Alternate-Site Anesthesia Services

Patient assessments as well as diagnostic and therapeutic clinical services are provided outside the traditional operating room setting.

When requested, an anesthesia care team provides conscious or deep sedation, regional anesthesia or general anesthesia for diagnostic evaluations. These diagnostic procedures may include magnetic resonance imaging (MRI), bone marrow biopsies, endoscopic procedures and cardiac catheterization. Therapeutic procedures include intracerebral embolization, transvascular intrahepatic shunt placement, radio-therapy for pediatric cancer, and minor surgical procedures.

Based on the patients’ conditions, these services may be provided in radiology suites, procedure rooms in a physician office complex, and endoscopy and cardiac catheterization laboratories. Our teams provide safe, efficient, and convenient services. We also provide consultation services for patients who are not candidates for standard preoperative anesthesia evaluation.

Why do I need to be sedated for my diagnostic procedure?

While some procedures such as MRI scans are entirely painless, some procedures (such as endoscopic procedures) due involve some discomfort that would be uncomfortable for most adults. These procedures occur at a wide variety of locations within the medical center and an anesthesia team will be available to safely perform the sedation.

Why can't I eat or drink before the procedure?

You cannot eat or drink because you will be sedated for the procedure. Sedative medications may cause the muscles of the throat, esophagus and stomach to relax. This may allow food and other stomach contents to come up into the esophagus and throat and these contents may then go into the windpipe and lungs. This can result in severe lung infections. To minimize this risk, patients should not eat or drink before sedation.

What are the risks of sedation?

The majority of patients undergo sedation safely with no side effects or adverse events. The minor side effects of sedation include nausea, vomiting, mild allergic reactions, headache and dizziness. Some patients may experience prolonged or excessive sedation and in some, sedation may fail requiring the procedure to be performed with general anesthesia.

The more serious adverse effects of sedative medications are slowed breathing, decrease in blood pressure or abnormal heart rate and rhythm. These adverse effects are fortunately rare. These risks are further reduced by obtaining a detailed medical history, choosing the best sedative medications based on this history and by giving the medications in small doses and monitoring their effects closely. Also, careful observation and close monitoring of children during the procedure reduces risk from sedation. The most feared of the risks i.e. death and permanent injury are extremely rare and are further reduced by the above precautions.

How long does the sedation last? Will I need to stay in the hospital once the procedure is complete? When can I resume my normal activity?

Depending on the sedative medication used and your response, most patients are awake at the end of the procedure and ready to go home soon thereafter once specific discharge criteria are met. Most patients are able to resume their normal activity within a few hours after the procedure. This does not, however, include driving! You must arrange for transportation home from the hospital after you are discharged.

What is MRI?

Magnetic Resonance Imaging or MRI entails obtaining images of the body parts using a powerful magnetic field. It does not involve harmful radiation.

Why might my child need sedation or general anesthesia for MRI scanning?

The MRI scanning is performed in a special room on a special table within a tube. The magnet makes a thumping and a monotonous sound during the scanning. Some patients may also feel really claustrophobic during the procedure if they are awake. Hence, patients may not tolerate the scanning for these reasons. Also, the procedure may take anywhere between 30 minutes to up to 3 hours depending on the body parts to be studied. Any movement on the part of your child may affect the image quality. It is for these reasons that children are referred for administration of sedation or general anesthesia.
 
Is the procedure painful?

No, MRI scanning is not a painful procedure.
 
How will my child be prepared for general anesthesia?

You will be called by the nurse from the MRI area who will explain to you what to expect and also give you instructions regarding fasting for the general anesthesia.

On the day of the procedure, your child will be first seen by a nurse who will complete a check-list. Following this, you and your child will be seen by the anesthesiology team which includes an attending pediatric anesthesiologist along with a resident anesthesiologist or a CRNA (Certified registered nurse anesthetist).  The anesthesia team will perform a detailed history and clinical examination and obtain your permission for anesthesia on a consent form.

How will my child be administered general anesthesia?

Administration of general anesthesia or sedation will be performed in the "induction room". In younger children, anesthesia is usually administered using anesthetic gases via ‘face mask’. This is called "gas induction". Once the child is asleep, an intravenous drip is commenced and anesthesia maintained by either using a gas or using intravenous anesthetic medicines. In some instances the anesthesiologist may insert a ‘breathing tube’ that goes down the throat to help better maintain breathing. However, the tube is removed as the child wakes up. After induction, the child will be moved into the MRI scanner where the anesthetic administration will be continued. Your child will be monitored continuously by our expert pediatric anesthetic team.

In older children, who will tolerate an intravenous line placement, an intravenous anesthetic medicine may be administered for induction instead of a "gas induction". The choice of the technique used is at the discretion of the attending anesthesiologist.

If you decide to be present during induction of anesthesia, you may notice that your child resists the mask, splutters, coughs, makes funny gurgling sound, up rolls eyeballs etc. This is the ‘excitement phase’ of anesthesia and may be seen in most children before they drift off to sleep. Please do not feel distressed when you see that. Also, the anesthesiologist may ask you to step out at anytime during the induction process.

What will happen after the scanning procedure is done?

After the scanning, your child will be transferred to the recovery area where a specialized pediatric nurse will monitor your child.

Can I be present during the scanning?

Yes, you can be present with your child during "anesthetic induction" until the child is asleep. We may ask you to leave during the intravenous line placement and during insertion of the ‘breathing tube’ if one is necessary. Once your child is transferred into the scanner, you will be allowed, if you wish, to be present in the scanner room as well as during recovery of your child. There are certain hazards involved if you carry metal objects on your person and the MRI technician will ask you in detail regarding this history.

Can I bring my child’s favorite toy?

Yes, you can bring your child’s favorite toy with you. 

How will anesthesia be administered to my child?

Anesthesia will be administered either intravenously or via a face mask depending upon your child’s age and clinical condition. Further, maintaining the anesthetic may or may not involve using a breathing tube for the duration of the procedure. Your child will be allowed to keep his/her favorite toy until he/she is asleep.

Can I be present during administration of the anesthetic?

Yes. At the discretion of the attending anesthesiologist, you may be given the option to be present while your child goes to sleep under sedation or general anesthesia. Once your child is asleep, you will be asked to leave and come back after the procedure is done. For some procedures such as MRI and CT scan, you may be given the option to be present for the entire duration of the procedure.

Where will my child be recovered after the procedure?

Your child will be recovered in a special area called the ‘recovery area’. Your child may be drowsy for some time after the anesthesia is stopped. Your child may also be administered oxygen for some time until he/she wakes up. The recovering nurse will give you further discharge instructions.

Will my child be in pain after the procedure?

Depending on the nature of the procedure, your child may experience discomfort or pain following the procedure. Typically, for diagnostic procedures, your child may experience some mild discomfort rather than pain. Please consult the attending anesthesiologist regarding this. Every effort will be made to pre-empt and treat your child’s pain and discomfort.