General Anaesthetic / for 4 Year Old

One thing you can do is go on the nhs list and then call repeatedly to ask about cancellations - these happen all the time, so are a good way to get seen.

My 2 year old has had multiple ga. You can have gas or canula. Can also have an oral sedate before (like calpol) which relaxes them. I’m not gonna lie of course it’s not a nice time as a parent and you always worry. But the teams we’ve been under have been fab, so reassuring and kind

Not quite the same thing.... But my elderly hamster recently had general anaesthetic for dental surgery amd he cam through it just fine.

My 4yr old had his tonsils out. They put him under GA while he was looking at his iPad. I was taken to recovery and he was crying as he came around (v common) so I went on the trolley with him. Within an hour he was fine. He can't remember any of the crying now but does remember the hospital food!

DD did at 4 months for an MRI and was totally fine. I actually managed to get her to sleep before the GA which was easier, although she did get upset as she was going under. I just wish they'd had me there when she woke up but they called me in soon after. Needed to be done x

I would want to know how many 4 year olds they were sedating each year and how they maintain their anaesthetic skills for that group if it's not many (even if it's 'just' sedation you need to be able to manage an anaesthetic because it's a pretty fine line). I'd also want to know how well the local is likely to work if there's current infection (local doesn't work so well when there's infection so the sedation may need to be deeper...which runs the risk of becoming an anaesthetic). I wouldn't be wildly keen on sedation for shared airway in a remote site in a 4 yr old (but perhaps that's just because I work in a hospital where it's not common practice).

Obviously as an anaesthetist I have a particular viewpoint as a result of my own training and experience, so read my comments with that in mind. I am also an experienced dental sedationist, though only for adults. Personally, I would not be enthusiastic about iv sedation for a small child, especially outside a hospital. People sometimes talk about sedation and general anaesthesia as if they are 2 completely different things but they are really just different points on a spectrum with many of the same benefits but also similar risks.

Both as a professional and as a parent my personal preference would be for a general anaesthetic in a small child because the airway is controlled and once the child is anaesthetised the dental team can get on with things quickly. As I say, I have no experience of dental sedation in this age group, but with adults the aim is to have the patient sedated enough to be calm and but still awake enough to maintain their own airway and to be sufficiently cooperative with the dentist. I can't imagine that is very easy with a very young child. There is a fine line to walk. Too little and the child may be distressed and the procedure difficult to perform. Too much and you risk crossing the line from heavier sedation into a GA but without a controlled airway.
I'm sure the clinic you mention does have very well trained staff, enough equipment etc or they they wouldn't get through the necessary statutory inspections and so on, and I'm sure it's possible for a skilled practitioner to provide safe sedation for even very small children but I think the fact that it is not something that is widely offered in either the private sector or the NHS does say something. Personally, if a small child of mine needed to be sedated I would prefer the safety net of being in a hospital and for them to have a GA with the airway controlled from the outset.

They are the same. For instance, medicines.org gives details for an antibiotic called Clarithromycin 250mg/5ml Oral Suspension.

My daughter had lengthy surgeries at 5 months old, 1 year, 3 years and 8 years.

She's absolutely fine (apart from the issue that required the surgery in the first place) and doesn't remember much of any of them expect the most recent one.

Please don't worry about it, if it needs doing for her health then it needs doing.

You'll generally find that the doctors and nurses and especially the anaesthetists are used to dealing with anxious children.

I was put under 4 times between 2 and 5. Then again at 6 for dental work. It was fine. Kids tend to recover quickly from it. The bit I hated was having the numbing cream on the backs of my hands so I wouldn't feel the cannula. Apparently I was somewhat difficult about it and made my anesthetist crawl into the Wendy house with me for a pretend cup of tea before I let him put the cannula in.

DS was prem and had surgery when under one.

What are the antibiotics and what is the strength of them? I.e. X mg per X ml?

I'd go back to your dentist in the first instance, to check that there isn't an abcess or something like that. If there is, antibiotics may help relieve the pain. Your dentist may be able to speak to the hospital dental service and ask them to expedite matters given your DD's pain, but I'm afraid that can't be guaranteed. Unfortunately there are a lot of children in the same boat as NHS dental services are overwhelmed. 6-12 month waits are common I'm afraid. The teams will be working flat out but the demand is just so high. But there is no harm in asking, and there may be something else going on that the dentist can help with in the meantime so I'd give your own dentist a call in the morning and let them know what's happening,

@AgeingDoc and @Greybeardy
Thanks that makes a whole lot of sense. It was Scotland on outskirts of Glasgow. DS was 3 and had finger caught in a door, the tip was hanging off.

When we got in the car I opted for the local general hospital, who did what they could before sending us on our way.

My DS had one at 4 for a hernia. He was fine but became delirious when emerging from the GA. It's apparently common but no one told me this could happen. It didn't last long though and we were home the same day.

Not sure what the set-up in that hospital was (guessing possibly not England, so perhaps things are different wherever it is). As per PP though, it's not just the need for anaesthetic that determines where the best place for an operation is. Not every hospital has plastic surgery for example, so it may have been that anyone needing plastics gets shipped out. There needs to be adequate paediatric ward capacity & paediatrician cover too. Sometimes a child with medical problems might need transferring out for even routine surgery if that condition could be a problem perioperatively that would be difficult to manage at the original hospital.

It may have been the need for a plastic surgeon that was the limiting factor rather than/as well as anaesthestic factors. There's generally quite a few factors involved in the decision where the best place for someone to be treated is and for a child age and size will come into it as well as what the required surgery is and whether the child has any coexisting medical conditions. All UK consultants will have been trained in paediatric anaesthesia but those who work in specialist centres doing more complex work with children will have done more and will have the necessary experience to deal with tiny children, those with underlying medical conditions and those having complex surgery. But it's the whole team that matters,not just the anaesthetist, so the surgical paediatric and nursing staff as well as the anaesthetic team. You need a critical mass of patients of any particular type for clinical teams to be able to maintain the necessary skills so a lot of straightforward paediatric surgery can be done perfectly well in general hospitals but sometimes it is preferable for particular children to be in a specialist children's hospital.

It's bread and butter for our daycase unit. He'll be absolutely fine.

Tiny babies go under general anaesthetics all the time, let alone four-year-olds. Obviously any parent worries about this kind of thing, but it's really not a big deal at all.

I had a general anaesthetic when I was younger than your child. It was no big deal at all. My friend's son had heart surgery as a two-year-old and another had a kidney operation when he was only a few months old. Your child's operation won't take very long and it will be much less traumatic for them than having to have it done under a local. It's all going to be fine - try not to worry!

@Greybeardy
Is it maybe just a Heath Board policy that children should be treated at the Children's Hospital?

I'm going off a rushed comment from an A&E nurse. Almost 5 years ago but it feels like yesterday, LO and a finger injury, that had a plastic surgeon put back together.

After gently highjacking the OPs thread I just wanted to say how kind and helpful anesthetists are on here. There was another thread recently about C sections under GA and they couldn't have been more supportive.

I feel we are in very good hands. Thank you