Continued: what do parents need to know?
More about the information that parents should have before their child has a surgical procedure:
Question: Is this facility capable of managing the patient if the unexpected happens?
Largely because of the drive to cut cost, but also because of pressure applied by surgeons and others to do every known case, many facilities are not staffed or equipped to manage infants and older children that have complex chronic disease. Case in point is the child that has pyloric stenosis. Many small rural medical centers are pressured to take care of these infants without the resources, personnel or equipment, to do so. For most children that are healthy and older than three or four simple surgical procedures can be managed in almost any accredited medical center or ambulatory facility. For the young and the sick, this is not true. Parents have to ask the specific question " Is this facility prepared to manage my child if there is an untoward event?" Is there a resuscitation plan for children? How many children do you take care of? Be skeptical of the answers if they don't pass the "sniff"test!
Question: What are the risks of Anesthesia for my child?
After a child is three years old and if the child is healthy the risks of general anesthesia approach those of healthy adults. Over the last twenty years the mortality statistics for anesthetized patients has dropped tremendously. This is because of better training, better technology, and enforcing high standards. So thirty years ago the risk of death for a healthy person was about 1: 100,000 and in 2009 the risks are greater than 1: 2,000,000. Yes we do have a good health system.
For infants and sick children, the risks are greater, and the statistics will vary with the acuity level of the patient. But this is the issue, the mortality statistics for infants vary with the training and experience of the person that is taking care of them. In my mind, this is not a guarantee of an outcome, but it does suggest that little ones should be taken care of by those that have the specific training to do what needs to be done. Most children's hospitals and academic medical centers have fellowship trained pediatric anesthesiologists. It makes a difference and if your child is less than two years old or has serious co-morbid conditions, then as a parent you should ask about the training and experience of the people that present themselves to you.
Rae Brown MD
Question: Is this facility capable of managing the patient if the unexpected happens?
Largely because of the drive to cut cost, but also because of pressure applied by surgeons and others to do every known case, many facilities are not staffed or equipped to manage infants and older children that have complex chronic disease. Case in point is the child that has pyloric stenosis. Many small rural medical centers are pressured to take care of these infants without the resources, personnel or equipment, to do so. For most children that are healthy and older than three or four simple surgical procedures can be managed in almost any accredited medical center or ambulatory facility. For the young and the sick, this is not true. Parents have to ask the specific question " Is this facility prepared to manage my child if there is an untoward event?" Is there a resuscitation plan for children? How many children do you take care of? Be skeptical of the answers if they don't pass the "sniff"test!
Question: What are the risks of Anesthesia for my child?
After a child is three years old and if the child is healthy the risks of general anesthesia approach those of healthy adults. Over the last twenty years the mortality statistics for anesthetized patients has dropped tremendously. This is because of better training, better technology, and enforcing high standards. So thirty years ago the risk of death for a healthy person was about 1: 100,000 and in 2009 the risks are greater than 1: 2,000,000. Yes we do have a good health system.
For infants and sick children, the risks are greater, and the statistics will vary with the acuity level of the patient. But this is the issue, the mortality statistics for infants vary with the training and experience of the person that is taking care of them. In my mind, this is not a guarantee of an outcome, but it does suggest that little ones should be taken care of by those that have the specific training to do what needs to be done. Most children's hospitals and academic medical centers have fellowship trained pediatric anesthesiologists. It makes a difference and if your child is less than two years old or has serious co-morbid conditions, then as a parent you should ask about the training and experience of the people that present themselves to you.
Rae Brown MD
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