FAQs

ANESTHESIA FOR CHILDREN HAVING EYE SURGERY

Benjamin Ticho, M.D.

What types of anesthesia are appropriate for children having eye
surgery?
Either general or local anesthesia is indicated during eye surgery to reduce or eliminate pain. Local anesthesia, which blocks sensation to one area of the body but does not affect general consciousness, is occasionally used for children having eye surgery. General anesthesia, which puts the whole body “to sleep” and eliminates the possibility of movement, is more commonly used. Occasionally, general anesthesia may be required to perform a complete eye examination on a child, even if no invasive surgery
is planned.

How is anesthesia administered to children?
General anesthesia is typically administered in two stages. First, a relaxing drug is delivered as a gas through a scented face mask causing the child to drift off to sleep. An intravenous (IV) line is usually placed in a vein of the arm or leg after a young child is asleep from the mask. Older children may have the IV line placed before going to sleep.
After the child is asleep, a mask may be held over the child’s mouth and nose for a brief procedure (such as opening blocked tear ducts). For other eye procedures, however, a breathing-tube is placed in the windpipe to allow the anesthesiologist to control the child’s breathing and maintain anesthesia during surgery. Anesthetic agents (inhalation agents) delivered through the tube or medications given intravenously maintain the anesthesia. The breathing tube is removed at the end of surgery before the child is fully awake. The IV can be removed in the recovery period when the child is drinking well.

How is anesthetic “sleep” different from normal sleep?
Anesthetic “sleep” is quite different from normal sleep because the potent medications affect every organ of the body. Achieving and maintaining the desired effect requires continuous monitoring and adjustment. Your anesthesiologist has the experience and knowledge to decide which agents are best for your child and to administer them in a safe manner as possible.

How should you prepare a child for surgery?
Parents should tell children old enough to understand why they are having surgery. Your hospital may provide tours to show its facilities and explain its procedures to the child. Most children are inquisitive and may be fascinated by all the machines in the operating room. They should be encouraged to ask questions. The staff, nurses, and doctors will try to make the hospital experience a positive one.

Is a medical examination needed for children before undergoing general anesthesia?
Before surgery, a medical history and physical examination may be performed to be sure your child is sufficiently healthy for anesthesia.

Do anesthesia complications tend to run in families?
It is important to know if any blood relatives had serious problems with anesthesia such as a high fever (malignant hyperthermia) or not breathing, as some of these rare problems can be hereditary. Relatives may have had nausea with anesthesia. Nausea is also common after strabismus surgery but medications to ease the discomfort are available.

What can a child eat or drink prior to general anesthesia?
In general, your child should not eat food or drink baby formula for eight hours or drink anything, even water or breast milk, for four hours before surgery. The stomach must be empty to avoid possible anesthesia complications. The hospital staff will give you specific instructions about what time your child must stop eating and drinking.

Can a sedative be given to calm a child before going into surgery?
Children may receive a liquid sedative prior to surgery to help ease any apprehension. A sedative comforts children as they await their surgery, reduces anxiety as they move into the operating room, and helps them forget the events immediately associated with their surgery.

Isn’t general anesthesia dangerous?
Although strabismus surgery is usually quite routine, children are extensively monitored by the anesthesiologist while they are asleep. Serious reactions to anesthesia are extremely rare. All precautions are taken to ensure children’s safety while they are asleep.

What is a laryngeal mask airway?
Modern anesthesia techniques also often include special breathing tubes (called laryngeal mask airways) that reduce irritation to the windpipe during surgery and lessen sore throats afterward.

What happens during the recovery from general anesthesia after
surgery?

Once the surgery is complete, the tube is removed and normal breathing resumes. The child is then transferred from the operating room to the recovery room and over the next hour or so gradually wakes up. During this time children are often groggy and confused but receive supportive care and reassurance from the recover room staff who are also monitoring the child’s heart rate, blood pressure, and respiration. During the next few hours the child will still be sleepy, sometimes cranky, and may have a
lowered tolerance for discomfort or pain. Additional reassurance and the use of mild pain medications are helpful when needed. Most children are back to many normal activities by the next day. Occasionally a child will sleep for hours, especially after a long surgical procedure or if sedating pain medications are required.

What are the side effects of anesthesia?
Children may be nauseated or vomit after eye surgery, particularly muscle surgery. Although the nausea may last for hours, it is rarely serious. Everything possible should be done to reassure the child and make him or her comfortable. Medication is sometimes helpful.

What are the risks of anesthesia?
Serious anesthesia complications, such as brain damage or death, are exceptionally rare. Generally healthy children tolerate anesthesia at least as well as adults. Whenever possible, elective eye surgery should be avoided when the child is ill. Anesthesiologists and surgeons should be informed of all medical conditions and all medications the child is taking. They should also be informed of any anesthetic problems the child or any blood relative has experienced, as there are some rare hereditary conditions, which are associated with a greater risk. Dr. Ticho operates only at institutions well-versed in the care of children.

Will my child wake up during the anesthesia?
The anesthesiologist monitors with concentration of inhaled anesthetic vapors to assure that your child will not be aware of pain or other aspects of the surgery.

Can strabismus surgery in pediatric patients be done with topical or
local anesthesia?
Some strabismus surgery in teenagers and adults can be done with a local anesthetic. Unlike its use in adult cataract surgery, topical anesthesia, consisting of numbing eye drops to the surface of the eye, may not provide sufficient patient comfort to be used during eye muscle surgery.

Strabismus surgery typically requires 30 minutes or longer to complete. The patient must be still and comfortable during this period to avoid potentially serious complications that may result from sudden unexpected movements. As most children cannot be expected remain still for the time necessary to complete the surgery, nearly all children require general anesthesia in order for eye muscle surgery to be performed safely and comfortably.

Summary
Anesthesia for children is generally safe. Complications may be minimized
by avoiding food and drink before general anesthesia and postponing
elective surgery if the child is ill. Modern anesthesia allows surgery or
examinations to be performed without pain or anxiety.