Anesthesia for pediatric cancer patients: What parents should know

Throughout cancer treatment, patients may undergo anesthesia for a variety of reasons. Surgery may be the most obvious, but patients may also need anesthesia when they have a port placed, receive a biopsy or even undergo diagnostic imaging tests like MRI or CT scans.  

But what happens when a child or young adult needs anesthesia? 

“Kids aren’t just small adults,” says pediatric anesthesiologist Vivian Porche, M.D. “They’re unique patients with unique needs.”

As a pediatric anesthesiologist, Porche has special training and years of experience treating children and young adults. She knows what makes treating these patients different. 

Here, she answers four common questions parents often have before their children undergo anesthesia.

1. What type of anesthesia is used for pediatric patients?

The type of anesthesia your child receives depends on several factors, including their age, diagnosis and the procedure they’ll be receiving. There are three main types of anesthesia:

• Local anesthesia stops pain in a specific area while patients are still awake and alert. “When you go to the dentist and receive numbing medication in your mouth, that’s local anesthesia,” Porche says. 

• Regional anesthesia numbs a much larger area, like the abdomen or an entire limb. Epidural anesthesia, which is sometimes given during childbirth, is a form of regional anesthesia.   

• General anesthesia puts patients to sleep during their treatment to make sure they’re not in pain or able to move. This is used for certain surgeries and other procedures that require patients to be completely still for a long period. 

Anesthesia can affect your child’s ability to breathe on their own, so they may be intubated during treatment. 

“When you’re awake, you naturally take deep breaths periodically to keep your lungs and airway strong,” Porche says. “But when you’re sedated, your care team may have to do that for you.” 

During this process, an anesthesiologist will place a tube into your child’s airway to keep oxygen flowing through the lungs and other vital organs. 

This is particularly important for pediatric patients who breathe more quickly than adults and whose airways are shaped differently.  

“Infants and children have a much higher larynx than adults, so intubating them requires skill and experience,” Porche says. 

Parents should seek care from a cancer center with experience treating and sedating pediatric patients for the safest treatment, she adds. 

2. Can I be with my child while they are sedated? 

At MD Anderson, a parent or caregiver is usually allowed to be with the patient until the procedure starts. From there, your child will be under the care of the anesthesiologist and a certified registered nurse anesthetist (CRNA) throughout the procedure. These trained experts monitor all vital functions and make sure the patient is OK throughout the treatment. 

Letting your child go to a procedure can be scary for both of you. As a mom and a physician, Porche tries to talk to patients the way she’d talk to her own kids. “I tell them they’re going to have some medicine that will help them take a nap so we can fix their boo-boo or something like that,” Porche says. “I’ll sing to them or stroke their hair to make them comfortable.” 

For children with high anxiety, Porche says there are other ways to help ease the transition into sedation. “We may give children a small dose of relaxation medicine to calm them down before receiving an IV or give them laughing gas to take the edge off,” she adds. 

3. What are the potential side effects of anesthesia in children?

The main side effect patients experience after anesthesia is grogginess. Your child may wake up feeling slightly disoriented and tired. Porche says this is normal. 

If a patient is intubated, they may have a sore throat or scratchy voice for a few hours or days after treatment. In rare cases, anesthesia can cause nausea, dizziness and an abnormal heart rate.  

Some studies show that repeated anesthesia for patients under age 3 can cause long-term effects on the brain, so Porche says young patients should only receive enough medicine to keep them comfortable during treatment. 

Talk to your child’s care team if you have concerns about side effects.  

4. How long will it take my child to wake up after undergoing anesthesia? 

The longer a patient is under anesthesia, the longer it may take them to wake up. It’s best to let children wake up on their own to avoid a negative experience.  

Parents and caregivers are usually allowed to see their child in the recovery area as they start waking up, Porche says. 

Patients sometimes have what’s called “emergence delirium,” which is an extreme state of confusion upon waking up from anesthesia. Children may scream, cry or become extremely agitated. Try not to worry, Porche says. This is very common, and they will generally calm down when the medicine has cleared their system.  

Depending on the treatment, your child may be given something to eat or drink shortly after waking up. Encourage them to follow their care team’s recommendations to achieve the best results from their procedure. 

“There’s no one-size-fits-all approach to pediatric anesthesia,” Porche says. “We tailor everything we do to each patient.” 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.