Paediatric series no.13 - Anaesthesia for children having proton beam therapy

Before starting treatment, your child will have an anaesthetic assessment appointment. At this appointment you, and your child, will meet with an anaesthetist. You will have discussions about their general health, any previous anaesthetic experiences and for the anaesthetist to answer any questions you may have.

The anaesthetic assessment appointment will happen at your child’s visit to the PBT centre, which is in the Grafton Way Building, before their PBT planning scans. This process will be outlined in your appointment letter.

General anaesthesia means that drugs are used to induce a deep sleep. This is different to conscious sedation, where drugs are used to produce a calming effect. As your child requires a general anaesthetic, to keep them very still for planning and treatment, they will need pre-anaesthetic fasting.

Pre-anaesthetic fasting is the restriction of food and fluid prior to having a general anaesthetic. It has been a traditional practice for many years to ensure patient safety. Pre-anaesthetic fasting reduces the risk of liquids or food entering the lungs (also called aspiration) while your child is under general anaesthesia.

• No food or milk for six hours before the anaesthetic
• No formula milk/weaning foods for six hours before the anaesthetic
• No chewing gum for four hours before the anaesthetic
• No breast milk for four hours before the anaesthetic
• No water or clear fluids for two hours before the anaesthetic. If your child does not like water, other clear fluids are allowed, such as black tea, diluted squash, and other non-fizzy clear drinks. To determine if the fluid is clear enough, newsprint should be visible through a glass of the liquid.
• If there are any changes to the general guidance above, a member of the anaesthetic team will let you know.

Many children will be staying in PBT accommodation or travelling from home, if the distances to travel are reasonable, and will be treated as out-patients. Every day, you and your child will report to the PBT reception on B3. Once checked in, you will be asked to go and wait in the children’s lounge on B4. The health play specialists will be there to ensure there are plenty of fun activities your child can do whilst they are waiting.

A paediatric recovery nurse will meet with you and your child to assess their health and take some vital signs measurements. This way, we can ensure they are fit to have an anaesthetic. They will also put an ID band on your child’s wrist or ankle.

When it is time for the anaesthetic you and your child will be escorted to one of the GA induction rooms within the anaesthetics suite on B4. Only one parent will be allowed to accompany them, but there will be support from the health play specialists. No siblings can go into the anaesthetic room.

The general anaesthesia will be given by a consultant anaesthetist. They will be assisted by an anaesthetic practitioner. The anaesthetic drugs will usually be given using your child’s central access line (Hickman Line, PICC or Portacath) or a peripheral cannula. Sometimes, the anaesthesia will be given by asking your child to breathe anaesthetic gas from a face mask.

After your child is asleep, they will be taken for their PBT planning scans or treatment. You can wait in the waiting area on B4, the children’s lounge, the Macmillan Living Room on B3, or go for a refreshment break.

After the procedure is complete your child will be transferred to the PBT first stage recovery area. The paediatric recovery nurses will closely monitor your child as they wake up from the anaesthetic. They will call you, when it is safe, so that you can be with your child.

When you arrive on B4 please tell the reception staff that you have received a call from the GA team and a member of the team will escort you to PBT first stage recovery. Parents waiting in the children’s lounge will be called through by a member of the reception team.

When assessed as safe to do so by the paediatric recovery nurses, your child will be transferred to the PBT second stage recovery area. The paediatric recovery nurses will be responsible for discharging patients each day of their PBT procedure.

Your child will only be discharged when the paediatric recovery nurses have assessed them as being close to their pre-anaesthetic levels of drinking, eating, and mobilising. This is to ensure they are fully recovered and are fit to go back to the accommodation or home.

Some children will remain as inpatients when they have PBT. Every morning you and your child will come from the paediatric oncology ward, T11North. A nurse and a porter will escort you both through the underground tunnel to PBT. After your child has adequately recovered from their anaesthetic, you will both be escorted back to T11North, by a nurse and porter.

During treatment, children will periodically have routine blood tests, swabs for infection, central line dressing changes and some other simple paediatric oncology interventions. These supportive care procedures and investigations will be done whilst they are asleep. This is to save them from any further distress.

You and your child will meet several anaesthetists, anaesthetic associates, anaesthetic practitioners, and paediatric recovery nurses during treatment. However, each week there will be some familiar faces. Most children and their parents settle into the routine of their daily treatment extremely well. Please ask the anaesthetic staff at any time if you have any concerns or worries.

General anaesthesia is a very safe procedure. However, as with all drugs and techniques there are some risks. A member of the anaesthetic team will discuss these risks with you before your child starts treatment. These risks include:

Nausea and vomiting

Occasionally, anaesthesia can make children feel sick. Your child will be given anti-sickness medication whilst they are asleep to prevent any nausea and sickness.

Distress and anxiety

Generally, with a full explanation of what is going to happen, children accept anaesthesia without too much upset. The combined involvement of parents, health play specialists, anaesthetic staff and ward staff helps children accept their treatment.

Other more serious risks

General anaesthesia can extremely rarely lead to more serious consequences, including brain damage or death. These very rare events obviously come to the attention of the media and so cause parents huge anxiety.

All anaesthetists work to eliminate these risks for your child. An anaesthetist will monitor your child constantly throughout their treatment. Any worries you have can be discussed with the anaesthetist at your child’s anaesthetic assessment.

My child’s keyworker is:

Paediatric/TYA Clinical Nurse Specialist
Tel: 07929 079599

Paediatric/TYA Specialist Therapeutic Radiographer
Tel: 07817 941313

Radiotherapy/PBT Health Play Specialists
Tel: 07929 834430/ 07929 834428
Email: uclh.radiotherapyplayspecialists@nhs.net

T11North Ward
Tel: 020 3447 1102

T11North Nurse In Charge (available 24 hours)
Tel: 07939 788096

Proton Beam Therapy Reception
Tel: 020 3456 8000/8001

If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.
Tel: 020 3447 3042
Email: uclh.pals@nhs.net