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More Information about Anesthesia Services

Your team

Your child’s anesthesia care team will include an attending anesthesiologist and either a nurse anesthetist, a pediatric anesthesia fellow or a senior anesthesia resident.

Your first contact with an anesthesia provider will typically take place on the day of surgery. Once you have been admitted to Children’s Hospital and brought to a pre-operative holding room, the anesthesia team will meet with you and your child. The anesthesia team will have already had access to your medical records via Vanderbilt’s computerized system but will need to confirm and clarify any necessary details. Afterward, we will formulate an anesthetic plan and discuss it with you.

What to expect

The anesthetic plan for the vast majority of our patients, including those having procedures in the operating room, cardiac catheterization lab or MRI scanner, will be a general anesthetic. Your child will be asleep for the entire procedure. (A small number of patients having catheterizations will not have general anesthesia).

There are two common ways of inducing general anesthesia. In most adults and children mature enough to accept IV placement, it will be an intravenous induction. This means that the anesthetic agents will be injected into the bloodstream through an IV and travel to the brain where they cause the anesthetic state. The other way of inducing general anesthesia is via an inhalation (mask) approach. Anesthetic gases are inhaled through the mask into the lungs, absorbed into the blood, and travel to the brain causing an anesthetized state. This route is most often used when a child is very young.

For patients with an IV, a sedative dose is often given in the holding room. If an IV has not been started, children who are anxious about being separated from their parents will often receive a dose of sedating medicine. This can be given by mouth (most common), nose, or injection (if a child refuses to take the oral/nasal dose). Once appropriately relaxed, the patient is then brought to the operating room where basic monitors, such as a blood pressure cuff and pulse oximeter, are placed.

Once monitors are in place, anesthesia is induced. After the patient falls asleep, an IV will be started if not already in place. The anesthesia providers will supply breathing support for the patient, initially through a face mask followed by a breathing tube.

The team will place any intravenous catheters, arterial line catheters, central venous catheters, and a bladder catheter after the breathing tube. The patient will then be prepped for surgery.

Monitored anesthesia care (MAC)

As previously mentioned, some situations in the cardiac catheterization laboratory may require that patients undergo procedures while not under general anesthesia. This would generally only happen with older patients, such as teenagers. These cases feature monitored anesthesia care (MAC). The patient receives intravenous medications for sedation and relaxation, but not general anesthesia that causes sleep. The goal with MAC is to keep the patient comfortable and breathing on their own.

The cardiologist will use local anesthetics (Novocaine-like medications) to numb any part of the body where a catheter will be placed or an incision made.

The advantages of MAC for the patient are a quicker recovery from sedation and avoidance of side effects such as sore throat or hoarseness from a breathing tube and less nausea.

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