General anesthesia for children

Introduction

In infancy, general anesthesia is usually unavoidable for important operations. Its purpose is to temporarily switch off the child’s consciousness to relieve him or her of emotional stress and to calm him or her down so that no surrounding tissue is damaged during the operation. Immobilization over longer periods of time is only possible under general anesthesia.

General anesthesia may also be indicated in small children for procedures that are normally performed in the waking state in adults, such as gastroscopy, as it is not possible to explain to them in advance exactly what will happen to them. The primary aim is to avoid psychological trauma. If an infant is to undergo an operation that requires a general anesthetic, there are a few things that need to be considered.

Infants are not “little adults”, i.e. the infant has a different metabolism, a different body composition (higher relative water content) and not yet fully matured organs compared to adults. In addition, in relation to its body volume, it has a significantly larger body surface area, so that it cools down much faster. All these are factors that doctors have to take into account when administering an anaesthetic. This is one of the reasons why it is advisable to have operations performed in infancy in specialized centers, which often deal with this patient group.

Preparation for general anesthesia

Before the procedure, the anesthesiologist clarifies some questions with the parents. Important things to be recorded are pre-existing illnesses of the child, allergies, as well as currently existing colds. If possible, a child should not be exposed to anesthesia for up to six weeks after an infection, as the risk of respiratory complications is then increased.

If vaccinations have been administered in advance, an interval of at least two weeks (vaccination with live vaccine) or at least three days (vaccination with inactivated vaccine) should be observed. In case of emergencies or other procedures that cannot be postponed, the anesthesia will still be initiated. In addition, the sobriety requirements are clarified during the consultation.

Infants are not allowed to eat solid food up to six hours before the procedure and clear liquids (water, apple juice, tea) up to two hours before the procedure. Newborns and infants may be breastfed or bottle-fed up to four hours before the start of the anaesthetic. Infants from the age of 12 months usually receive an anxiety-relieving, calming medication before the anesthesia is induced.

Midazolam (Dormicum®) in the form of a juice is used for this purpose. However, calm parents are particularly important for calming the child. They should be as normal and relaxed as possible with their child to avoid making him or her unnecessarily nervous.