Ask Dr. Marla: What are the risks of my child having anesthesia?

My daughter has to have her tonsils out. What are the risks associated with “going under”?
Should I be worried?

Answer:

I relate well to this question since, despite being a doctor, I had the same worries when my son needed a tonsillectomy! To answer your question I turned to Dr. Jerrold Lerman who is now Clinical Professor of Anesthesiology at Women and Children’s Hospital of Buffalo, but at the time, was Matt’s
anesthetist at Toronto’s SickKids Hospital. When asked about the safety of anesthesia, he
often tells parents that they are more likely to be struck by a car while crossing a busy major street than experience a serious complication during anesthesia. Today, anesthesia for children is very safe. However, there are some ground rules that must be followed. Here are his tips for elective surgery:

• It is most important that your child does not eat or drink before anesthesia, according to the instructions you were given. Not eating reduces risk of vomiting while under.
• All medical conditions, such as asthma, should be stable and well-controlled. This
  may mean a visit to your paediatrician to adjust your child’s medications.
• If your child has a cold, a fever higher than 38.5°C, change in behaviour, greenish-looking sputum or wheezing, the anesthetist will cancel the surgery. These signs may cause breathing difficulties and even pneumonia after surgery. If surgery is cancelled, it will be rescheduled two to four weeks later.

When do tonsils need to be removed?

There are two indications for tonsillectomy: repeated throat infections and obstructive
sleep apnea. Children with sleep apnea have an increased risk for breathing problems after
anesthesia, particularly those with severe sleep apnea. The risk is higher when other
conditions such as young age (younger than three), obesity and genetic defects are present. These children are ideally admitted overnight after surgery to monitor their breathing and oxygen levels. Most children have a small amount of blood oozing from their mouths after tonsillectomy, but this is usually not a concern. Overall, tonsillectomy is a relatively common surgery, which poses very little anesthetic risk for the healthy child.

Got a health question? Submit it to Dr. Marla.

Originally published in ParentsCanada magazine, April 2013.