Ask the Expert: When Isn't Anesthesia Needed During Pediatric Medical Procedures?

Ask the Expert: When Isn't Anesthesia Needed During Pediatric Medical Procedures?


Medical procedures, scary and stressful for pediatric patients, often require anesthesia to help children relax and remain still. However, sedatives are not always necessary. Kelly Wagner, child life specialist at MD Anderson Proton Therapy Center in Houston, shares when anesthesia isn't necessary and how to prepare children for and keep them calm during medical procedures.

In what medical procedures is anesthesia not necessary?

From a child life specialist’s perspective, non-sedation can be considered for least invasive procedures when anesthesia is not medically necessary, such as five-minute CT scans, some bone scans, or repeat MRI tests. At the PTC some pediatric patients do not have to go under anesthesia for proton radiation therapy, a very demanding procedure that requires being relaxed and still for a certain amount of time.


Who is involved with deciding whether sedation is used – the physician, the parents or both?

Physicians and parents are typically equally involved in deciding if anesthesia should be used. Doctors ascertain a child’s developmental capabilities and may suggest a trial simulation procedure without anesthesia. Many families at the PTC are aware of what proton radiation therapy requires from their children and are able to assess whether their child is up to the task or not. Also, as a child life specialist, I am often asked to evaluate a child’s ability to undergo a procedure without anesthesia.

What are the benefits of not using anesthesia during medical procedures?

Non-sedation treatment is attractive to parents for a number of different reasons. In addition to safety concerns, patients can eat and drink the morning prior to a procedure and can often go home sooner because they don’t experience drowsiness. Also, at the PTC, patients who undergo anesthesia-free proton radiation therapy without chemotherapy do not require intravenous lines to deliver sedatives, which can be challenging, time consuming, and technically difficult.

How do you work with children who are not going under anesthesia?

I try to prepare children as much as possible by showing them the medical equipment that will be used and explaining how things will feel, smell, taste, sound and appear. I also talk to medical professionals to find out what the child needs to do in order to successfully go through the procedure.

Whenever possible, I am present in the treatment room to create a calming presence, narrate what is happening, and provide an alternative focus point other than the treatment (watch a TV show on an iPad or listen to music.) I also provide benchmarks so that children can anticipate the sequence of events without someone telling them what is actually happening. Helping define an endpoint and provide comfort is necessary for a child to overcome a stressful situation.

How can parents help prepare their child for a medical situation without anesthesia?

Investigate to find out the procedure’s specifics: What will your child experience with their senses; what distraction items can they use; whether you or the facility’s child life specialist can be present during the testing; and if there are any non-pharmacological ways to overcome the child’s concerns about the experience.

Also, inquire how much time the procedure takes. Timing is especially important: Most preschool and early school-age children do best when prepared immediately before the procedure so they don’t have time to use their imagination to amplify their fears and anxieties. Older school-age and teenage children benefit from preparation a day or two in advance as they have more control over their imagination and have the ability to think more logically.

Prepare your child by explaining the procedure in a relevant, understandable way. Underscore its sensory aspects and offer choices for distraction. Always tell the truth and never minimize your child’s concerns. If your child is not adequately prepared, they may become distrusting of you or the medical environment.

Evaluate and ask your child how they experienced the procedure. Provide a lot of positive feedback, even if the outcome of the anesthesia-free procedure was not what your child had hoped for. Children may feel guilty or shameful if they did not meet the expectations of adults they trust and love, especially in high-pressure situations like medical procedures.

Kelly Wagner, a child life specialist at MD Anderson Proton Therapy Center in Houston, works with children and families to help them cope with hospitalization.

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