Department of Anaesthesia at The Children's Hospital at Westmead
Secretary: Lisa Meehan
Phone: (02) 9845 2367
Fax: (02) 9845 3959
Email: Lisa Meehan
Location: Operating Suite, Main building, Level 3
The Department of Anaesthesia at The Children's Hospital at Westmead provides care for more than 14,000 children per year, staffed by 35 paediatric specialist anaesthetists and senior anaesthetic trainees. We provide a world-class service, ensuring your child is receiving care of the highest quality.
- Anaesthesia for elective and emergency surgery in the operating suite and day surgery unit
- Anaesthesia for medical imaging (MRI, CT and interventional radiology) and in the Oncology Treatment Centre
- 24-hour acute pain management service, including daily acute pain rounds and consultation for difficult acute and chronic pain problems
- Support to the Burns Unit for provision of sedation and general anaesthesia for burns dressing changes, wound debridement and skin grafting
- Pre-admission clinics for more complex paediatric patients
- Emergency resuscitation services throughout the Hospital
- Consultation service for difficult peripheral and central venous access
- Liver transplant service
- Malignant hyperthermia (MH) testing unit for NSW and QLD
Acute pain service
The Department of Anaesthesia and the Department of Pain Medicine work closely together running a 24-hour acute pain service. The service includes daily ward rounds by a multidisciplinary team. The pain team guides the ongoing pain management of children after surgery to ensure they are as comfortable as possible. They also help care for children with other acute complex pain issues. The acute pain service can be involved in a patient’s care at any time, day or night.
See Pain Medicine for more information.
Preparing your child for anaesthesia
What is an anaesthetist?
An anaesthetist is a medically trained doctor who has done extra training in anaesthesia and perioperative medicine. The anaesthetist’s main job is to ensure your child is kept comfortable and safe during and after their procedure. For children, this often involves general anaesthesia, a bit like having a deep and controlled sleep. All of our paediatric anaesthetists have done extra training with a special focus on looking after children.
We know that coming to hospital with your child for an operation is very stressful, especially if it is your first time. Hopefully having a little more information about what to expect can help with your anxiety so this information, as well as you asking questions are very important starting points. There is no doubt that children pick up on any anxiety from their parents. So if we can answer any of your concerns, we can all work on making sure your child’s hospital experience is as good as possible.
What to tell your child and when to prepare them
It is important to prepare your child before coming to hospital. Children should be given some information a few days beforehand at a level suitable for their age and understanding. Children able to understand such things can be told:
- that they are going to hospital
- that they will be having an operation or procedure
- some basic information about what will happen to them in hospital and how long they will stay in hospital
It is important to be truthful and honest with your child and encourage him or her to ask questions. Storybooks and games are also available for sale at the Kids Health bookshop, which can helpful.
Sometimes it is tempting to think it might be easier not to mention too much to your child because you don’t want to worry them. Our experience is that most times your child will already be wondering what is going to happen. Your child is likely to want some information because, like most of us, they like to prepare themselves for what’s coming up.
It is important for anyone having an anaesthetic to have an empty stomach. If your child has food or excess liquid in his or her stomach when anaesthetised, there is a risk it could end up in the lungs. All children, even small babies, need to be fasted appropriately before having an anaesthetic. If you are coming in from home, a nurse will phone you the day before the procedure to give you your child’s fasting times.
Generally, your child CANNOT have any
- food or milk (including formula milk) within six hours of the anaesthetic
- water or clear juice within two hours of the anaesthetic
This means that your child can have a light meal six hours BEFORE the anaesthetic and can have a drink of clear fluids up to two hours before the anaesthetic.
Infants and babies that are fed with formula, need to have their last feed finished six hours BEFORE the anaesthetic. If your baby is breastfed, he or she can have a last feed finished four hours before the anaesthetic. If your child is not fasted appropriately the procedure may be delayed or even cancelled. This is for their safety.
Preoperative visit and meeting your anaesthetist
There are a few different occasions where you might first meet a member of the anaesthetic team:
- If you are coming in on the day of surgery, you will see your anaesthetist in Middleton Ward before the operation
- If your child is already an inpatient, you may see the anaesthetist on the day of surgery or the day before surgery on the ward
- Some children who are having bigger operations or have other medical issues may be seen in the pre-admission clinic before the planned date for the operation - you might not see your child’s actual anaesthetist at the clinic, but you will see one of the anaesthetists who will be able to pass on your child’s information
This is a chance for the anaesthetist to get to know all about your child and share some information about the anaesthetic and what to expect. It is a good chance to ask lots of questions or discuss any particular concerns. All our anaesthetists are very friendly and are more than happy to spend the time you and your child need on this.
Your anaesthetist will ask you about:
- your child’s medical history
- whether your child has had anaesthetics before
- any family history of problems with anaesthetics
- any recent illnesses including coughs or colds
- any allergies
- any regular medications
- any loose teeth
Premedication (a premed) is the name for medicine that is sometimes given before an anaesthetic. Not all children need a premed. Some examples of premeds are:
- Sedatives - if your child is very anxious, they might find it helpful to have something first that makes them feel more relaxed (this is usually given by mouth as a liquid)
- Pain medication – paracetamol (eg Panadol, Dymadon) is commonly given and will help with pain after the procedure
- Local anaesthetic cream – for some children, the start of the anaesthetic involves a cannula (needle) first (local anaesthetic cream is used to make the skin numb so that this needle doesn’t hurt)
Please continue with your child’s regular medications and puffers as per usual on the day of the procedure, unless you are told otherwise by a nurse or doctor. Oral medication can be taken before the procedure with a little water, if necessary.
You are welcome to bring your child’s favourite toy or comfort object into the anaesthetic room while they are going to sleep. This will help to reduce your child’s anxiety.
Parents in the anaesthetic room
The anaesthetic room is the room where your child will go to sleep for the procedure, next to the operating theatre where the procedure will take place. In most cases, we encourage parents to accompany their child into the anaesthetic room as having them there is a great comfort to the child. In certain cases, such as in emergency surgery or in babies under six months of age, we do not allow parents into the anaesthetic room so that we can focus completely on your child. It is up to your anaesthetist on the day of the procedure to decide if you can accompany your child or not.
The anaesthetic process
We often refer to general anaesthesia as being a bit like when you go to sleep. It is different though, because it is a deeper sleep and it is more controlled. Your child will also be monitored continuously by at least one anaesthetist.
There are two main ways that children can be anaesthetised. The first way is via a mask and the second is via a cannula (needle). Infants and small children generally tend to be anaesthetised by breathing in gas with a mask. When this happens, your child will either be on your lap or on the bed.
Usually the anaesthetist starts with some laughing gas, but after a while a slightly smelly gas is added. The smell is a bit like strong 'texta' or marking pen smell. The anaesthetic team might try a variety of tricks and techniques to make this a relaxed experience for you and your child. Some children, especially very young ones, do not like the mask or smell of the gas and may need to be held down gently when going off to sleep.
Older children have the choice of either the gas or an injection. If an injection is used, numbing cream is usually used for the site of the injection first. This can be discussed with your anaesthetist. Although the needle may take a few moments, going off to sleep is very quick once the medicine has been injected.
As children go off to sleep, it is very common for them to wriggle around, roll their eyes back, have noisy breathing and become very floppy. This is all normal and expected. Once your child is asleep, a volunteer or nurse will take you back to the waiting area while the team gets on with looking after your child.
Once your child is asleep, if they went to sleep with the mask, they will have a cannula placed in a vein, usually on their arm or foot. Through this your child can be given fluids, pain-killers and sometimes anti-sickness medication. During the entire procedure your anaesthetist will be with your child, making sure they are kept fast asleep and wake up after the procedure as comfortable as possible.
Regional anaesthesia is the injecting of local anaesthetic around nerves, numbing certain areas of the body. This is done under general anaesthetic and helps your child with pain relief, both during and after the procedure.
The main types of regional anaesthesia are:
- Epidural anaesthesia
An epidural is an injection between the spine bones (vertebrae) and a thin plastic tube (catheter) is left in the space near the spine. Local anaesthetic is given through this catheter and bathes the nerves of the spine. This leads to an area of numbness over the operation site (epidural block). Epidurals are usually used for bigger, more painful operations and tend to stay in place for around three days. Epidurals are used very commonly in children and are safe and very effective forms of pain relief.
- Caudal anaesthesia
A caudal is very similar to an epidural. The injection is at the base of the spine and a single injection of local anaesthetic is used. Catheters are not usually left in place. The caudal block usually last around six to eight hours.
- Nerve block
Local anaesthetic is injected around a specific nerve(s) of the body and numbs that nerve(s). Most anaesthetists will use ultrasound or a special nerve stimulator to find the nerve. Nerve blocks are used commonly for leg, arm and penis surgery and will give your child numbness over the operation site for six to 12 hours.
- Local anaesthetic infiltration
Surgeons inject local anaesthetic into the wound at the end of the operation that numbs the skin. This numbness lasts two to four hours.
After the procedure, your child will either be taken to Middleton Recovery (if you are going home that day) or to Todman Recovery (if you are staying in hospital that night). The nurses will point out where they are.
When your child first arrives in the recovery room, they are likely to still be waking up from their anaesthetic. At this stage, they need careful observation and care. This is done by a specialist recovery nurse who will also look after any further needs for pain medicine or medicine to deal with any nausea or vomiting.
As soon as your child starts waking up a bit more, the nursing staff will find you and bring you to your child as they continue to recover from the anaesthetic. Only two family members per child are allowed into the recovery room.
Some children wake up distressed even if they were calm going off to sleep. This is most common in preschool children, those who have had multiple previous procedures, and where the child or parent is very anxious. Most distress is due to waking up in an unfamiliar place and will settle with parental reassurance. Most children remain in the recovery room for 30 minutes to one hour before either going to the ward or going to the discharge lounge.
Pain relieving medication (analgesics) is given during the procedure to ensure your child is as comfortable as possible afterwards. The type and strength of pain relief given depends on the procedure.
For minor surgery, paracetamol (eg Panadol, Dymadon) and ibuprofen (eg Nurofen) are usually adequate to control pain postoperatively. Your anaesthetist and recovery nurse will discuss this with you.
For major surgery, your child may be given a patient controlled analgesia (PCA) or nurse controlled analgesia (NCA). These are pumps filled with strong pain relieving medication such as morphine. Older children can control their own pain relief by using a PCA - pushing a button themselves to control pain relief. Younger children will need to use a NCA - where a nurse to pushes the button for them. Children with a PCA, NCA or epidural will be seen daily by the acute pain service, who will continue to manage their pain relief on the ward.
Eating and drinking after an operation
Once your child is awake and feeling well enough, they will be given a drink or ice block in recovery. It is important not to give your child too much food too soon after the anaesthetic as this may lead to vomiting. Your nurse will advise you further. Some children who are staying in hospital may need to be kept ‘nil by mouth’ after the operation. This depends on the type of surgery.
Daystay patients will need to remain in the Middleton ward for at least two hours before they can go home. Some children may stay longer if they are feeling sick or need more pain medication.
Children who are to stay in the hospital overnight will return to the ward after the procedure and discharge from hospital is dependent on their surgical team.
Click here for fact sheets on Procedures and Tests.
Before you visit the Hospital, take the virtual tour.
Risks of anaesthesia
Complications and side effects
All medical procedures, including anaesthesia, have a small risk of complications and side effects. Current data has shown that Australian and New Zealand anaesthetists are amongst the leaders in the world for anaesthetic safety in children.
Fortunately, the risk of major disability or death in a child after anaesthesia is extremely low. Children that are otherwise healthy having a routine procedure have a very low risk of any complication both during and after the procedure (related to the anaesthetic). A factsheet on the risks of anaesthesia in infants is available here.
Some complications include:
- Chest infection from vomit coming up from the stomach and going into the lungs (one in 5,000 children). This is the reason why fasting is so important.
- Serious allergic reaction to one of the medications given (one in 20,000 children)
- Postoperative pain
Pain after surgery varies greatly from child to child. Children that wake up with pain usually settle quickly after receiving more pain medication. This is either given through their drip or as a syrup. Many children are given paracetamol as a premed to help with pain when they wake up.
- Nausea and vomiting
Nausea and vomiting affect about one in every 10 children undergoing anaesthesia and this usually settles quite quickly. There is a greater risk if your child has a history of sickness with anaesthesia or motion sickness. Some types of surgery such as eye surgery or ear, nose and throat surgery increase the risk of nausea. Your anaesthetist will be aware of this and give your child medication to try prevent this.
- Sore throat
A sore throat and hoarse voice may be caused by the breathing tube used as part of the anaesthetic. This can last for a day or two.
- Skin bruising
Inserting cannulas into children can be difficult, even in experienced hands. Several attempts may be required, particularly in babies and toddlers. Bruising at the sites of insertion may occur but will fade quickly.
- Regional anaesthetic blocks
Regional anaesthesia numbs the skin and muscles to a certain part of the body that has been operated on. Some children dislike the numb feeling or the weakness with the block. Most blocks work very well, however some not as well. If this is the case, additional pain medication will be added. Serious complications such as nerve damage, bleeding and infection are very, very rare. These can be discussed with your anaesthetist.
- Behavioural changes
Some children have temporary behavioural changes after being in hospital such as clinginess, fear of strangers or bedwetting. These usually settle in a short time.
If you have any questions or worries about the anaesthetic, please feel free to discuss them with your friendly anaesthetist.
Malignant hyperthermia clinic
Malignant hyperthermia is a rare inherited condition of muscles that only becomes apparent on exposure to many of the commonly used general anaesthetic agents. Children with a family history of maignant hypothermia or who have had an adverse reaction to general anaesthesia (that is thought to be related to this condition) will be assessed at the clinic.
See Malignant Hyperthermia Clinic for more information.
We undertake research in a number of areas related to anaesthesia and patient care. This includes pain management, pre-hospital trauma management, malignant hyperthermia, cardiovascular monitoring in theatre and monitoring of the brain during anaesthesia and intensive care. The Department supports the training of medical students in research activities and assists other departments in multidisciplinary research activities.
Training of anaesthetists in paediatric anaesthesia is one of the many important aspects of our work. Each year, over 30 registrars and five senior registrars (Fellows) rotate through the Department for training in paediatric anaesthesia.
The Fellowship year is undertaken by anaesthetists with strong interests in continuing in paediatric anaesthesia once qualified, and includes doctors from around the world. More information on training and working in our Department can be found here.
Continued medical education of doctors is crucial to maintenance of skills and awareness of current best practices. The Department’s members support several Continuing Medical Education (CME) programmes with talks, workshops and articles, aimed at improving knowledge of paediatric anaesthesia. Several members are active in the Australian and New Zealand College of Anaesthetists examinations process and other professional organisations including Society for Paediatric Anaesthesia in New Zealand and Australia and Advanced Paediatric Life Support.
The Department of Anaesthesia has a long history of providing assistance to less well-developed countries including Fiji, Papua New Guinea, Vanuatu, East Timor, Rwanda, Cambodia, Burma and India. This includes being part of volunteer surgical teams treating congenital heart disease and other childhood conditions, as well as educating anaesthetists from around the world.
- Ramanie Jayaweera - Joint Departmnet Head
- Andrew Weatherall - Joint Department Head
- Sarah Johnston - Deputy Head
- Jonathan De Lima -Pain service and research
- Jenny Chien - Supervisor of Training
- Sally Wharton -Supervisor of Training
- Justin Skowno - Research
- Stephanie Aplin
- Marianne Chan
- Michael Cooper
- Winnie Fung
- Peter Gibson
- Donald Hannah
- Susan Hale
- Hillel Hope
- Donald Innes
- David Kinchington
- Mark Lovell
- James MacDonald
- Ian Miles
- Michele O’Brien
- Kate Pennington
- Margaret Perry
- Lian Pfitzner
- Stuart Ross
- Andrea Santoro
- Kristen Schwager
- Rasa Venclovas
- Freda Vosdoganis
- Sue-May Koh
- Helen McPhee
- Jeeves Perera
- Gail Wong
- Janet Loughran
- Lucy Kelly
- Pavithra Pasupathy
- Tony Sousalis
- Victor Chan
- Katherine Lanigan
- Renee Burton
- Robyn Maina
- Caroline Mann