Ear Tubes and Anesthesia

| January 2, 2013 | 8 Comments

Is your child going to have ear tubes soon?  Read about what type of anesthesia to expect here.

We have a new little girl at home and hopefully she will not have to undergo surgery any time soon. But little kids can get recurrent ear infections.  And sometimes a surgeon may recommend ear tube placement.

Many anesthesiologists take care of children everyday who are having ear tubes placed.  These procedures are performed under general anesthesia.

This means your child will be asleep and unaware of any pain or discomfort during the procedure.  The anesthesiologist will be present for the entire duration of the ear tube placement to make sure your child is safe and comfortable.

But the anesthesia usually given to kids for “ear tube placement” can be a little different.

In the majority of cases, the anesthesiologist will have your child breathe anesthesia gases through a small plastic mask in order to induce general anesthesia. This process will take place in the operating room with the anesthesiologist, surgeon, and nurses present.  Very rarely, parents will be allowed to accompany their child into the operating room to be present as general anesthesia is started.  But this is not the norm and depends on hospital policy.

After your surgeon has spoken with you, the operating room nurse and anesthesiologist will take your child to the operating room.  Sometimes, the anesthesiologist will have recommended that your child drink some flavored medicine about 30 to 45 minutes prior to the procedure.  This medicine can help children relax prior to being separated from their parents.

It often contains Versed (ie. Midazolam), which may make your child drowsy and less nervous about separating from you when it comes time to proceed to the OR. Once this medicine is given, make sure to keep a close eye on your child. This can make them drowsy and affect their balance and coordination. If they are laying in the hospital bed, make sure the guard rails are up to protect them from falling. If they are in your lap, make sure you have a good hold of them.

But, not all anesthesiologists use this oral pre-medication for a variety of reasons (patient medical history, preference, etc) so once again, don’t be concerned if your child does not require this medicine.

Once your child is in the operating room, he or she will be closely monitored with the standard monitors that are used on all patients for the entire procedure: blood pressure, EKG, pulse oximetry, carbon dioxide measurement, etc. They will drift off to sleep as they inhale a mixture of oxygen and anesthesia gases.

This is not painful for your child. The anesthesia gases may smell a little funny, but that’s about it. In our practice, we have masks that have a bubble gum flavor so that the anesthesia gas has a more pleasant smell for the kids as they fall asleep.

Occasionally an IV will be started when your child is asleep.  Once again, this depends on a variety of factors, but will be discussed with you by the anesthesiologist.  After your child is completely asleep, the surgeon will perform the procedure.  Because your child is breathing anesthesia gas through the mask throughout the procedure, they will stay asleep.  When the surgeon is finished, the anesthesia gas is turned off, and your child begins to wake up.

It is not uncommon for kids to be disoriented when they wake up from the anesthesia.  The recovery room nurses are great at creating a comfortable environment for your child as they fully awaken from the effects of the anesthesia.  And the nurses will unite you with your child as soon as it is safe to do so.  Many of the nurses are parents themselves and know what it feels like to be separated from a child.

Has your child had ear tube surgery recently?  How was the experience?  Was your kid nervous about having surgery? Please let us and other parents know by leaving your comments in the forum.  No need to register, just let us know how it went.

Thanks so much for stopping by anesthesiamyths.com!

Dr. Joe

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Category: Pediatric Anesthesia

Comments (8)

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  1. Kimberly says:

    My daughter just had ears tube placed today and is 16 months old. She was given versed before she was taken back to the OR to help her seperated from us(parents). The procedure went as planned until she woke up in PACU thrashing and screaming with very little interruptions in this crying/trashing behavior. They discharged us even though she was still thrashing 30 minutes later. I brought her home and still very little change. I’m a ER nurse and I knew something wasn’t right. Called them on the phone in regards to my concern and as I thought she is having a “bad reaction” to the versed. It’s heartbreaking as a mother to have to put them through tube placement and be told its a easy procedure and hear everyone say all will be well after and it was far from that. The versed was given at 730 am and it’s 2pm and she just now is taking a nap but still moaning/sniffling and crying in her sleep. I’m not a fan of versed for pediatrics now but seeing the 2 percent adverse reaction in my daughter has played a enormous part in my feelings.

    • Kimberly,

      I am so sorry your daughter and family has had such a tough time today. But I appreciate that you left your comment here for others to see and learn from, including myself.

      We have a 9 month old daughter and I am not looking forward to the day that she has to have a procedure or surgery. The anesthesiologist will probably have to give me Versed.

      As you know, everyone responds differently to general anesthesia, including kids. It is not uncommon for children to have emergence delirium when they are awakening from anesthesia. It sounds like this is what your daughter may have experienced.

      I will use your story to help shape the conversation I have with parents prior to their child’s surgery. And I know your comments will lead others to ask questions and try to get as much information as possible prior to their child going under anesthesia.

      Let us know if her symptoms begin to resolve.

  2. Angie says:

    My child is 22 months and he needs to get tubes and possible have his adenoids removed too. He has never had a procedure or surgery. I’m very nervous about it. Is the removal of the adenoids difficult?

    • Angie,

      I’m glad you found the site and that you asked your question. A lot of other parents out there are wondering the same thing.

      Ear, nose, and throat surgeons are highly trained experts to take care of surgery on adenoids. I would direct your question about the ease of the surgery to your ENT physician.

      However, the removal of adenoids is a common surgery that is performed on children. We work with several fantastic ENT surgeons that perform several of these procedures in one day. In general, they are usually outpatient procedures meaning that your child will go home the same day of surgery.

      Your child will be under the care of an anesthesiologist (a physician) throughout the procedure. If there is any question about this, you should ask your child’s surgeon. Sometimes, a facility may use anesthesia nurses to provide the anesthesia under the supervision of an anesthesiologist. I would want my child to be under the one to one care of an anesthesiologist.

      As for the anesthesia for this procedure, your child will be asleep under general anesthesia the entire time. They will not remember any part of the procedure. Pain medicines will be given through an IV while they are asleep to keep them as comfortable as possible when they wake up from the anesthesia.

      I would recommend that you ask your detailed questions to the ENT surgeon prior to your child’s surgery. And you can always ask to speak to your anesthesiologist prior to the surgery as well.

      When I am taking care of children for these procedures, I am 100% focused on taking care of the child as if it were my own. I know my anesthesiologist colleagues feel the exact same. Your child will be in good hands.

      Let us know how it goes.

  3. Lesley says:

    My 5 yr old just had a tube put in her left ear this morning. She is doing well but I would like clarification on something that occurred in the operating room. As per the hospital procedure, I accompanied her to the OR and was with her until she was asleep. My 5 yr old was completely calm during the whole time in the hospital and when we had her lay on the table, and continued to be so, I was beside her and the Dr put the mask to her mouth and she was fine, he was telling her a story and she was listening and breathing calmly. When it seemed the anesthesia was taking affect, her arm jerked up to her face and she squirmed away from the mask by turning her head away and curling her body. They said it was normal and I was told beforehand that she might twitch, but this seemed like more and was more like thrashing. Is this normal? It was quite disconcerting for me as it seemed to come out of nowhere and I am hoping she wasn’t in any discomfort, or anxiety or she wasn’t fighting it off. I don’t think she remembers thrashing and I believe she was not conscious during it but it was awful for me to witness. Any info on if this is a normal occurrence and why it happens would help to alleviate my concern. Thank you.

    • David Draghinas says:

      Thanks for your question, Lesley.

      It sounds like what you experienced with your 5 year old was very normal.

      I believe what you saw was Stage 2 of anesthesia. Anesthesia is broken down into several stages, beginning with the induction of anesthesia in Stage 1. Stage 2, also known as the excitement stage, is characterized by patient movement (erratic at times) and the possibility of variations in breathing patterns, heart rate, etc. Stage 3 is the zone where “surgical anesthesia” is achieved.

      As you are aware, because placing an IV while awake can be traumatizing to kids, we often start off a child’s anesthetic with the anesthesia gases. Once they are “asleep”, we can place the IV and continue with the rest of the case.

      *** Because Ear Tube placement is such a short procedure, there may not be an IV placed at all and the entire procedure is performed under “mask anesthesia”.

      Because the anesthesia gases don’t work on the body as quickly as our IV anesthetics, you can “see” the child go through the stages of anesthesia. That is what I believe you witnessed. Although I don’t think your child will remember any of that experience (you can ask him/her about the last thing they remember going to sleep), it can be very traumatizing to the parent. Some hospitals will not allow parents to go back to the OR (this being one of the reasons).

      I hope this explains a little better what you witnessed. If you have any specific questions about what you saw, you can also contact the anesthesiologist taking care of your child.

      Praying your little one is recovering well,

      Dr Dave

  4. Sherilyn Brown says:

    My 3 year old grandson had tubes put in ears on Wednesday. He came out of the anesthesia well good, was a bit sleepy and disoriented afterwards but fared nicely in time to go home. He was happy and played like nothing happened all that day. That night he had a horrible nightmare, shaken and trembling. We thought okay nightmares happen, then he had another one the night after and then continued to have horrible catatonic shaken and trembling for the next few nights after falling asleep. He has never had nightmares, a few talking in his sleep but never nightmares. Can this be an adverse reactions to the anesthesia? It is so frightening to see.
    Thank you

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