He will wake up, right?
October 27, 2010 9:59 AM   Subscribe

My 11 month old son is getting tubes put in his ears tomorrow morning. I'm not concerned about the procedure itself so much as I am about the general anesthesia. He will only be out for about 15 minutes, but I want to know how dangerous this really is.

He has no medical conditions we know of other than chronic ear infections. I have never had a negative reaction to anesthesia, but do not know about (anonymous donor) the other side of his gene pool. I've heard anecdotal horror stories, but nothing medically concrete (more like scared co-workers telling me he may not wake up). I know there is a risk, but I'd like to know why and how high. I know YANAD, but if you have any recent experience with small children and anesthesia I'd like to hear from you. Procedure will be done at a hospital with a pediatric anesthesiologist.
posted by LizardOfDoom to Health & Fitness (27 answers total) 2 users marked this as a favorite
 
Your coworkers need to STFU. Who the hell tells a worried mom that her kid might not wake up?! They remind me of the coworkers who - while I was heavily pregnant - sent me articles about psychotic women murdering pregnant ladies and cutting the babies from their uteruses.

In any event, if you want cold hard facts: it's very safe. Here is an article on anesthesia complications during your kiddo's exact surgery. The rates are VERY low... in a normal, healthy patient, they're listed as 0.09%.

Good luck to you and the wee one!
posted by julthumbscrew at 10:11 AM on October 27, 2010 [2 favorites]


How was this not covered by the informed consent process? You should tell your doctor that he or she should discuss these concerns with his or her patients / the patients' parents.

The rates are VERY low... in a normal, healthy patient, they're listed as 0.09%.

You misread the table. The incidence in normal, healthy patients is 9%. However, most of those were minor adverse events. Major adverse events were much rarer.
posted by jedicus at 10:14 AM on October 27, 2010


General anesthesia is when they dope you up to the point that you can't protect your airway, requiring at least mechanical support of the airway if not full-on mechanical breathing support.

IANAD, but it strikes me as somewhat unlikely that they're going to put your son that far under for a procedure this minor. What they're probably going to do is sedate him for the procedure, so he'll be "unconscious," but probably only enough to keep still while they do their thing.

This is the kind of anesthesia used in dental surgery. They're working in your mouth, so they can't put a tube in there, but they do need you to sit quietly while they do extraordinarily unpleasant things to you. So they sedate you, but they don't use general anesthesia.

General anesthesia is, as far as I understand it, usually limited to major surgeries, i.e. messing with major internal organs like the heart, lungs, kidneys, etc. It is more dangerous than sedation, so it's avoided wherever possible, and while again, IANAD, it seems unnecessary in this application.

You should obviously talk to your doctor about this, as the distinction isn't one that laypeople tend to appreciate--I only know about it because I have health professionals in the family--but you and your son should both be fine.
posted by valkyryn at 10:15 AM on October 27, 2010 [1 favorite]


There is probably no routine procedure that someone HASN'T died during, so your coworkers' scary anecdotes aren't very helpful.

Relax - there is no way they would anesthetize him if there was any serious risk of this, unless as a last resort.
posted by hermitosis at 10:15 AM on October 27, 2010 [1 favorite]


With ANY surgical procedure, there's some chance of a problem arising. However, I had at least 4 different sets of tubes in my ears as a kid. All the surgeries went fine. This was in the '70s too, so I'm sure that things have even improved since then.
posted by blaneyphoto at 10:19 AM on October 27, 2010


Eeek - thanks for the catch, jedicus - serves me right for skimming medical articles at work!
posted by julthumbscrew at 10:23 AM on October 27, 2010


IANAD, but it strikes me as somewhat unlikely that they're going to put your son that far under for a procedure this minor.

That would've been my layman's guess as well, but according to the journal article on anesthesia complications in this procedure, general anesthesia with ventilation is the usual approach.
posted by jedicus at 10:25 AM on October 27, 2010


Well that's the article we're looking for then.
posted by valkyryn at 10:27 AM on October 27, 2010


Seconding julthumbscrew, especially about the idiotic coworkers. Who are not only lacking in tact, but in facts. Here is a 2005 paper looking at outcomes of pediatric anesthesia for various procedures. Some of the results are alarming*, but the situations most resembling yours were 100% safe** (in a smaller sample size than JTS's paper). Namely: hospital-based, pediatric equipment, pediatric specialists.

*Dental anesthesia - yikes! Maybe this is what your coworkers have heard about, but they still need to shut their yaps.
**Of course you know that this is not a guarantee, just a reflection of a small sample size.
What is it with this game of "Let's Freak Out The Pregnant Woman/New Mother"? The perps are usually mothers themselves. I'm usually the tactless one in any group, but even I know that this is pointless and cruel. WTF, ladies?
posted by Quietgal at 10:34 AM on October 27, 2010 [1 favorite]


When my then 1yo needed stitches, the surgeon wanted to put her out, his rationale being she wouldn't be thrashing around. I wasn't comfortable with this, thinking even the small chance of an issue wasn't a worthwhile tradeoff for a (possibly) smaller scar. Once I stood firm, one of the nurses popped up with "we can give her . That will relax her enough there won't be issues". It was a drug they oddly administered by dripping into her nose. Unfortunately, I do not recall the drug, but that might give you a hint.

In short order, child was happy and relaxed, like a little drunk. Doc stitched her up and you can barely see the scar.

So...you are allowed to push back on doctors, as long as you apply some common sense. No general for stitches is reasonable (I think)...no general for an appendectomy, not so much. They *do* have options.

posted by kjs3 at 10:40 AM on October 27, 2010


I have read that this is the most commonly-performed surgery in children under five and that complication rates are very, very low. And doctors who do it get a ton of practice!
posted by Eyebrows McGee at 10:45 AM on October 27, 2010 [1 favorite]


If you have read the Wikipedia article referenced above, I ask you to please notice the dates of the studies referred to. Mortality due to anesthesia in the 1950's is less than irrelevant. Meanwhile, the most recent data is not really about anesthesia. "All cause post-operative mortality" doesn't really give you an idea of the dangers of general anesthesia itself -- these include death rates for people who've just had open-heart surgery, for instance.

Also, "general anesthesia" includes a wide variety of medications and medical techniques. Nitrous oxide is considered general anesthesia, for instance (or so the internet tells me.)

Your doctor -- who knows what kind of anesthetic will be administered -- should be able and ready to provide you with hard data. Your coworkers should be able and ready to cease comment.
posted by endless_forms at 10:47 AM on October 27, 2010


Oh, and one of my close friends just had this done on her 15-month-old. No problems. She was in back for 20 minutes and was already waking up when they brought her out. She clung to mom for a bit and then was fine. They had it done at an outpatient surgical center so I imagine you're one rung up from that being at the hospital with all the extra emergency stuff available.
posted by Eyebrows McGee at 10:50 AM on October 27, 2010


@ jedicus and julthumbscrew: Actually the incidence of complications in healthy children is listed in the summary as 9%, but in the actual report as .09%. I guess it's hard to know which is the typo...

@ julthumbscrew and quietgal: I know, right?! I think someone should do a study on this phenomenon. There has to be some diagnosable psychological issue with these people.

Thanks all, this is definitely helping to keep me from freaking out :)
I don't mind medical-ese.
posted by lodie6 at 10:52 AM on October 27, 2010


My kid had this done about six months ago. Best. Thing. Ever. His hearing went from 70% or so impaired to functionally normal in two weeks (and in the car ride on the way home he was telling us he could hear better); he's had two colds since that didn't progress to ear infections (100% had gone to ear infections in the previous two years), and he was happy, up, and hungry within an hour of going out.

Two other things to consider. First, this is an extraordinarily routine matter and doctors/anesthesiologists have huge amounts of experience in dealing with this. Second, if your child ever needs general anesthesia in the future, having this under your belt will make that experience so much better, because you'll know if there is any major bad reaction to worry about. The dosages for such a short procedure are such that any complications are extraordinarily unlikely to be serious. Relax, this is the best thing to be done, and you'll be really happy once it's over.
posted by norm at 10:58 AM on October 27, 2010 [2 favorites]


Totally antecdotal, but I had 4 general anesthetics before the age of 7, including 2 before the age of 2. They obviously weren't recent (early-mid 80s), but I would imagine human anesthetic protocols have only gotten safer and safer in the last 30 years. I certainly know that's true on the vet side (I'm a vet) and we use a lot of the same the same drugs.

The first two were in a children's hospital, the second two were in a non-pediatric specialty hospital. All were with pediatric anesthesiologists and there were no anesthetic complications.
posted by peanut butter milkshake at 11:07 AM on October 27, 2010


Actually the incidence of complications in healthy children is listed in the summary as 9%, but in the actual report as .09%. I guess it's hard to know which is the typo...

9% is definitely the correct figure. All of the other numbers throughout the report are in line with that, including the raw data. The .09 in the table is not labeled as a percentage.
posted by jedicus at 11:08 AM on October 27, 2010


There is a lot of speculation going on in this thread, I hope I can clear some of it up. I am an anesthesiologist in an children's hospital and we do this all the time; I have had days where we did 10 sets of ear tubes before lunch. So I speak from a fair amount of experience when I answer.

First of all, there is some truth to the idea that for this procedure the anesthesia is more of a risk than the tube placement. This is not because anesthesia is particularly risky so much as that it would be hard to have a life-threatening complication from ear tubes by themselves. To put it in perspective, an analogy I use (I have seen the statistics behind it but don't have time to track them down now) is that if you have to drive more than five miles to the hospital, you are more likely to be injured in a wreck going to or from the hospital than you are to be injured in an anesthetic mishap at the hospital. The article jedicus cited is good; you will note that there were no deaths in the 3000+ patients studied. I would add to that that in the 11 years we have had a stand-alone children's hospital we have had no deaths related to that sort of procedure; the very few intraoperative deaths we have had have been in severe trauma patients, patients with severe heart defects, and similar situations where the patient was known to be at high risk going into the OR. Bottom line: anesthesia for ear tubes is extremely safe.

As to what we typically do for this procedure, when the patient arrives we review the history, make sure the parents know what procedures is being done, and that sort of thing (we particularly make sure that instructions on not eating and drinking were followed). Then we give our patients something to drink that contains a sedative and some pain medicine. After a few minutes we head to the OR where we hook the patient up to all our usual monitors before giving him a face mask to breathe through. The anesthetic gas delivered via the mask will induce general anesthesia in about a minute and we will let the surgeon go to work. We typically don't need an IV or artificial airway for this but will make exceptions on a case by case basis if the patient needs something more than usual. At the end of the procedure we turn off the gas, watch the patient for a few minutes in the OR to make sure he is waking up without problems, then head to the recovery room. Although most patients wake up fine, the two biggest problems noted in the paper above were "prolonged emergence" and "agitation". The first simply means that they took longer than expected to wake up; this is not unusual and happens for a variety of reasons but eventually resolves itself. The second refers to something also known as emergence delirium, which is when a patient (typically a child under 5) wakes up crying and is inconsolable. I warn you of this because it can be upsetting to parents, especially when they don't expect it. This too eventually goes away on its own, and most children never experience it to begin with.

Despite the length of this post I have left out a number of details and other things will vary from hospital to hospital, so my answer above is just a general idea of what happens. I would suggest that to ease your nerves you get to the hospital a little early and when you sign in ask to talk to your anesthesiologist. They will be able to give you answers that apply specifically to your situation and ease your mind a little. Of course, the thing that will be best is when you see your son after surgery and know that he is OK!

Feel free to memail me if you have other questions. You also might be interested to know that Chicago is the home of the American Society of Anesthesiologists, so there are plenty of well-qualified anesthesiologist up there to take care of you!
posted by TedW at 11:10 AM on October 27, 2010 [18 favorites]


I had tubes when I was a kid.

I went from legally deaf to being able to hear again (at age 4). Suddenly I could hear birds, ice in water glasses, ppl talking from further than 10ft away, etc.

Mine was an extreme case, but I had tubes for 9 years - that meant 9 operations to re-insert the tubes, each used general anesthesia. Most of them used gas, the last one was via IV.

Your kid will be fine. This is pretty standard in & out stuff as medical procedures go.
posted by jpeacock at 11:14 AM on October 27, 2010


I'm really glad TedW posted in this thread.

My daughter had general anesthesia for dental work at a young age (3) - an older child wouldn't have needed it, but at her age she was "pre-cooperative," as they say. I was a wreck. I even put off the procedure so I could get textbooks through interlibrary loan and read all about it first.

The anesthesia machine monitors absolutely everything and will take care of regulating the air and medications going in. This made me feel so much better. The only risk I could really find was the one you are likely talking about, which is a reaction to the medication. It is hereditary and rare. If it was to happen, it would happen immediately, so once the procedure has begun, you can relax and know that he's not at risk.

They didn't give my daughter the sleepy drink referred to above, but just had me put on scrubs and carry her into the procedure room. Then they gave her a mask, which put her out, and escorted me out before administering the IV. She was scared, but then, at 11 months old, your child will be less likely to understand what is going on, and it will probably be you who is more scared.

I cried the whole 45 minutes she was out. A nurse came and told me when she was being moved to recovery, and only then could I get ahold of myself and realize she was going to be fine. Irrational, I know. After letting her wake up, they came and got me and I held her while she cried - probably some of the emergence delerium described above. Not like I expected her to be happy, though, so no big deal. She was grouchy for a few hours, then she was back to herself.

Get some bags for throw-up when you are in the recovery area and take them with you. Anesthesia can cause vomiting without much nausea, and my daughter threw up with no warning on the car ride home.

Also, she remembers none of it. She wasn't traumatized. I think that's an effect of the medications.

Hang in there!
posted by Knowyournuts at 11:38 AM on October 27, 2010


Our son had to have a double hernia/hydrocele operation at 3 months old. I hear you. At 6 weeks he had RSV so severely he was in the hospital for a week on oxygen, deep suction, IVs, steroids, nebs, the works. I was terrified of what anesthesia would do. Like your son, his surgery was very short and we had the lead of the children's hospital do ther surgery which made us feel confident in the team she chose to work with. We feel that if the best surgeon was working on our son, she wouldn't have chosen a flunky.

But still, things can be out of her control and things could go wrong but it is rare. Ask questions. Be 1,000% honest in his medical history. They'll do a precheck with vitals, check his airway passage for size, etc.

Good luck and speedy recovery. All things medical are scary for our little ones.
posted by stormpooper at 12:09 PM on October 27, 2010


Oh as a tip, hey may be incredibly gassy after the procedure from the anesthesia. See if they'll allow some GasX to be brought with. Our son was miserable/in a lot of pain from the gas build up.
posted by stormpooper at 12:10 PM on October 27, 2010


Hey, I've had emergence delirium! Never knew there was a name for it. Basically, after my surgery at 5 years old to get ear tubes and a tonsillectomy, I woke up screaming my head off for my mother to the extent that the nurse picked me up and carried me out of recovery to my mother. I remember it very well. (I don't think a nurse would do that now...) Then, when I was about 20 years old, I was put under general anesthesia to get four impacted wisdom teeth removed. Also woke up screaming at everyone in recovery that I WAS COLD!!! Then a while later, I fell back asleep for a bit and woke up for real. I remembered it all and immediately wondered why I was so obnoxious. No lasting ill effects at all. In both instances, I wasn't scared or upset. It was more like absolute fury at being away from my mother/cold. As soon as I got my mother/a heated blanket, I shut right up and fell back asleep. I was a flower girl in a wedding less than a week after the tubes and tonsillectomy, FWIW.

So anyway, when my one year old needed anesthesia for tubes in his clogged tear ducts, I worried he'd be like me and get all loony. He wasn't screamy, but spent a little while in recovery crying/whining in my lap. He asked for juice and then hit the nurse who tried to give it to him. An hour or two later, he was at home eating lunch like nothing had ever happened. He needed anesthesia a year later to get the same tubes removed - that time he was perfectly fine afterwards.
posted by artychoke at 2:09 PM on October 27, 2010


Our daughter had tubes because she had glue ear. I wish we'd had it done earlier, but we hadn't picked up on the fact that she had become practically deaf. She was absolutely fine after the operation. It was totally untraumatic. When we came home from the hospital I put the kettle on and she ran over to it, staring. She hadn't realised that it made a sound :-(

Then she needed tubes again and she may have had a bit of emergence delirium, because she woke up crying - but once again, absolutely fine an hour or so later. Hearing is terribly important, especially for little kids. I am so glad we were able to help her.
posted by Joe in Australia at 3:37 PM on October 27, 2010


Thanks everyone! Little LizardOfDoom came through just fine. He was a bit cranky/disoriented in recovery, but is sleeping at home now. The doc said it was a good thing that we had it done today - he had a new ear infection and the right eardrum was getting ready to rupture (again). Hearing should be back to normal soon :)
posted by lodie6 at 9:33 AM on October 28, 2010 [1 favorite]


My 22 month old has had general anaesthesia (I'm including the deep sedation needed for three MRI's in this) six times in the last month. Each time she has had no problems related to the procedure or to the anaesthetic, and has woken up "happy" - or at least not pukey and grumpy.

The waiting through the surgery or procedure is torture though and I don't know of any real remedy for that other than don't do it alone.

I would very strongly urge you not to listen to co-workers or anyone other than your medical professionals. There are many insensitive people in the world who have no real empathy, or, rather, they may mean well but they cannot hear their words in an anxious, worried parent's head. Even the dietician assigned to us was completely full of wrongheaded and (frankly) distressing opinions about my daughter's prognosis, likely complications, etc., to the extent I reported her and had her removed from our team. if this is true of a "professional" working in a hospital, then imagine how useless and misleading the average Joe on the street or cubicle is.

Also, people tend to remember bad outcomes they hear about through the media or "a friend of a friend" and these become low level urban myths, whereas the extraordinary routine-ness of the procedure that TedW alludes to is, well, literally unremarkable
posted by Rumple at 11:01 AM on December 11, 2010


Oh, well, somehow I missed your last comment, lodie6. I'm so happy (but not surprised!!) to hear your little one came through with flying colours.
posted by Rumple at 11:02 AM on December 11, 2010


« Older What would you/do you track in a daily record?   |   Hey! That's My Creative Title! Newer »
This thread is closed to new comments.