them to separate from the parents and we always ask the parents to accompany the child up to the operating room entrance that is the policy of our Hospital in rare cases we may ask the parents to come in but mostly we receive them at the operating room entrance and the administration of anesthesia is mostly in terms of gas inhalation we have an apparatus which is just like a regular oxygen mask which is held onto the baby's uh face which covers its mouth knows and that through that we give an anesthetic gas which makes the child drowsy so as the child keeps inhaling this gas the child falls asleep and then we administer the intravenous line or the drip as it's called in layman's language and the intravenous anesthetic agents are then administered through that l so the child will never remember how the child was anesthetized the last thing the child will probably remember is the mask being held to its face and by the time the child wakes up the surgery is done and the child is awake awake so to add to this uh as a surgeon what I personally follow is uh I would have had the interaction with the parents and the child in the OPD room so there's a kind of a bond which is already developed between us uh and when basically the child has a stranger anxiety so uh if you have noticed that I keep accompanying the child along uh till the OT table so that someone familiar uh who's there with with the child the child also might feel though scared a little less whatever that I could contribute from my side as a surgeon side so that those ways as at manipal sajur road we do take care so that the child has a pleasant experience that definitely helps uh the next question are parents allowed to watch while anesthesia is given I think you have already touched upon this but a little more as a policy uh we have seen that um uh children become more uh aggressive or more tensed and ask for more attention than the parents are around and also from the parents point of view they may feel the the way we are administering anesthesia and the whole OT environment uh very uh scary so for these two reasons we don't um advise them to accompany the children uh but your children are perfectly safe in our hands we do take care of them like our own children yes well said sir uh how will the child be post anesthesia when can we feed the child uh usually uh the child will be a little drowsy which is the way we want the children because if we make them totally awake and bring them out the they will be very anxious and they may start uh crying and screaming and all that we don't want that correct so we kind of make sure the child is drowsy we after the surgery is over and the child wakes up from anesthesia we have a separate post anesthesia Care Unit or pacu for short where all the postoperative patients are held we have separate um beds and separate monitors for children as such uh because they require specialized equipments so we do have all that for all kinds of children so we keep them there and we would have already communicated to the mother even before the uh child wakes up from the surgery yes so that they can change into the scrubs and be waiting by the bedside uh to receive the child correct so apart from the nurse who is in the PSU the one of the parents is allowed who can spend time with the child and they can also uh have a relief to see that the child is all right yes so the when the child has the surgery is done and the child is wheeled out of the OT room in the recovery the parents are already there to receive the child and the child is in a known environment or a person with a known person which is more comforting yeah and so answer the next part of your question when can the child start feeding yes if it's very small children who are exclusively breastfed maybe an hour is enough but generally we want them to be fasting for at least 2 more hours uh just so that we can make sure that the child is okay one basic thing is definitely that the child should be awake and alert before we start feeding more than the time so once the child is awake and alert and we feel the child is otherwise all right we start we encourage the children mothers to feed uh With Sips of water the child doesn't have any issues tolerating that then we move over to uh clear I mean juices milk or soft solids in a graded manner many parents do have a concern as to is it two hours already the child would have been fasting before surgery further two hours post surgery so they're usually scared but out of experience I'm sure you will also agree that with the kind of drowsiness and also with the mother comforting most of the time this two hours they will not even realize that it is 2 hours and the child is ready to take feeds at the end of that time corre yeah um next question is uh what are the precautions to follow before anesthesia yeah the most important uh thing in terms of uh the anesthesia point of view is the fasting status we want the children to be fasting for at least 6 hours that is in case the child is taking formula feed milk the cow's milk or any solid feeds if it's very small babies who are exclusively breastfed we are okay with 4 hours of fasting and if a child has had some water or clear liquids we are okay to be fasting for maybe 2 hours before the surgery yes yes uh the last question uh sir what about pain uh if you may please please highlight as an anesthetist role in the pain management post surgery yeah this is uh a topic which we give lot of importance too because although the parents and the children are very anxious before the surgery if you add a pain component to this when the child wakes up the whole experience is very bad and children in pain are very difficult to manage um both from the parents point of view and from the hospital point of view so we do take care right from the time the child is antiz uh to make sure that the child is comfortable when the when he or she wakes up this is in terms of intravenous painkillers we do have strong medicines which we can use during the surgery in addition we have what are called the regional anesthesia blocks we follow ultrasound guided nerve blocks uh there are various procedures which are done on the spine and on the Torso of the baby where the surgery is done or even in the upper limbs or low limbs where we can Target specific nerves and administer under ultrasound Guidance the painkillers which will effectively give them pain relief for about 8 to 10 hours yes so by the time these uh painkillers were off we would have supplemented them with intravenous painkillers which are given Round the Clock yeah so the children are definitely happy almost for 85 to 95% leave there yes so uh with my interactions with sir also what we always follow is before even we cut make a cut on the body if the analgesics are there and the blocks that you mentioned just like it works very similar to epidural anesthesia which mothers take during delivery and even in fact better than that uh so since the brain has not even perceived the pain uh even though the child is untied uh the brain has not perceived the signals from the nerves it has already been blocked post surgery when the child wakes also the pain perception is hardly anything correct so that way uh and post surgery I think most of the time I've seen you prescribe simple drugs like paracetamol which can continue as a maintenance after the medicines have already been given during anesthesia so that way uh most of them have always been uh happy especially what I have noticed in the W when I go for postoperative rounds is uh minor cases like hernia hydrosil circumcisions the child uh is already walking around and by afternoon and uh even major cases like hypospadia since you are usually give cordal anesthesia uh with the catheter the tube which is there to drain the urine uh they're quite comfortable in wearing the diaper and the next day the child is holding the parents hand and doing a little bit of walking around in the room so definitely pain management uh as what you have highlighted makes uh the hospital experience more pleasurable yes that's our whole idea yeah uh so these were the most common points which the parents have always been raising uh I hope the concerns are addressed any further queries please do reach out to us at manipal hospital sarjapur Road thank you yes we always ready to address your concerns yeah thank you sir thank you [Music]

Dr.

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