THE world of medicine is vast and complex. There are several specialities and sub-specialities, then ‘sub-sub-specialities’. Anaesthesiology, for example, is a speciality that spans across internal medicine, surgery, paediatrics and emergency medicine.

Anaesthesia is the class of drugs used to make you sleepy as well as relieve and prevent pain during surgeries and procedures. These drugs are further divided into:

1. Local Anaesthesia. This drug numbs a small area of the body. For example, if you need stitches, we inject a local anaesthetic around that area of skin so you don’t feel when we stitch (or suture) your wound.

2. Sedation. This medication causes you to relax and sleep during a procedure. Think of when we need to pass a camera down your throat into your stomach to look for ulcers, or you need to have your wisdom tooth pulled. When you wake, you won’t remember the procedure.

3. Regional anaesthesia. This drug (temporarily) blocks the nerves of a large area of the body so you can’t feel anything. For example, if a mother needs to have a C-section done, the doctor will inject medication into her back causing numbness and no pain everywhere below the waist.

4. General anaesthesia (GA). This is when we say “put to sleep”. These drugs will make you totally unconscious and unable to feel pain or any stimuli. We use GA for more invasive procedures like surgeries of the head, chest, abdomen.

Getting news that you or your child needs a procedure or surgery can be one of the most frightening things. The anaesthesiologist will be there to go through what happens before, during, and after surgery.

My colleague, Dr Brittany Smith, who is a resident in the anaesthesiology and intensive care unit (ICU) department at the Bustamante Hospital for Children (BHC), walked me through the ins and outs of what happens when a child comes in for surgery/procedure as a “day case”.

Your child may have to come in a few days before the procedure to be reviewed by the surgery doctors as well as the doctors who will “put him or her to sleep”. At this visit, the anaesthetist/anaesthesiologist will ask you the parent (or guardian or caregiver) about how healthy your child is. They may ask, “Is there any cough or cold?”; “Any fever or signs of infection?”; etc. The doctor will examine your child’s mouth and throat to assess how easy or difficult it will be to intubate (place a breathing tube down the throat) which is required in certain procedures.

If your child is sick with a cold or cough, it decreases the safety of putting your child to sleep, and so it is very important that you tell the doctor if your child has had a cold or cough in the prior two to three weeks before surgery. If so, the surgery must be postponed to a later date. I know this is very annoying and most times inconvenient; however, your child’s safety is of utmost priority. We look at blood results (usually done earlier that day or week) to make sure your child’s blood count is normal, there is nothing in the blood tests pointing to any signs of infection, if baby has sickle cell disease, plus any other blood tests relevant to that particular surgery.

The doctor will explain what they will do — place an IV (drip) in her hand, and have her inhale a gas to put him or her to sleep. For day cases, inhalation anaesthesia is used to put baby to sleep in 99 per cent of cases, and intubation is rarely done. Towards the end of the procedure, we lower the inhaled gases to allow baby to wake up. We also give pain medications to prevent discomfort when baby wakes up.

Once all this is explained to you, there is a form you must sign giving permission for us to go ahead with the surgery as well as to administer anaesthetic drugs. This is called the Consent for Procedure and Anaesthesia form. (NB only a parent or legal guardian will be able to sign the consent form).

The doctor will explain what to do and what not to do before surgery. These include:

1. Don’t give baby any solid food after 12:00 am the morning of surgery

2. Baby is allowed to drink clear fluids (water, apple juice, mint tea) up to 5:30 am the morning of surgery

3. Don’t give baby any sweets or candy before surgery

Bring with you:

1. Child’s birth and immunisation passport, clinic card, and sheet of paper outlining which surgery is being done

2. A change of clothes, including underwear or diapers

3. A toy, book, blanket, or an electronic device to help child feel comfortable in the waiting area

4. Water or juice for after the surgery

5. Baby wipes or alcohol wipes

6. Face masks for you and child

7. If child is on any medications (like for the heart, or stomach, or any medication taken on a regular basis), please take the medication with you and let the doctors know when the last dose was. If your child has asthma, take the asthma pumps

Next week we will look at what to expect on the morning of the surgery and the possible complications from anaesthesia.

Dr Tal’s Tidbit

Knowing your child needs any kind of medical procedure done can be very scary. The anaesthesiologist is the amazing doctor who will ensure you child is sleeping, pain- free and safe before, during and after the procedure or surgery.

Dr Taleya Girvan has over a decade’s experience treating children at the Bustamante Hospital for Children, working in the Accident and Emergency Department and Paediatric Cardiology Department. Her goal is to use the knowledge she has gained to improve the lives of patients by increasing knowledge about the health-care system in Jamaica. Dr Tal’s Tidbits is a series in which she speaks to patients and caregivers providing practical advice that will improve health care for the general population. Email: dr.talstidbits@gmail.com IG @dr.tals_tidbits