Monday, February 23, 2009

Surgery Concerns for Children

My son recently had to have a cavity filled at the dentist's office and was given Versed in order to alleviate his fear of the big needle they used to numb the area they worked on.

He had this procedure done once before and it was a strange experience that I was hoping we wouldn't have to go through again. The effects of Versed are similar to those of alcohol. We were told that our son would be unbalanced, perhaps say strange things and become very sleepy afterward.

His dad dropped him off after the procedure and I had to carry him inside since he couldn't walk. His legs were like rubber. Once we got inside, he asked me if he could go to sleep. Obviously, this is not like him at all, since he's an average 5-year-old with an abundance of energy that keeps him wanting to be active and move all the time.

I had the opportunity to ask an expert about Versed and other issues surrounding anesthesia since I was introduced to the book, Before the Scalpel, by Dr. Dhar.

Author Panchali Dhar, MD, is an Assistant Professor of Clinical Anesthesiology and Anesthesiologist at New York-Presbyterian Hospital/Weill Cornell Medical Center and is board-certified in Internal Medicine and Anesthesiology. She has demystified the process and terms associated with anesthesia and arranged the information in an easy to understand topic-by-topic sourcebook. In Before the Scalpel, Dr. Dhar takes readers into the complicated, fascinating, cutting-edge world of anesthesia.

Here is a brief interview with Dr. Dhar based on questions that many parents have about anesthesia:

1) Do patients really have options when it comes to anesthesia? How much of their choices depend on the insurance coverage they carry?

Certain surgeries do allow anesthetic options. For example, a face lift can be done under deep sedation with local anesthesia or under general anesthesia. A hernia repair can be done under deep sedation with local anesthesia, a spinal, an epidural of under general anesthesia. The right anesthetic is tailored between you, doctors and pertinent surgical issues (such as time length of surgery).

At no point does the type of insurance dictate the anesthetic choice. Every patient is treated equally regardless of insurance or social situation. That is what being a doctor is all about.

2) For moms (like me) who underwent a C-Section, I've always wondered if my child was affected in any way from the anesthesia administered or if there are any risks associated with this?

Regional anesthesia is the most popular form of anesthesia offered to women in labor. It allows a woman to enjoy her labor pain free. Spinal and epidural anesthetics are safe and are provided to thousands of women throughout the world. The amount of medication placed through spinals and epidurals is just enough to make mom comfortable. These medications are targeted to nerves around the spinal cord, and almost zero crosses over to the blood stream. The baby does not get affected. The nice thing about epidural is that if a C-section is necessary, additional medication can provide for a stronger anesthetic level.

Sometimes it is not possible to provide regional anesthesia. This is usually due to technical reasons, emergency situations or various medical reasons. The safety of the mother is always a priority for the anesthesiologist. Some situations require a general anesthetic where the mother is put out completely. The dose of general anesthetic is kept to a minimum until the baby is delivered. Again, thousands of healthy babies are born through C- section under general anesthesia. Not to worry. There are no long lasting effects on the baby.

3) Parents don't want to think about the worst case scenario (their child needing an emergency surgery) but what is the number 1 thing we should know "just in case" this should happen?

If your child should need surgery, make sure the anesthesiologist is particularly trained in "pediatric anesthesia". Children are not miniature adults. The organs such as the heart, lungs, and kidneys don't function at adult levels until the age of 5! Precise medication dosing is based on the exact body weight. All equipment is downsized to miniature levels for the tiniest of newborns.

4) What risks are known about the sedative Versed, provided for children during dental procedures, and what is the difference between these liquid sedatives and a local anesthesia?

Sedative drugs such as Versed are basically short acting Valium type drugs. They make you sleepy, decrease anxiety, and block memory formation. In children under sedatives, monitoring the oxygen level and breathing are important for obvious reasons. Liquid sedatives do not block pain at the site of the dental procedure. A local anesthetic still has to be injected at the site of surgery. The sedatives simply allow the patient to be more accepting of that gigantic needle yet to come.

For details on surgery concerns for children, check out this video:

In Before the Scalpel: What Everyone Should Know About Anesthesia, Dr. Dhar walks readers through the various steps that ensure a safe and pain-free experience during medical procedures that may require or benefit from anesthesia. Before the Scalpel is formatted and illustrated for quick and easy reference in an interactive manner. This is a take-along-book to the doctor’s office, with outlines and room to make notations. Each chapter is a mini crash course for any person who is concerned about the anesthesia aspect of surgery.

1 comment:

Nikki Leigh said...

Good Monday Morning Sondra

Thank you very much for sharing this important information with your blog readers. The information in the book that was relevant to children was info that I really wanted to get out to parents - and that is just one of the subjects that Dr Dhar discusses in the book. I appreciate your help in telling people about this valuable resource.

Nikki Leigh