What is anesthesia
Anaesthesia is a loss of sensation, especially pain. Local anesthetic It numbs only a local part of the body. The man in the body does not feel pain, but remains active and aware of what is happening.
When you use general anesthetic the person is unconscious,unable to breathe and move, does not feel pain. To provide the necessary oxygen to support life level, it is necessary to supply air through the tube through the larynx into the trachea. The tube in the trachea remains throughout the operation and at the end it is removed before the patient awakening.
The surgeon or a member of the medical team shouldYou explain what actions and procedures planned. You will be asked to sign a formal consent form. You should ask questions if you do not fully understand what the consent. If your child is able to understand the meaning of the procedure or surgery, it may also be asked to sign the same form.
In most cases, children with Hunter syndromenecessary to operate in a large hospital with an experienced pediatric anesthesiologist. For many surgical procedures, it is important to choose the anesthesiologist before selecting a surgeon. It is essential that the anesthesiologist examined a child with Hunter syndrome in advance. The fact that the child might die during the operation, if the anesthetist does not take into account the peculiarities of Hunter syndrome. First, it is unusual (paradoxical) reaction to pain medication (anesthetics), and secondly, there is a great risk of suffocation due to airway features narrowed due to deposition of mucopolysaccharides.
In order to avoid possible complications from the use ofanesthesia in children with Hunter syndrome, you and your child's physician should conduct pre-operative examination and assessment of the impact of anesthetic action plan in case of unforeseen circumstances. To assess the degree of risk of potential problems during anesthesia, you need to consult a cardiologist and pulmonologist. Some children are afraid of injections, some can not tolerate the smell of gas. The anesthesiologist must find the best method of anesthesia for your child.
The anesthesiologist must visit your child before surgery / procedure and prescribe the necessary drugs to prepare the child for anesthetic.
Sometimes parents accompany the child to the operating room and remain there until he falls asleep. If you feel that it will help your child, you should discuss this with the anesthesiologist.
Preparation for surgery
Abstinence from food
You have to say that your child untilanesthetic nothing to eat or drink (usually 4-6 hours). The fact is that if a child's stomach is filled, during use of anesthesia there is a risk of emesis. Therefore, it is important to release the stomach before the operation.
Drug preparation for surgery - isdrugs that are given to a patient before the general anesthetic. They can menitsya depending on the age of the patient and type of surgery. Some drugs are given to help the child relax, to reduce moisture in the mouth and throat in order to increase the efficiency of the anesthetic to be given. The drugs are given by mouth (orally), intravenously or intramuscularly in the thigh or buttock.
If an anesthetic must be givenintravenously, special anesthetic cream one hour before the start of the main anesthetic can be applied at the site of needle insertion. It is important that the child felt the needle entry. Unfortunately, anesthetic cream is only effective on the skin and helps anesthesia by intramuscular administration.
Inform the medical team regardingthe level of development of your child and his problems with vision and hearing. Bring glasses and hearing aids, to help doctors communicate with your child. After training predmedikamentoznoy feeling of dryness in the mouth may occur in the operation of the child. Some children may be irritable. Some children can be an attack of weakness in the legs. Therefore, the child will be much more secure if he would lie in bed or sit with friends. If your baby falls asleep, it was best if he was lying on the bed or be maintained in a horizontal position, because if it remains in a vertical position, can lower the blood pressure.
Sometimes predmedikamentoznaya preparation for the babywith Hunter syndrome may have the opposite effect - the child will be very energetic and not lethargic. If this happened in the past, you need to tell the anesthesiologist about it. Tell also about the drug, which produced such an effect. Do not forget to do it - may depend on your child's life. If you do not accompany the child to the operating room, you should discuss with the nurse when you better see the child before surgery. This will avoid unnecessary anxiety. Remember that it is not necessary to disturb the child at the last minute before the operation.
Movement with the child into the operating room
The nurse always accompanies the child to the operating room. In some hospitals, children are allowed to bring along a favorite toy, doll or blanket, but will be much better if you take away that.
Before entering the operating room you will be asked to wearspetsailnuyu clothing and shoes. The anesthesiologist will explain the entire procedure to be used for your child. As mentioned earlier, sometimes with intravenous anesthetic child previously allow sleep or ask the child to breathe through the anesthetic mask. Anesthesia for young children can sometimes be done on the knee of one of the parents, while the tube with anesthetic gas will be maintained around his face. Once your child is asleep, you will be asked to leave. It is important to leave as soon as you are asked. The anesthesiologist must very quickly make a lot of things to ensure that your child is safely anesthetized.
When your child is in the operating room
At this time, many parents prefertake a walk or eat. If your child may require intensive postoperative therapy, you can ask the doctors to inspect cooked in the intensive care room in advance. Many operations last longer than planned, and children usually spend some time in the intensive care room to recover before returning to the general ward or discharged from the hospital. If you are worried, you can ask the nurse checked, making your child. In some hospitals, you will be allowed to visit the child is still in the intensive care room.
In general ward
After applying an anesthetic yourthe child may be sleepy or slabosoznatelnom be able to, but the sound of your voice will help him relax and sleep more deeply. The nurse will tell you when your child will be safe to drink something.
Problems of children with Hunter syndrome
Deposits of glycosaminoglycans (mucopolysaccharides)all tissues (eg nose, tonsils, adenoids, throat, trachea, heart), their effect on bone formation complicates the use of anesthesia. These deposits narrow the nasal passages, increase the tonsils, adenoids and tongue, and are the cause of free excess tissue formed around the larynx. These problems severely limit the examination of the larynx with the help of a laryngoscope (a medical device for the inspection of the pharynx). When relaxing the muscles in the predmedikamentoznoy training or general anesthesia increases the obstruction (degree of obstruction) of the respiratory tract. In addition, hard cervical spine when the spine is not strong enough not to allow the anesthesiologist to place the head and neck in a position to better examine the larynx. Limited movement of the jaw, a short neck and thick mucous difficult examination of the larynx even very skilled anesthesiologist. There are other factors that increase the risk of anesthesia - naprirmer, thick skin and contracture (painful muscle contraction with limited joint mobility) joints make it difficult intravenous access, especially in an emergency. Glycosaminoglycans deposits in the heart and blood vessels also contributes to an increased risk, but the risks associated with heart and blood vessels are much smaller in comparison to the problems of the respiratory tract.
What can be done?
Your child with Hunter syndrome increasedthe risk of anesthetic. Therefore safer to carry out the procedure in a large hospital, which has experience working with children with Hunter syndrome, even if you need to travel to another city or region. Your child may need to stay with a special tube inserted into the larynx and trachea, to breathing apparatus for some time after the operation. Thus, your child needs a hospital with increased pediatric care. Outpatient treatment is not suitable!
If you are worried about the proposed operation,discuss it with your pediatrician and geneticist. They can offer surveyed elsewhere. Anesthesia risks and benefits of surgery must be strictly weighed. Make sure that the anesthesiologist knows the status of your child and any problems. rejection of specific anesthetic drugs or the stabilization of the neck in patients with cervical spine problems patients - steps to make the process more secure can be taken. Local anesthesia can be selected for some procedures. If the patient has significant risks associated with anesthesia, it is often possible to determine before surgery. Can be useful survey pulmonologist and cardiologist. Pulmonologist may recommend a sleep study, and pulmonary function test. Pulmonologist can evaluate the anatomy of the respiratory tract using a flexible bronchoscope.
Since patients with Hunter syndrome areairway obstruction, which may lead to the impossibility of intubation, or other conventional methods. In this case, you can use alternative methods. To skip the breathing tube into the trachea at the beginning of the procedure the flexible bronchoscope can be used. Or you can use a laryngeal airway in combination with a flexible bronchoscope. However, these methods require that the anesthesiologist had the experience of their application.