Your child will have repeated general anaesthetics during retinoblastoma treatment and follow up.
General anaesthetic is given for:
- EUA
- Surgery (e.g. central line insertion, enucleation).
- Painful procedures (e.g. lumbar puncture, bone marrow aspiration).
- Painless procedures that require laying still (e.g. MRI, radiotherapy).
Eating Restrictions
Eating before general anaesthetic can cause life-threatening complications. Your doctor or nurse will give you specific fasting instructions.
Clear fluids can be given up-to 2 hours before the anaesthetic. E.g. water, non-fizzy soft drinks, jelly, ice lollies and clear broth. Most hospitals consider breast milk a clear fluid, but some do not. Ask your doctor about this.
Following your doctor’s instructions about these restrictions is very important. The procedure may be cancelled or postponed if you feed or give drinks to your child during the fasting period.
Consultation
An anesthetist will visit you on the ward. He will examine your child’s heart rate, breathing and airway and ask questions to ensure she is well for general anaesthetic.
Use this time to ask questions and discuss any concerns you have about the anaesthetic. If your child has particular coping techniques to reduce anxiety, you should make the anaesthetist fully aware of these, and discuss any potential difficulties in their meeting these needs.
Questions to ask the anaesthetist include:
- What pre-anaesthetic and anaesthetic medications will be used?
- What are the side effects of these drugs?
- What method will be used to give the anaesthetic?
- What monitoring equipment will you use?
- How long will it take for the anaesthetic to wear off?
- Can I accompany my child during induction?
Pre-Medication
Some hospitals give pre-anesthetic medication to relax an anxious or upset child. Not all children need this, but if you feel your child may be anxious on procedure day, ask what “pre-meds” can be given to help her.
Induction
You may be allowed to accompany your child until she is asleep, and this can be very therapeutic. Some hospital policies do not allow this. Others leave the decision to individual doctors. Always ask if you can stay with your child.
General anaesthetic is given by mask or IV injection
Mask: is standard for babies and young children. The mask will be placed over your child’s mouth and nose, and she will be asked to take regular deep breaths to inhale the anaesthetic,
Injection: can be used if your child already has an IV or central line. Some children fear the mask and prefer an IV be inserted for this procedure.
If your child doesn’t already have one, an IV will be inserted once she is asleep, to give fluids or medications during the procedure.
Your child’s breathing and heart rate will be carefully monitored, and she may be intubated. This involves passing a flexible tube through her mouth into the throat. This tube will be removed when the procedure is complete.
After the Procedure
Your child will be taken to Recovery until she is fully awake. She may sleep for several hours after the procedure, but this is normal.
Some children are irritable, upset and confused on waking. This is normal, but certain drugs can cause or increase symptoms. Ask the anaesthetist about potential side effects.
Crying after general anaesthetic is normal and aids removal of residual anaesthetic, speeding up recovery. Your child is unlikely to be in pain on waking as painkillers are given during the procedure if it is potentially painful.
Intubation may cause your child’s throat to feel sore for a few days.
Children are often hungry, especially if the procedure was delayed. Give clear fluids like apple juice first. Babies can have breast milk as usual.
Your child will usually be allowed to leave once she is fully awake and has had something to drink and eat. Babies under two months old are often admitted overnight for routine monitoring
