Food and Drink
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All types of food (including cow's milk): Stop 6 hours before the estimated operation time
Breast milk (for newborns and infants): Stop 3 hours before the estimated operation time Clear fluids (water, dilute squash): Stop 1 hour before the estimated operation time |
Resources for families and young people
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Local Anaesthetic Cream
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There are two types of cream:
EMLA Cream: Slower in onset, needs to be on for two hours to have a full effect. Almost never produces any adverse skin reaction. Can be left on for as long as required, continues to be effective for up to 45 minutes after removal. Ametop Cream: Faster in onset, effective in 45-60 min. Commonly results in mild local skin reaction, but with no long term sequelae. Must be removed after 60 minutes, but continues to be effective for up to 45 minutes after removal. The cream will be covered with a clear dressing. If children massage the cream it does not matter, in fact it helps it to work more effectively. If some leaks out, again this does not matter, but don't let your child eat it or rub it into their eyes! If you find that most of the cream has been lost, please ask your nurse for more. Please explain to your child that the cream will take the sting away, but they will experience a sensation of pressure when I place the cannula. |
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Induction of anaesthesia
Anaesthetics are the drugs that are used to start and maintain anaesthesia. Some anaesthetics start with an injection into a vein. Other anaesthetics start with breathing a gas. I can tell you more about how the anaesthetic may be given at the pre-operative visit. I will also explain what other medicines can be given, such as pain relief medicines. I will ask you about your child’s previous experiences with anaesthetics or injections and will ask you and your child if you have a preference for how the anaesthetic is given. I will talk to you about which way he/she would prefer to start the anaesthetic. Sometimes there are medical reasons why things have to be done in a certain way. Nothing will happen unless you understand and agree with what has been planned. You will be able to raise any issues you have on the day of surgery or before.
Inhalational Induction
We will ask one of you to sit on a chair, next to the theatre trolley and hold your child on your lap. We usually prefer only one parent to accompany your child to theatre. When they feel safe and secure in your arms, I will come towards the face with the anaesthesia mask. Over a period of about one minute the child will gradually fall off to sleep. As your child drops off to sleep, my anaesthetic assistant will help you and we will lift them from your lap onto the theatre trolley. I will look after them from then onwards. As children are going off to sleep and just at the point that they are becoming unconscious, they may start to move vigorously. This is a normal, short-lived phase of anaesthesia- please don't worry. They are unaware of this movement. At this point you will be escorted back to the ward.
Intravenous Induction
This is the usual method used to begin anaesthesia in adults and is the method of choice for children older than 6 years. Some children as young as 4 years who have easy veins may be suitable for this method of induction. If your child is older than 6 years or if you have chosen this method of beginning anaesthesia please make sure that local anaesthetic cream is applied before the operation is due to start. When you arrive in the anaesthetic room the local anaesthetic cream will be removed. With your child either sitting on your lap or lying on the theatre bed, I will place a cannula into a vein. I usually suggest that you bring something to distract your child in the anaesthetic room (e.g. book, iPad) whilst I place the cannula.
Inhalational Induction
We will ask one of you to sit on a chair, next to the theatre trolley and hold your child on your lap. We usually prefer only one parent to accompany your child to theatre. When they feel safe and secure in your arms, I will come towards the face with the anaesthesia mask. Over a period of about one minute the child will gradually fall off to sleep. As your child drops off to sleep, my anaesthetic assistant will help you and we will lift them from your lap onto the theatre trolley. I will look after them from then onwards. As children are going off to sleep and just at the point that they are becoming unconscious, they may start to move vigorously. This is a normal, short-lived phase of anaesthesia- please don't worry. They are unaware of this movement. At this point you will be escorted back to the ward.
Intravenous Induction
This is the usual method used to begin anaesthesia in adults and is the method of choice for children older than 6 years. Some children as young as 4 years who have easy veins may be suitable for this method of induction. If your child is older than 6 years or if you have chosen this method of beginning anaesthesia please make sure that local anaesthetic cream is applied before the operation is due to start. When you arrive in the anaesthetic room the local anaesthetic cream will be removed. With your child either sitting on your lap or lying on the theatre bed, I will place a cannula into a vein. I usually suggest that you bring something to distract your child in the anaesthetic room (e.g. book, iPad) whilst I place the cannula.
Information for children, parents and carers
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Joint professional guidance on the use of general anaesthesia in young children
Association of Paediatric Anaesthetists, Royal College of Anaesthetists, Association of Anaesthetists
Executive summary
- Studies on immature animals have demonstrated that general anaesthetic agents can induce changes in the central nervous system. Some of these studies have also suggested longer-term effects on learning and memory tests.
- To date the results from both epidemiological studies and prospective trials in the human infant have failed to show adverse effects on cognitive development from a single anaesthetic episode of short duration (less than an hour). Data from longer exposures and multiple exposures to surgery and anaesthesia are difficult to interpret due to multiple confounding variables.
- Continuing to use reliable familiar techniques for paediatric anaesthesia is emphasised. There is no evidence of a particular anaesthetic technique being better than another in terms of influencing any potential long-term neurological effects in humans.
- Parents/carers enquiring about the neurological effects of anaesthesia in their infant should be advised that surgery is carried out in infants only when necessary and that there is no indication of a long-term neurological effect from a single anaesthesia exposure. They should be referred to the current advice to parents on the APAGBI website.
- We do not regard a discussion of the potential influence of infant anaesthesia on long term cognitive development as mandatory at every preoperative.
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Dr Sumit Das 2026