An anesthesiologist is a medical doctor who, after medical school and internship, specializes in all types of anesthesia, including general anesthesia. All anesthesiologists have at least four years of training after medical school. It is the anesthesiologist's job to keep your child safe and comfortable during surgery and recovery from anesthesia. The anesthesiologist never leaves your child's side until he or she is safe and stable in the postanesthesia care unit.

Your anesthesiologist takes several factors into account when recommending the type of anesthesia. Some of those factors include the type of surgery or non-operative procedure being performed for your medical history. These types of anesthesia are not always clearly defined, and patients may progress from one level of sedation/anesthesia to a lighter or deeper level during the procedure. For this reason, the American Society of Anesthesiologists (ASA) considers anesthesia a continuum, from light sedation to general anesthesia. Understanding that the level of sedation/anesthesia is a continuum, the ASA has published the following definitions:

• Minimal Sedation
  A level of sedation that relieves anxiety but preserves consciousness. The patient is typically relaxed but readily responds to verbal commands. Blood pressure, heart rate and respiratory function are generally unaffected.
• Moderate Sedation
  A level of sedation that depresses consciousness and relieves anxiety and pain. Under moderate sedation, purposeful response to verbal command or light tactile stimulation is maintained. Blood pressure, heart rate, and respiratory function are generally unaffected or minimally affected.
• Deep Sedation
  A level of sedation in which the patient is not easily aroused, but responds purposefully to repeated or painful stimulation. Blood pressure and heart rate are generally maintained, but intervention may be required to maintain respiratory function.
• General Anesthesia
  The patient is completely unconscious, and not responsive to painful stimuli. Blood pressure, heart rate and respiratory function are often compromised.

General anesthesia itself is exceptionally safe. Most healthy patients do not have any problems with general anesthesia.

Generally, children are anesthetized by allowing them to breath a little anesthetic gas through a facemask. We add your child's favorite flavor to the mask and play different distraction games to help ensure your child has a smooth transition to "sleeping" under general anesthesia. After your child is asleep, an IV is usually started. Selection of appropriate anesthetic agents is dependent upon many factors.

Your child's heart rhythm, blood pressure, the amount of oxygen in your child's blood, temperature, and level of consciousness will be monitored closely by his or her anesthesiologist.

It is very important your child adheres to the fasting rules prior to his or her surgery. The safest way for your child to receive anesthesia is on an empty stomach.

As a general rule, your child should not eat or drink anything after 11 PM on the night before his or her procedure. If procedure is scheduled after 10 AM, your child may have up to one cup or 8 oz of water or clear liquids up to three hours before scheduled time of procedure. Clear liquids are any type of liquid that you can see through clearly when poured into a glass, such as Gatorade and apple juice. There should be no solid material floating in the liquid, such as orange juice. Absolutely no milk or dairy. During fasting time, your child may be instructed to take certain medications with a little water. If criteria is not followed, your child's procedure may be postponed or cancelled.

Be sure to ask your doctor which medications your child should take on the day of surgery. Most medications can be continued as scheduled, right up until the morning of surgery and taken with a sip of water. Tylenol (acetaminophen) or Advil (ibuprofen) may be taken for pain. We suggest your child receives his or her usual dose of any inhalers/nebulizers for asthma or reactive airway disease the day of the procedure. Diabetes medications need to be discussed. Please call your anesthesiologist.

Consult your doctor's or dentist's office if your child has a fever, flu-like symptoms, or another major illness.

Short sleeve t-shirts and soft pants are best for all children. Your child may also wear sweatpants, pajamas, or loose fitting 2-piece clothing without "feet" attached.

• A small blanket (fleece preferred)
• An extra change of clothes
• Favorite security object from home (stuffed toy, blanket, pacifier)
• Preferred bottle or cup and/or formula, if applicable
• Diapers (if still wearing diapers)
• Wear loose fitting 2-piece clothing or pajamas- no pajamas with feet attached
• Storage case for glasses, contact lenses, and/or retainers, if appropriate
• If your child has a recent Pediatrician or other healthcare provider visit, please bring a copy of your child's History and Physical or other offices' notes.

Your child will be brought to another room for recovery. This is where you will rejoin your child as he or she awakens from anesthesia. During recovery, your child's blood pressure and pulse will be checked periodically. When your child is fully awake, he or she will be discharged home. Most patients are able to go home 30 minutes after his or her procedure.

• Have plenty of liquids such as Gatorade, apple juice, and popsicles on hand
• Tylenol or prescribed post-op medications
• First meal should be light, e.g., bread or crackers or soup (avoid fast food)
• Avoid active play for at least 6 hours after procedure
• Normal activities can be resumed by the next day with very little residual effects
• If there is an urgent matter, please call Texan Anesthesiology at 512-596-1775 or your doctor's or dentist's office.
• If there is an emergency, please call 911