Anaesthetic Specialities
doctor and patient

Anaesthetic Specialities

Regional anaesthesia, as the name implies, refers to a group of techniques that anaesthetise only a specific region of the body.

Simple enough, but to understand how it works one needs to have a basic idea of the way the human body is wired. Nerves start as millions of bits of flayed wire (receptors) that are stuck under the skin and other tissues. These fire an electric current when they are excited (by cold, heat, pinprick etc.). The nerves (or ‘wires’) take electric currents up through the spinal cord (the ‘mains cable’) to the brain (the ‘computer or processing unit’).

Interestingly, the brain, despite being the ‘seat’ of pain, is a wobbly mass of jelly that does not feel pain itself. Indeed, operations on specific parts of the brain are sometimes carried out with the patient fully awake.

With a general anaesthetic we effectively turn off most of the brain. This stops the patient feeling pain, but also abolishes other functions. For example, many types of general anaesthetic will stop a patient’s breathing. This important function can be easily entrusted to a machine. However, if the patient has a bad chest (for example from cigarette smoking or a recent infection) a general anaesthetic may be unsafe or risky.

With regional anaesthesia we can block the electrical impulses going to the brain before they actually reach it. So if the brain does not receive these messages, there is effectively no pain. You can have a finger sliced off, and if the brain does not get told about it then it may as well not have happened.

For a small skin operation, or a tooth extraction, we can block the flayed wires (receptors) thus stopping the pain impulses from forming.

We can also block the wires (nerves) or, in certain areas, bundles of them (plexuses). This is what anaesthetists do when we perform what is known as a ‘nerve block’. The procedure involves locating a specific nerve or plexus, using one of various methods, and using a needle to deposit local anaesthetic around it. The simplest of these are ‘landmark’ techniques, whereby the anaesthetist applies his or her knowledge of anatomy to locate the nerves. Nowadays we use ultrasound technology to actually visualize specific nerves on a screen. This recent advance has opened up a new world of regional block techniques.

Anaesthetists can also block pain impulses at the level of the ‘mains cable’, or spinal cord. This is what we do when we perform a spinal or an epidural. If we block the spinal cord at the middle of the back, we block all electric currents from the lower body. This means that an operation such a Caesarean section can be carried out painlessly whilst the patient remains fully awake.

There are side effects, as well as risks and complications associated with regional anaesthesia.

When we carry out a nerve block, we usually block muscle movement as well as sensation. This is an example of a side effect that is difficult to work around. The nerves that carry sensation to the brain also contain fibres that transmit data from the brain to the muscles, instructing them them to move. When that communication is cut off, muscles are paralysed. Up till a few decades ago patients used to lie in bed for several weeks following a major operation. For example, after a hip replacement patients needed six weeks in traction, unable even to turn in bed. Nowadays they are encouraged to walk less than a day after the operation. Of course, this has been made possible with newer types of surgery and the use of modern hi-tech materials, leading to greatly improved results. The emphasis on early mobilisation has led to the development of methods whereby we block smaller and smaller individual nerves that contain more pain fibres and less or no motor fibres. Also, some local anaesthetics are being developed that block pain fibres in preference to motor ones.

Some side effects are specific to the type of regional anaesthetic that is being carried out. For example, a spinal anaesthetic is often associated with a drop in blood pressure (causing light-headedness if not treated promptly).

Very rarely, structures close to the site of injection can be damaged. For example, an injection at the top of the chest to numb nerves going down into the arm can be associated with injury to the lung (which is close by). These are becoming very uncommon with advances in ultrasound technology and anaesthetists that are more experienced at using it.

Despite our many precautions, sometimes the nerve itself can be damaged by the needle or by the local anaesthetic itself. This can take a few weeks to resolve, in which case it is considered ‘temporary’, or the function of the nerve may recover after several months or never recover fully at all. This is considered ‘permanent’ and is extremely rare

Other extremely rare side effects include an allergic reaction to the local anaesthetic, or a reaction where too much local anaesthetic enters the bloodstream causing toxicity.

Although it is important to be properly informed of the possible risks, the alternative is often either remaining in pain or receiving strong intravenous pain-killers. These two alternatives are also, in themselves, related to their own side-effects and risks.

It is important to note that regional anaesthesia does not necessarily replace a general anaesthetic. The two often work hand in hand, with the general anaesthetic providing pain relief for the surgery itself, and the regional anaesthetic serving to provide post-operative comfort for several hours (even days).

Welcome to the Information Page about how Anaesthetists (tobba tal-lopju) can help you, and can be involved, in your labour and delivery.

Anaesthetists are medical doctors who are specialized in giving anaesthetics i.e. how to keep you unconscious and pain free during a surgical procedure. We are also specialized in treating pain.

At Mater Dei (the main public hospital in Malta), you may meet the following who are part of the Team:

    1. Consultant Anaesthetists. A doctor who has specialized as above and who is ultimately responsible for the anaesthetic and pain relief you receive. The most senior anaesthetic doctor.
    2. Resident Specialist Anaesthetists. A doctor who is also specialized as above, who you will more likely meet outside regular hours e.g. afternoon or at night. Also a very senior doctor.
    3. Anaesthetic Trainees. Doctors who are still specializing in this field of medicine and who work under supervision of a Resident Specialist or Consultant. Some are junior (Basic Specialist Trainees) and some are senior (Higher Specialist Trainees) but all anaesthetic doctors are licensed doctors who have worked for at least two years after finishing medical school.
    4. Anaesthetic Nurses. These will assist the Anaesthetic Doctor if you require a surgical procedure and will therefore be present in the Operating Theatre.

Below are some situations where you might require the assistance of an Anaesthetist. If you feel any of these apply to you, or you would like more information before or during your labour and delivery, please ask your Obstetrician or Midwife to contact us.

It is good to know that when you are in labour and admitted to Labour Ward/ Delivery Suite, there is always an Anaesthetist available who you can talk to.

We will try to keep all the information on this page up to date. We have written this keeping in mind the local situation in Malta, as well as medical literature from local, European and international studies. We have also used information from the website www.labourpains.com written by the Obstetric Anaesthetists Association in the United Kingdom.

During Labour

Labour is a painful experience. There are a number of options available to help with this. Not all involve an Anaesthetist.

Pain Relief not needing Anaesthetist involvement:

  • Non-medication techniques e.g. massage, breathing exercises, aromatherapy. You can do these yourself or with the help of your partner.
  • Entonox. This is a gas mixture of oxygen and nitrous oxide. It is also known as “laughing gas”. A midwife can suggest this and show you how to use it. You breathe the gas in through a mouthpiece when a contraction is present and continue to breathe in deeply from the mouthpiece for the duration of the contraction. There is no need to remove the mouthpiece from your mouth to breathe out. When the contraction is over, the mouthpiece should be removed and you should breathe air when you have no contractions. Timing the use of Entonox to contractions and breathing air in between is very important for it to work well.

Advantages: Easy to use; Not harmful to baby; Works fast; Does not last long but you can use it any time
Disadvantages (short-lived): Does not take pain away completely; Nausea (common) and vomiting ; Dizziness

  • Opioids. These are strong pain killers given by an injection into a large muscle (e.g. arm or leg). In Malta, pethidine is used. This can be suggested and given by a midwife.
  • Advantages: Removes pain for a while; Can be repeated; Some women says it makes them more relaxed during labour
  • Disadvantages: Baby may be sleepy and need help with breathing if pethidine is taken towards the end of labour; Effect only lasts a few hours at best; Nausea and vomiting; Drowsiness; Some women are disappointed with the pain relief and feel less in control; May slow down your breathing and you may need an oxygen mask

Pain Relief given by an Anaesthetic Doctor


Epidural. This is the best pain-killer technique available (the gold standard). It is performed by an Anaesthetist and is a procedure that requires your understanding and cooperation to perform safely.
You should ask for an epidural as soon as you feel you need it for pain relief. Let your midwife know early if you have already decided, before you are in labour, that you would like an epidural.

Procedure:

You will need to be assessed for an epidural by the anaesthetic doctor. He/she will explain the procedure, answer your questions and gain your verbal consent. Your partner or midwife should be present during the consent process.

Blood tests are taken before an epidural is inserted to ensure your blood is clotting well and that you do not have signs of infection. This reduces the risk of bleeding and infective complications. If you had high blood pressure during pregnancy, your kidney and liver function will also need to be checked. The midwife will check your blood pressure and temperature before the procedure and will insert a small plastic tube into a vein in your hand to give you intravenous fluids.

An epidural is done in two steps. Each step takes around 15-20 minutes.

A. Inserting the Epidural Catheter

You will be asked to sit or lie down on your side. The anaesthetist will wash your back with a cold antiseptic solution to make the skin sterile (and reduce the risk of infection). This will need to be allowed to dry. In the meantime, the doctor will set up his/her equipment. You can still use entonox during contractions if you prefer. You will be asked not to move during the procedure – this is very important to reduce complications! If you have a contraction, tell the anaesthetist. He/ she will pause the procedure, and will continue when you tell him/her that the contraction is over. Your back will be covered with a sterile cover. You must try to curl your back into a “C” shape, like an angry cat, to open the space in between the bones of your back. Then, a sharp pin prick will be felt at the bottom of your back – this is the local anaesthetic to numb the skin. Sometimes it burns for a few seconds when inserted. From then on, the procedure should be painless, though you will feel a lot of pressure in your back. This is normal. Advise the anaesthetist if you have a contraction, or feel any sharp (like a shock) back or leg pain. It is important not to move at all times. Once the epidural catheter (long thin piece of plastic) is in place, all needles will be removed and the catheter will be taped to your back so that it does not come out.

B. Getting the Epidural to Work

Once the epidural catheter is in place, you can lie down on it as you cannot kink it. The doctor will start giving you painkiller medications (local anaesthetic plus opioid) to remove the pain. The first dose is usually a test dose to make sure the epidural catheter is in the right place. Let the anaesthetist and midwife know straight away if you feel unwell; if you hear strange noises (like ringing or buzzing in your ears); if your lips go numb or you start tasting strange things; or if your legs go very heavy. If all is well after the first dose, the anaesthetist will give you more and more medicine until the pain goes away. You should expect the painful contractions to get shorter and shorter until they disappear completely.

Frequent Questions about Epidurals:

  • What are the advantages of an Epidural?

Usually provides excellent continuous pain relief throughout labour; does not directly affect your baby; can be used to provide anaesthesia for a Caesarian Section if this becomes necessary

  • What are the disadvantages of an Epidural?

Temporary leg weakness and numb legs; increases the risk of forceps or ventouse vaginal delivery; may slow down the second stage of labour by some minutes (i.e. from when you are fully 10cm dilated to when the baby is delivered); low blood pressure; itching; raised temperature; mild pain and bruising at site of insertion (epidurals are NOT associated with long term back pain); some epidurals do not work well and may need to be adjusted or replaced.

  • What are possible complications of an Epidural?

Like every procedure, an epidural comes with the risks of complications. These include:

- Not working well enough to remove labour pains (10% chance; common)
- Severe headache (1.8% chance; uncommon)
- Drop in blood pressure (2% chance; uncommon)
- Temporary nerve damage i.e. numbness on the legs/ weak foot which resolves by 12 weeks (0.1%; uncommon)
- Nerve damage lasting more than 6 months (1 every 13,000 women; rare)
- Severe nerve injury including being paralyzed (1 every 250,000 women; extremely rare)
- Infection of the central nerves (1 in every 50,000 – 100, 000 women; very rare)
- Blood clot near the central nerves (1 in every 170,000 women; very rare)
- Accidental unconsciousness (1 in every 100,000 women; very rare)

  • What do Anaesthetists do to reduce complications?

Firstly the Anaesthetist will talk to you and get to know your medical history. Precautions are taken to reduce specific complications:

- Severe headache: The procedure is done by a trained doctor. It is important that you do not move during the procedure. If you have a contraction, tell the Anaesthetist. This communication will reduce the chances of headache, since an epidural is a delicate procedure and the anaesthetist will need to “feel” for the right space to insert your epidural. Any sudden movements can make the needle move to the wrong space and cause headache.

- Drop in blood pressure: Your blood pressure will be monitored closely by your midwife and will be quickly treated if it drops. You will have a “drip” of fluid to reduce this complication.

- Nerve damage. The procedure is done by a trained doctor. A blunt (not cutting) needle is used. Again, it is important that you do not move during the procedure. If you have a contraction, tell the Anaesthetist. This communication will reduce the chances of nerve damage.

- Infection. The procedure is done in a sterile way (like surgeons prepare for operations). He/she will wear a cap, mask, gown and gloves. Your skin will be cleaned to make it sterile too. All equipment that will enter your body is sterile and single use, and only opened directly before the procedure.

- Bleeding/ blood clot. Your blood tests will be checked before the procedure if needed. A blunt (non cutting) needle is used by a trained doctor in the procedure. Again, it is important that you do not move during the procedure. If you have a contraction, tell the Anaesthetist. This communication will reduce the chances of bleeding.

  • Who should have an Epidural? Is it ever medically recommended?

Any woman in labour can ask for an epidural. It is usually done at “maternal request”.

Sometimes epidurals are recommended by the anaesthetist, the midwife or your obstetrician. Reasons can include:

  • High body mass index (this is calculated using your weight and height). This is because there is a higher risk of intervention (e.g. instrumental delivery, Caesarian Section) in women with high weight and having an epidural can make you more comfortable and might avoid the need for a general anaesthetic.
  • Pre-Eclampsia or Pregnancy-Induced Hypertension. If you are having high blood pressure in pregnancy, it is recommended to get an epidural for labour pain. This will help to avoid further increases in the blood pressure due to pain and stress, which can be dangerous for you and the baby.
  • History of heart disease. If you have a history of heart disease before or during pregnancy, an epidural may be recommended for labour pain. This is to reduce the stress and high blood pressure related to the pain of labour which may not be good for your heart disease.

 

  • Are there times when an Epidural should not be done?

Epidurals are contraindicated if:

  • The mother refuses the procedure. An epidural cannot be done without your consent. However, if you give verbal consent, that is sufficient.
  • Allergy to local anaesthetics or opioids. If you are allergic to the medications used in an epidural, you should not have it.
  • Infection. If you have a high fever and are unwell, or if your blood tests show that you have an ongoing infection, it may not be possible to have an epidural as this may increase risks of complications. Discuss this with the Anaesthetic Doctor.
  • If you have a bleeding tendency or the blood tests show that your blood is not clotting well, it may not be possible to have an epidural as this may increase risks of complications. Discuss this with the Anaesthetic Doctor.
  • If you have had major surgery to your back, have metalwork in your back or a history of nerve disease or nerve damage, it may not be possible to have an epidural. Discuss this with the Anaesthetic Doctor.
  • If you are unstable or very unwell, it may not be possible to have an epidural. Discuss this with the Anaesthetic Doctor.

During Caesarian Section


If you need a Caesarian Section for any reason, you will need an anaesthetic to keep you comfortable and pain free during the procedure. This will be taken care of by the Anaesthetic Doctor and Anaesthetic Nurse.

a. Emergency (unplanned) Caesarian Section
The type of anaesthetic you receive will be decided on by the anaesthetist with your consent. There are three options:
- Epidural, only if you already had one for labour pain. There is no time to put in an epidural if it is an emergency.
- Spinal, will be discussed below. This is the recommended option if there is available time and there are no contraindications as above.
- General Anaesthetic, will be discussed below. This is the option used if there is no time for a spinal, or if it is not safe to have a spinal anaesthetic.

b. Elective (planned) Caesarian Section
The type of anaesthetic you receive will be decided on by the anaesthetist with your consent. There are two options:
- Spinal, will be discussed below. This is the recommended option if there are no contraindications. It will allow you to be awake for the birth of your baby and to see him/her as soon as they are born and to hear them cry. Your partner will also be able to join you in the operating theatre for the Caesarian Section.
- General Anaesthetic, will be discussed below. This is the option used if a spinal anaesthetic is contraindicated for any reason. This means you will be unconscious for the procedure. Your partner will have to wait outside the operating theatre if you are asleep.

Here is more information about Spinal Anaesthesia and General Anaesthesia.
a. Spinal Anaesthesia
This is the recommended type of anaesthesia for Caesarian Section. It is a very safe procedure and is widely used in Malta and worldwide. The anaesthetic doctors at Mater Dei are very experienced in this type of anaesthesia.
It is recommended because:
- It is safe for you, since you will be awake and able to breathe yourself throughout the procedure
- You will be awake for the birth of your baby and can be accompanied by your partner, if you wish
- The baby is not exposed to anaesthetic medications.
- Recovery after this type of anaesthesia is usually less painful than after general anaesthesia
- You may be allowed to eat and drink earlier after the operation, compared to if you have a general anaesthetic

The spinal usually takes about 10-15 minutes. You will need to have monitoring for your heart rate, blood pressure and oxygen levels in the blood before the procedure. The Anaesthetic Nurse will take care of all these. A “drip” will be inserted in the back of your hand and the Nurse will attach fluids to it.


Then, you will be asked to sit or lie down on your side. The anaesthetist will wash your back with a cold antiseptic solution to make the skin sterile (and reduce the risk of infection). This will need to be allowed to dry. In the meantime, the doctor will set up his/her equipment. You will be asked not to move during the procedure – this is very important to reduce complications! Your back will be covered with a sterile cover. You must try to curl your back into a “C” shape, like an angry cat, to open the space in between the bones of your back. Then, a sharp pin prick will be felt at the bottom of your back – this is the local anaesthetic to numb the skin. Sometimes it burns for a few seconds when inserted. From then on, the procedure should be painless, though you will feel some pressure in your back. This is normal. Advise the anaesthetist if you feel any sharp (like a shock) back or leg pain. It is important not to move at all times. Once the needle is in the right place, the medications will be injected and the needle removed. A dressing will be placed on the skin puncture. You will then be asked to lie down on your back as a spinal works very quickly. Full effect should be obtained in about 5 minutes.


You should expect your legs to go warm and heavy. You may also feel pins and needles in your legs. You will be numb to pain from the nipple level down to your legs. It is normal to still be able to feel touch, pressure or pulling on your tummy. The important points are that you feel no pain and that you are not able to move your legs (moving your toes is OK!). The Anesthetic doctor will test the spinal to make sure it is working before the obstetrician starts the Caesarian Section.


The Anaesthetic Doctor and Nurse will also be present throughout the Caesarian Section to keep you safe and comfortable. If you have any concerns at any point, let them know. Once the Caesarian Section is finished, they will accompany you to the Recovery Area where you will be able to spend time with your baby, partner and midwife before going back to the ward.


The contraindications (page 6) and complications (page 4) of a spinal anaesthetic are similar to those of an epidural mentioned above.


If for some reason your spinal doesn't work (this happens very rarely), then the anaesthetist will be able to give you a General Anaesthetic at any point in time.

b. General Anaesthesia
This is performed when a spinal anaesthetic is contraindicated or when there is no time for it. This is the fastest anaesthetic procedure and is also used when you, or your baby, are unwell. The anaesthetic doctors at Mater Dei are also very experienced in this type of anaesthesia.


Your partner will not be allowed into the operating theater if you have a General Anaesthetic as you will be asleep and will not need moral support.

It is recommended when:
- A spinal doesn't work or cannot be done
- If you are too unwell to have a spinal
- When it is urgent to deliver your baby as quickly as possible

The procedure involves:
Monitoring of your heart rate, blood pressure and blood oxygen levels (not painful) and then an intravenous “drip” will be inserted in your hand and fluids started. A tight mask will be placed on your face to fill your lungs with oxygen and deliver increased oxygen to your baby. You will feel pressure on your neck by the Nurse to avoid acid going from your stomach and into your lungs when you are asleep. The Anaesthetic Doctor will then give you intravenous drugs to make you fall asleep. You should remember nothing else from this point onwards.


You will then wake up in the Recovery Area. Your baby, partner and midwife will join you there. If you are feeling nauseated or in pain, the midwife will be able to give you medications to make you feel better.

Complications associated with General Anaesthesia include:
- Sore throat after the procedure (common)
- Painful muscles after the procedure (common)
- Nausea and vomiting when you wake up (common)
- Damage to teeth or cuts to lips (occasional)
- Difficulty with securing your airway and giving you breaths while you are asleep (uncommon)
- Acid from your stomach going into your lungs causing inflammation and infection (quite rare)
- Awareness or being awake during the procedure (uncommon)
- Severe allergic reaction (rare)

Pain Relief After Caesarian Section


Your Anaesthetist is in charge of making sure that you are comfortable after the operation. The following pain killers are usually given (unless you have an allergy to them of course!).


- Paracetamol regularly every six hours (intravenous, oral or suppositories)
- Diclofenac (Voltaren) regularly (intravenous, oral or suppositories)
- Morphine Patient Controlled Pump. This is attached to your intravenous line. You will be able to give yourself a small dose of morphine any time you need it. The Anaesthetic Nurse will show you how to use it when you are in the Recovery Area. It is safe for breastfeeding mothers too. It is not possible to give yourself an overdose if you are the ONLY ONE using this machine.


The midwives in the ward will be monitoring you to make sure you do not get any complications, which are: nausea, vomiting, feeling sleepy, itching or low blood pressure. If the complications occur, the midwives on the ward will be able to treat you, or call the Anaesthetic doctor to see you if needed.

We hope that you have found this reading useful in your preparation for your delivery! Feel free to ask to speak to the Anaesthetist when you are admitted to hospital to give birth 🙂

What is general anaesthesia?

A general anaesthetic ensures that your child is fully asleep and free from any sensation during an operation. It consists of a combination of medications given either as a gas to breathe or as an injection. General anaesthetics are only given by anaesthetists.

Anaesthetists are specialist doctors who look after children before, during and after an operation. Their job is to ensure that children are 'asleep' ,safe and pain-free throughout the test or operation and wake up comfortably at the end.

Why do I need to see an anaesthetist?

Your child will be assessed at the Pre-Operative Assessment Clinic (POAC) where an anaesthetist is present to discuss the anaesthetic plan. This will include the type of anaesthesia, pain relief plan and any required tests prior to the operation

An anaesthetist will also see you on the ward on the day of the operation to assess your child's general health and to discuss the anaesthetic.

The anaesthetist will ask you if your child has had an anaesthetic previously and whether he or she has any allergies. They will also discuss options for anaesthesia and pain relief medication, and whether your child would benefit from taking a pre-medication (pre-med) which can help ease anxiety. This may include use of suppositories for pain relief or a special injection of local anaesthetic during or after the operation.

You will also be asked whether your child was unwell in the past two weeks (cough, fever, on antibiotics) and may possibly be examined by the anaesthetist prior to the operaton, to ensure maximum safety for your child.

Why should my child not eat or drink before having an anaesthetic?

It is important that your child's stomach is as empty as possible as this reduces the risk of vomiting during and after the test or operation. This will be explained at POAC and in your admission letter.

The guidelines for fasting prior to an operation are shown here. Please discuss with your doctor/nurse if you’re in doubt or not sure.

Ingested Material Minimum Fast
Clear liquids (eg water) 2 hours
Breast milk 4 hours
Light meal, infant formula, other milk 6 hours

What happens in the operating theatre?

Now you will be accompanied from the ward to the operating theatre.Your child will either have an anaesthetic gas to breathe or an injection. When you meet the anaesthetist, they will tell you and your child the options for the anaesthetic and the best option in your case. There is a general tendency in Malta to think of the gas as the only option for anaesthesia in children. Each option has its own benefits.

If the choice is an injection, your child might have some numbing cream applied to his/her wrists or hands. The cannula (little plastic tube from which anaesthetic is given) will be placed here. We are very good at this and we’ll do our best to make it as smooth an experience as possible. Once the cannula is in place the anaesthetic will be given through it. The effect is very rapid

If the choice is the mask, we’ll explain to you and your child how we’ll be holding the mask and that they will soon smell a funny smell (the anaesthetic). The anaesthetist will explain everything to you before and during the procedure. It will take a couple of minutes for the anaesthetic to start working. It’s common for children to become restless during this time. We will help you hold your child gently but firmly.

Younger children may sit on your lap. Older kids will have their anaesthetic whilst on the hospital trolley. They can bring a toy down with them if they wish

The anaesthetist will closely monitor your child's blood pressure, pulse, temperature and breathing throughout the test or operation, ensuring that they are safe and fully asleep. When the test or operation is finished, your child will be transferred to the recovery room. This is a large room in the operating theatre suite where your child wakes up from the anaesthetic. A nurse closely looks after each child until they are fully awake and comfortable enough to return to the ward.

Can I stay with my child?

One parent or guardian is very welcome to come to the anaesthetic room and you will be able to stay until your child is asleep. Once they are asleep, you will return to the ward with the ward nurse.

Distress on waking

Some children show some signs of confusion and/or distress when they wake up. This is more likely in younger children. A few children become very agitated. They may cry and roll about or wave their arms and legs.

The recovery room nurses are experienced at looking after children at this time. They will consider whether more pain relief will help. If a child wakes in distress, this is naturally worrying to parents and carers. The nurses and your anaesthetist will advise you on how best to comfort and reassure your child.

How safe is anaesthesia? Are there any after-effects?

The degree of risk will depend on your child’s medical condition and the nature of surgery for which anaesthesia is being provided. You will be able to discuss this with an anaesthetist before surgery but the following is a general overview of side effects and potential complications of anaesthesia.

Most children recover quickly and are soon back to their usual activities after an anaesthetic. Some children may get side effects - however, these are usually mild. Headaches, nausea (feeling sick, sometimes with vomiting) and a sore throat are common but can usually be treated effectively.

Other side effects generally just need time to wear off and include tiredness, dizziness, and disorientation on waking, which can be distressing both for children and for their parents. Some children may also have disturbed sleep patterns for a few days after an operation.

More serious problems are uncommon but include a minor cut lip, damage to teeth, an allergic or other reaction to a drug, and breathing difficulties either during or after an anaesthetic. People often worry about the risk of awareness during anaesthesia but fortunately this is very rare. When it does happen, it tends to be awareness of sounds only, and in children does not seem to be associated with subsequent psychological problems.

Risks cannot be removed completely but modern equipment, training and drugs have continued to make anaesthesia safer. An anaesthetist will be with your child throughout their anaesthetic to monitor their progress and to help them to wake up as comfortable as possible.

Other procedures that an anaesthetist may perform for your child – such as insertion of an arterial line, central venous line, or epidural – will have their own specific side effects and risks of complication. You will have a chance to discuss the plan for anaesthesia, its risks and how they relate to your child with an anaesthetist before surgery.

Useful Links

Below is a link to the Official Website for the Association of Anaesthetists of Great Britain and Ireland. Here you will find useful information, similar to the above, as well as material to help explain the anaesthetic and the operation to your child

Click here

And here is a link to a cartoon you can watch together explaining the experience you’ll go through, from the moment you step into the hospital

Click here

 

References

AAGBI Official website

Great Ormond Street Hospital Guidelines

University Hospitals Bristol NHS Foundation Trust

Mater Dei Hospital Malta Guidelines