Procedure of general anesthesia in children

The anesthesia can now be induced. There are two different ways of doing this: firstly, the anaesthetic can be introduced by means of a mask, and secondly, it can be introduced by means of medication injected directly into the vein. Mask induction is usually reserved for younger children, venous induction for older children.

Since children are more sensitive to pain, the second option allows a pain-relieving plaster to be applied in advance near the injection site so that the child does not feel the injection. During mask induction, the child inhales a mixture of anaesthetic gas and oxygen through a mask placed on him or her. The anaesthetic gas sevoflurane, which has a pleasant odour, is usually used here.

As soon as the child is asleep, a vein access can then be placed through which further medication (painkillers, muscle relaxants (drugs to relax the muscles)) can be administered. The substances administered depend on the type and extent of the planned intervention. In most cases, the parents are allowed to stay with their child until he or she falls asleep.

However, sometimes this is prohibited for hygienic reasons. Subsequent steps of the anaesthetic induction are then carried out in any case without the presence of the parents. Since the child does not breathe on its own during general anesthesia, it must be mechanically ventilated.

For this purpose, a tube is inserted into the windpipe (intubation). This is only possible when the anesthesia is sufficiently deep and the child’s muscles are relaxed. The oxygen saturation of the blood can then be continuously monitored using special adhesive electrodes.

After successful intubation, the child is additionally connected to an electrocardiogram (ECG) to measure the heart activity and to a blood pressure monitor. During the operation, the child is placed on warm blankets.Disinfectants and other necessary solutions are warmed up if possible to prevent the child from losing unnecessary heat. A probe placed either in the rectum or nasopharynx can be used to continuously monitor the child’s body temperature.

In addition, the child is given infusions with nutrient solutions and electrolytes during the operation. In the event that there is a major loss of blood during the operation, blood preserves already prepared for the child are available in advance. After completion of the operation, the child is taken to the recovery room, where it can sleep in the presence of its parents and wake up in peace.

In order to ensure that the child is pain-free after the operation, adequate pain therapy is part of the treatment. Paracetamol suppositories, which can be administered to the child as soon as the anesthesia is induced, have proven to be effective. In case of moderate pain after the operation, for example, Diclofenac (Voltaren®) can be used, or for even stronger pain Piritramid (Dipidolor®).

For procedures below the navel, a so-called caudal block can also be performed. In this procedure, a local anesthetic is injected between the vertebral bodies just above the coccyx so that the nerves running in this region are numbed. The advantage of this regional anesthesia is that the child requires less anesthetic during the procedure and remains pain-free for several hours afterwards. The procedure is performed while the child is already under anesthesia, so that he or she is not aware of it.