All medical procedures including anaesthesia have a small risk of complications and side effects. Many of these risks cannot be predicted beforehand and can occur with skilled anaesthetists without any error or mistake in judgement or technique.
Minor side effects
Minor side effects from anaesthesia are quite common. Some of these are listed below. We don’t routinely list every possible side effect or complication of anaesthesia but aim to give you enough information to ask questions and make an informed choice about anaesthesia for your child.
Child distress
Some children can become uncooperative or combative, requiring restraint, as they are anaesthetised with a mask. Distress at the start of anaesthesia can be very upsetting for a parent. Parental assistance can be very useful in this situation.
IV insertion difficulties
Inserting an intravenous drip into children’s veins can be difficult even for experienced paediatric anaesthetists. Several attempts may be required, particularly in babies and toddlers. Bruising at the sites of injection may occur but will fade quickly.
Nausea and vomiting
This can occur in about one in ten children but generally stops within a day. The risk is much greater if the child has a history of vomiting with anaesthesia or motion sickness, or there is a strong family history of vomiting with anaesthesia. You should tell the anaesthetist about any of these. Some operations are more likely to cause your child to vomit after surgery.
Sore throat
Sore throat sometimes occurs after anaesthesia, most commonly due to a tube placed in the throat to allow breathing during surgery. This settles quickly after 24 hours.
Behavioural changes
Some children may develop transient postoperative sleep disturbances and behaviour changes such as difficulty/anxiety going to sleep, night terrors or vivid dreams. Bed-wetting has also been described. Occasionally these can take a few weeks to settle.
Pain after surgery
Pain after surgery varies greatly from child to child. Pain relief techniques need to be adjusted for each child to provide analgesia with safety. Occasionally the routine methods of pain relief will not provide complete analgesia.
Local anaesthetic block effects
Side effects from local anaesthetic blocks are uncommon. Some children dislike the numbness or weakness that happens with the block. If the block is unsuccessful another method of pain relief may be needed.
Major complications due to spinal or epidural block are extremely rare but include permanent nerve damage, epidural infection and convulsions due to local anaesthetic. You may wish to discuss these with your child’s anaesthetist.
Is there risk of serious complications?
Fortunately the risk of major disability or death in a child after anaesthesia is extremely low in Australia. The risk of a disastrous outcome in an otherwise healthy child having routine elective anaesthesia is very low. Death due to a complication of anaesthesia occurs very, very rarely.
Pneumonia
Pneumonia caused by food or fluid from the stomach entering the lungs is the most common major complication during anaesthesia in children. This occurs about once every 5,000 anaesthetics and can require intensive care treatment, usually with no long-term problems.
This is the reason that fasting your child is so important. Infants and children having emergency surgery are at most risk.
Allergic reactions
Allergic reactions to anaesthetic agents are extremely rare in children and most are reversible.
What about serious health conditions?
Major medical or surgical conditions in a child can increase risks, but this effect is usually small.
Unknown risks
There is some evidence that anesthetic agents may affect the developing brain in newborn animals. The significance of this in human babies and toddlers is unclear. Due to the theoretical risk, as a general rule, only essential or urgent surgery is performed on small babies. Parents should be encouraged to discuss the timing of planned procedures with their child’s doctor. A risk-benefit assessment regarding the age of the child, urgency and type of procedure versus the consequences of delaying surgery should be considered and applied to each child’s case before a decision is made.
More information can be found on the Smart Tots website (external site).