When kids need anesthesia for a medical procedure, it’s normal for both them—and their parents—to feel anxious. In this episode of Your Child is Normal, Dr. Jessica Hochman speaks with pediatric anesthesiologist Dr. Jacqueline Drummond Lewis (aka Doc JC), author of Adventures with Doc JC: The Unseen Planet. Together they explore what anesthesia actually is, how it works in kids, and how families can better prepare their children before a procedure. Dr. Lewis shares practical tips, reassures us about safety, and explains how imagination and preparation can reduce fear for everyone involved.
Click here find the book Adventures with Doc JC: The Unseen Planet
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Episode Transcript
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Unknown (00:00):
Hello, listeners. This is Dr Jessica Hochman. I'm
excited to share that I am nowbooking sponsorships for your
child as normal for this fall.
If you have a product, serviceor a message that you think our
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sponsor an episode, and I'll letyou know for a good match and
get back to you now welcome toyour child is normal. Today,
we're talking about a topic thatcan bring up a lot of anxiety
for families. Anesthesia,whether it's for ear tubes,
dental work or more involvedprocedure, the idea of your
child going under can be scary.
But what if there was a way toprepare your child and yourself
(00:41):
that felt empowering instead ofoverwhelming. My guest is Dr
Jacqueline Drummond Lewis,better known as Doc JC, she's a
pediatric anesthesiologist andthe author of a beautiful new
book, adventures with Doc. JC,the unseen planet. Her book is a
wonderful tool for helpingchildren prepare for anesthesia
by using imagination instead offear. In this episode, you'll
learn how anesthesia works, whatparents should know about safety
(01:03):
and why preparing kids inadvance can make such a big
difference in their experience.
Whether you're facing aprocedure next week or you
simply want to be informed forthe future, this conversation is
packed with calm, clear andpractical guidance. And before
we get started, if you'reenjoying this episode or other
episodes from the past, pleaseconsider sharing your child is
normal with a friend, sharingepisodes and leaving a review is
the best way to help thispodcast grow so I can continue
(01:25):
my mission of helping parentsenjoy their parenting journey.
Now on to my conversation withDoc. JC, Dr Lewis, I'm so
excited to have you here.
Welcome to your child is normal.
Tell us about yourself and whatdo you do for work?
Jessica, thank you. It's been anhonor to be here. And I am a
(01:46):
pediatric anesthesiologist, andmy passion is really to help
children come to us, trying toimagine us as friends, and
that's the reason my bookadventures with Dr, JC, the
unseen planet is now here I seethat curiosity and their
(02:07):
imagination, and we are nottapping into that, so I want
this book to open that for them.
And my passion is anesthesia.
Why? Because I like to help themto go through procedures that
are super painful, but they gowith zero pain and zero anxiety,
and at the end, they just goback to their normal
(02:28):
life. For many families, Iimagine they must experience
anxiety before they have aprocedure that might require
anesthesia for their child. Soit sounds like you wrote a book
to utilize the naturalimagination of children to make
them more comfortable.
That is correct. And I feel thatthe reason anesthesia creates
(02:51):
such an anxiety, not only inlittle ones, but in big ones
too, is because when it'sportrayed in movies like for
example, there was one that camethat is just like, yeah,
horrific stories aboutanesthesia, right? And we don't
have the chance, because wedon't have an office, per se, to
establish communication with thefamily until they walk into the
(03:15):
procedure place, either a clinicor a hospital, and at the same
time, it's a very intenseconversation to have. So
anesthesia is seen like, yeah,that unseen planet that my kid
is going to go but I don't knowanything about it. Nobody has
talked to me. So I think that'sthe bridge that I want to create
(03:35):
asa pediatrician. I do find that a
lot of parents come to me whenwhen their child is recommended
to have a procedure that mayrequire anesthesia. Many parents
come to me with questions andconcerns. They're nervous that
anesthesia might pose some harmto their child. Can you speak to
that at all? Are there any harmsfrom general anesthesia that
parents should be aware of fortheir
(03:56):
kids? Yeah, and I will start byjust reassuring like I'm going
to quote here that back in 20,24 million procedures in
pediatric care has been donesuccessfully through general
anesthesia. And when I talkabout pediatric anesthesia, I'm
(04:17):
talking from neonates. Those arethe ones that are from zero to
30 days of life they have, thenthe toddlers and then the teens,
all of them are really beingcare by pediatric
anesthesiologists. And back in2016 the FDA created this
(04:39):
announcement or warning aboutthe effects of anesthesia in
children that are less thanthree years of age, but it's
also related with that durationof the procedure, and it's
longer than three hours ormultiple procedures, and
especially in those cases, isnot a one. One to One, but has
(05:01):
been cases reported thatdecreases learning or affect the
learning of the child, but justin general, those are not the
typical procedures that thechild are going to have. So to
answer to your question,anesthesia has been really,
really safe, and I heard in oneof your podcasts with one of my
(05:24):
favorite ENT physicians to workwith, Dr Nina Shapiro, she said
surgery in children is muchsafer because anesthesia is
safer. And I 100% agree on that.
I feel very grateful that welive in an era when anesthesia
exists, that's for sure. Yes,but I I find it very helpful to
(05:47):
hear from you that when it comesto risk, which I think is what
is on the forefront of all ofour minds when we have a child
that's about to have aprocedure, that if it's a
shorter procedure, it seems likethat risk is much lessened.
Yeah, the explanation of therisk was mainly about the side
effects that anesthesia can havelonger term for the learning
(06:11):
disabilities that the FDA wassaying so short procedures for
sure, we can say confidentlythere's nothing to worry about.
So the numbers are less thanthree years of age and longer
than three hours or multipleprocedures. So if that's not the
category, I will say, feelconfident that there's really no
(06:32):
effect long term. And even inthose one in those categories,
there's still studies to reallymake sure, because it's not a
one to one.
Now, a lot of parents, they getnervous just by hearing the word
anesthesia. Can you explain whatanesthesia really is, and how is
it different from childrencompared to adults?
(06:53):
And I will say to the parentsthat are listening, is
completely normal to feelnervous about anesthesia. The
word itself is so clinical andso serious, but I have to say,
as I mentioned, it's prettysafe. And if I want to break it
down to simple words, anesthesiais the medication that we
(07:14):
administer to our patients, inthis case, to your children, so
they be able to go to procedureswithout feeling anxiety, no
recollection and no pain? Is itdifferent from adults? Yes, it
is because we take inconsideration that children has
(07:34):
different way of metabolizingthe anesthetics that we give so
all of that takes inconsideration before we
administer the medication, theirage, their weight, their medical
history, and their developmentand their anxiety.
Now I get many phone calls fromparents that will mention a type
(07:56):
of anesthetic that is going tobe used in a future procedure,
and they ask me, in particular,if that medication is safe for
children. Can you explain thedifferent types of anesthesia
that may be offered and explainalso, maybe, how you may decide
which one is safest for eachchild? Yes,
we have four main groups, butthat decision has to be
(08:19):
determined with the type ofprocedure, and then we take in
consideration the age of thechildren and if it's going to be
an outpatient procedure, or isgoing to be procedure that is
going to be done in thehospital. And last but not least
is the level of anxiety of thechild. For example, I'm going to
(08:41):
start with the simple one is thelocal anesthesia. It's an
injection that is used for veryminor procedures like stitching
someone. The second one is whatwe call regional anesthesia, and
this is when we injectmedication in a bigger area,
like, for example, for an arm, ahand, a leg. So it's really
(09:03):
specific areas, and specificallyin pediatrics, this is something
that we use to decrease theamount of pain medication used
during the procedure and afterthe procedure, they will require
less because the pain medicationis already given. The third one
we call monitor anesthesia. Wecall it also Mac. It's not a Big
(09:26):
Mac, it's Mac, MS, monitorAnesthesia Care. And with that
one we will administer throughan IV medications that will
decrease their pain or theirlevel of anxiety. This one is
used for very minor procedures,not for real big, involved
(09:47):
procedures. And the third one iswhat people have in mind when
they hurt anesthesia is reallygeneral anesthesia. What is
that? That medication is reallyputting your kid in a. Deeper
level of sleep. During that deeplevel, the child is not going to
be experiencing any pain,remembering anything, and not
(10:12):
having any anxiety. So anyprocedure as painful as they can
see, is going to be reallyseamless on their general
anesthesia. All of theseprocedures are really taking
care by specialized team andbeat to beat, bread to bread,
moment by moment, we areadjusting whatever is needed to
(10:35):
keep your child safe.
And let's say somebody findsthemselves with their child at a
hospital where the child maybenefit from having anesthesia
before a procedure. Does it haveto be a pediatric
anesthesiologist, or could it bea general anesthesiologist?
That's a topic of discussion,but I will say not all the
(10:57):
hospitals have pediatricanesthesiologists, but as a part
of our training, we havepediatric anesthesia training as
well. So it's just a matter ofcomfort, and what is the
practice of the hospital that istaking care of that for the
parents? I will say, when youhave that conversation, you can
(11:17):
ask, you can ask, howcomfortable you are with doing
children like the age of mychild, and depending on that,
you can assess and make thatdecision.
I think that's great advice. Ireally do, because you can get a
lot from ascertaining theconfidence from the
anesthesiologist by asking thequestion, do you feel
(11:39):
comfortable giving my childanesthesia and see what they
say, I agree with that, becauseunfortunately, I find there are
not a ton of pediatricanesthesiologists. I
agree with that, yeah, yeah. Butthat doesn't mean that they are
not other generalanesthesiologists that are very
confident doing pediatrics, Iwill say, for the majority, less
(12:01):
than one year of age or twoyears of age, they really have
to be a pediatricanesthesiologist, because the
physiology, you have to be moreconfident with that. I'm not
saying not with the other ones.
But if I have to make adistinction, I will say to the
parents, really ask about thebackground of the anesthesiology
(12:23):
that is going to be involved andmake that decision.
In my experience, there havebeen many situations where I've
seen it can go both ways, wherea child, for example, could get
stitches without being underanesthesia, and also, I've seen
them get stitches underanesthesia. And one big benefit,
(12:43):
I think, to using anesthesia isthe child does not remember at
all, because the kids that we'vehad to use purposes for to hold
them down to put stitches in, Ican tell that subsequent visits
to our office, they're a lotmore nervous where when they
don't remember what happened.
That's to the child's benefit.
In a lot of ways,I agree with that. And in that
term, I think the preparationalso takes time, if it's only
(13:06):
stitches, if you can reallyexplain, you can have them to
participate and not forsomething. And that's number
one, we have to take the childto be the center of the care and
not the procedure. So if thechild is really not prepared,
even when you talk, he's notreally interested in being
(13:27):
participant, why you going toimpose something like Apple
post? It's not going to work.
It's just going to increase hisanxiety or her anxiety. So in
that sense, I think it's betterjust to talk to them in their
own language and see where theyare and meet them and provided
(13:47):
what they need so they can havethe better experience that they
can have in thatprocedure. So do you have any
unique tricks up your sleeve asan anesthesiologist to help kids
feel more safe and feel calmerbefore having a procedure,
personallythe night before, when I talk
with the parents, I talk to themand I ask them, I assess, how is
(14:11):
the family being prepared forthat? Not surprisingly, the
majority, no, we haven't sayanything, and I say, No, no,
this is the moment that you'regoing to have a conversation.
And take that conversation asyou're going to Disneyland on a
ride. Is really frightening, butyou are excited about it. So
(14:32):
that's what you need totranslate to your child. Your
child is very intuitive, andregardless you don't mention
anything, they feed on yourfear, but if they hear that,
okay, it's gonna be like a ride.
Is really nerve wracking, butthe benefits are this and this
(14:53):
and this, that makes adifference. And I will say it
doesn't have to be the nightbefore you. So if your child is
someone that really wants toknow more, why not start the
conversation early? And there'san article showing that that
perioperative time doesn't startright when you walk into the
hospital. It starts way before,and that way before, only you
(15:17):
and your child will know howlong you need to prepare. And
that's why I think thisadventure with Dr C to the
unseen planet is a tool, becauseit's going to help you get an
idea, in a magical way, aboutwhat is anesthesia. So hopefully
the parents or the adults of thefamily will be able to get more
(15:42):
relaxed and will open theconversations
for you. Dr Lewis, do you haveany special tricks that you use
on kids to help them feel moreat ease and more comfortable?
It depends is really, I thinkthat's part of the of the job
that I really love, is to meetthem where they are. Some of
them bring a toy, and they talkto me about the toy, so I engage
(16:06):
through the toy. What is goingto happen? And they really love
it that way. Other ones they arecoloring, so we just talk about
coloring. So it's really to meetthem where they are, but it's
not only meeting the child, it'smeeting the parents as well. And
my trick is, I start by, are yousure they are your parents,
(16:26):
like, Are you sure you're withthe right team? And I start from
there. We have magic doors. Sothey get to open the magic doors
when they want it. But it's notone tool fits everyone. They
have their own and unique way,and I love it. Their imagination
is amazing.
That is for sure. I amconstantly inspired by the
(16:48):
imagination of children. Now, Ifind that the real concern that
parents ask me when it comes toanesthesia with their kids, they
ask, how can you guarantee thatmy child will wake up? That's a
big, dark fear that I notice alot of parents have. What is
your answer to parents, when youhear that question, I
say, we gonna be giving themedication even though he's
(17:12):
going into deep levels of sleep,we have all these monitors that
are telling us if the medicationis a lot a little or is just
right? So by knowing that, webecome like this pilot that is
reflecting on the informationthat is receiving from the
(17:33):
corporate to really tell howmuch they have to tweak. So we
tweak the whole time. Is notlike we just put them to sleep,
and we wait until the procedureis done, no B to B, bread by
bread, we look into how is theresponse to the medication that
we are giving, and we know thatevery child have different
(17:53):
responses to differentmedications, and we have the
tools to treat them dependingwhat needs to be done
that's a very helpful way tounderstand it. I think one of
the most common scenarios whereparents are considering
anesthesia and they havequestions and concerns are
children who have sensory issuesanxiety, or a lot of kids with
(18:16):
autism, for example, have a hardtime with especially I find
dental procedures, yes, anddentists will recommend to them,
we do have, we do have apediatric anesthesiologist. I
would consider using using thistool to make the procedure
easier. And parents are quitenervous. And what I find is a
lot of parents will ask me, Howimportant is it that we fix this
(18:39):
cavity? For example. You know,they'd almost rather leave the
cavity in than consider usinganesthesia sometimes. So how
would you reassure parents thatare particularly nervous with
using anesthesia?
So I say in general. So that'stwo points that you have. But
let's, let's go back to thechild with special needs, right?
(19:01):
For those, I think thatconversation needs to start, not
the night before, but way, waybefore. Once they are scheduled
to have a procedure, you canreach to the physician who's
ordering to say, how can I getin touch with the team that is
going to do it? Because you havethe right to say, This is what
(19:22):
makes my child more comfortable,like, for example, bright lights
really disoriented. So we candeem the lights, we can deem the
lights in the operating room,and it's still efficient. And in
that sense, the child knows thathe or she being respected by
keeping what makes them morecomfortable hearing? There's a
(19:44):
lot of different sounds, a lotof different smells that there's
no way to prepare them. But ifthat's something that is
triggering for especially withsounds, we can decrease the
amount of stimulation or findthose headphones. Phones to
cancel the noise. So there's alot to be creative about that,
(20:05):
and especially for those child Ireally think are there is in the
power of the parents to speakfor them, to let us know what
works for them, what doesn'twork. And especially there's
some words right that we can saythat make them comfortable. And
in my book, I have theseinteractive section, and that's
(20:27):
where I give the whole familythe power to create their own
adventure. In your adventure,you want to bring this, you
bring it, and that's how youpresent to us. Okay, this is my
adventure, and this is who I'mcoming and bringing to my
adventure. In that sense, itdoesn't feel that we are
imposing something. And forautistic children, I think
(20:51):
knowing what is there ahead oftime will give them at least the
chance to refresh it. I thinkit goes back to what you're
saying about meeting familieswhere they are, because I do
find for many parents where kidssuffer from severe anxiety, for
example, when you offer them theoption of anesthesia, I find
that that gives families a lotof relief. And
(21:15):
just going to finish with theanxiety of the parents, I will
say the majority of the time isnot knowing what is going to
happen with the child. Andagain, this tool gives you an
idea what is anesthesia. And Iwant to make clear that even
though I'm showing one way ofgiving anesthesia, that doesn't
mean that when you go to thehospital, you demand. This is
(21:37):
the way that needs to be done.
This is a story based on truefacts, but he's making it a
magical adventure so parents andchildren have an idea of what is
to visit planet anesthesia, andthat will decrease your anxiety.
If you have known to this storymore, you're going to be able to
be open and again, children andtheir home team, they really
(22:01):
need to speak the same languageso they can really to a
storytelling learn together andcommunicate what they feel is
going to be more empowering forthem.
I'm very much looking forward toyour book making its rounds,
because it seems like it's goingto be a very helpful tool for
(22:22):
many families. Yes, thank you.
Now when it comes to theanesthesia wearing off, can you
give parents some awarenessabout what to expect in terms of
recovery from anesthesia?
Well, I have to start by sayingevery child metabolized
anesthesia differently, but justgeneral tools. We expect to have
(22:46):
them in the recovery room 45minutes to an hour. But that
conversation goes back and forthbetween the nurse taking care of
the child, looking at the vitalsigns, looking how he's waking
up, and what is the plan if thechild is going to be discharged
to a hospital room, or he'sgoing to be discharged home,
(23:07):
those things are in conversationbetween the surgeon, the
anesthesiologist, and the nursetaking care in the pacu, or how
I call the recovery station.
I'm reflecting on parentsstories. In the past, I've had
some parents that will tell methat it would that it frightened
them, because when their childwas coming out of anesthesia,
(23:29):
they seem to have a bad dream,or they yelled out loud. Is that
something common that you canspeak to so that if parents hear
this from their child, that theyknow that it is normal?
Yes, and yeah, I always say tothem, the child that you brought
today is not the same thatyou're going to meet in the
recovery room, and that'sabsolutely normal, and how it's
(23:51):
going to be different. Can begroggy, can be really agitated,
and especially when they haveprocedures like ear tubes, those
procedures, they go into a deepstate really fast and come out
of that really fast as well.
Plus their hearing is augmented,right? So it's very disoriented.
So there's no way to feel badthat they are feeling really
(24:16):
agitated, because it's a lothappening on them, but rest
assured, is gonna wear off. Soby the evening, you might have a
child that looks a little bitsimilar to the one that you
brought us, but for sure, afterthe following day, you will get
your child back. So work withyour child, try to keep the
(24:40):
environment as quiet as possibleand really give them the time to
process because it's a bigprocedure that has happened.
Another thing that helps isthings that they really like, a
blanket or a toy that is reallymeaningful to them to when they.
Wake up to have it near. So it'sa sense of familiarity in the
(25:02):
midst of all the things that arehappening after anesthesia.
Yeah, and I think that's a greatexplanation, because I think for
parents, the more that they knowahead of time what's normal,
what what they might expect fromtheir child, what might be
different after they recoverfrom anesthesia, I think will
relieve a lot of anxiety. Sothat's a great explanation,
(25:22):
and especially the ones thathave siblings, because they come
with the idea, oh yeah, she didgreat, fantastic. And I say,
totally fine. But every child,even siblings, will have a
totally different experience. Sobe prepared. Might be similar,
might be completely theopposite, and both are normal.
(25:44):
Out of curiosity, have younoticed an improvement in
anesthetic procedures sinceyou've been in the field of
anesthesia?
Oh, tremendously, really? Yeah.
It's fascinating how we arereally more child centered
approach. And I love that I amfrom Guatemala, and I did some
rotations, and unfortunately,during my medical training, we
(26:08):
were just the doctors doingwhatever was best for the child.
We were not the doctors doingwhat's best for the child with
the child. We were for thechild, but not with the child.
And that, to me, is a big, bigbonus, educating the public,
empowering the family to Yeah,you need to be the center. And
(26:31):
because we do X amount ofprocedures, that doesn't count
is one procedure at a time,I'm sure what must make a
tremendous difference in easingthe family's nerves. I'll bet
when they meet you, you havesuch a calm, relaxing,
informative presence that I'msure after they talk to you,
(26:53):
they feel much more reassuredand much better about their
child having anesthesia.
Thank you. Thank you. It's partof the passion. I think, in
general, I have not yet found apediatric anesthesiologist that
is not is working with childrenreally keep us that child like
(27:14):
attitude that we want toinspire, right? So I think is in
general, that's my bias that'sis because of them.
And I'm curious how much, howmuch more training does a
pediatric anesthesiologist haveto have compared to a general
anesthesiologist?
So after you complete your threeyears of general anesthesia, is
one or two years depending foryour training. So I did one year
(27:38):
and six months of pediatric ICU,wow. Well, on behalf of all the
children that you take care ofand the families that you that
you care for, thank you so muchfor thank you so much for
putting in that extra time.
Thank you. So if there was onefinal message that you could
leave with families, if they'reconsidering anesthesia for their
kids, what would itbe? Yeah, yeah, anesthesia,
(28:00):
especially in children, is notonly the child is the whole
team, and that's how I call it,the home team. So the more
prepared you are as a team, andespecially for the adults in the
home team, please make sure thatyou get answers that you speak
with people that are going to betaking care of your child so
(28:24):
your anxiety level doesn't getfeed to your child. But really,
I want children to be safe, soin order to do that, the adults
and especially the home team,needs to do those questions and
make sure that your child isbeing seen and taking care from
where the child is, andtell everybody about your book.
(28:48):
Where can they find it? BecauseI think that will be a great
help to families if they'repreparing for their child to go
under anesthesia.
This is called Adventureswithout JC, the unseen planet
has been available since June 3,and you can find it in Amazon.
There's also in Spanish. As aSpanish speaker, I think it's
(29:11):
important for the child tochoose the language of choice,
so it's aventuras con dog. JC,el planeta no vedoso and
felicidades si equista,aventuras el planeta no vedoso
on my website, WW, adventureswith Doc. JC, you have more
(29:34):
information, and you can reachme and post your questions, or
also on Instagram, at.jccable. It took a case to libro
as despondible, and lost andlost those English that is,
gracias a guy Los Angeles,tenemos ESA riqueza cultural
(29:58):
porque no Explora LA.
Amazing. Well, thank you somuch. Thank you for
thank you for doing what you'redoing. It gives me a lot of
comfort to know that childrenthat are in our community will
have you as a potentialpediatric anesthesiologist. So
thank you for the work that youdo. Thank you. Bye. Bye. You
Hello, listeners. This is Dr Jessica Hochman. I'm
excited to share that I am nowbooking sponsorships for your
child as normal for this fall.
If you have a product, serviceor a message that you think our
listeners would benefit from,whether it's for parents, kids,
healthcare or family life ingeneral, this could be a great
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checking the show notes. Justclick the link that says how to
(00:20):
sponsor an episode, and I'll letyou know for a good match and
get back to you now welcome toyour child is normal. Today,
we're talking about a topic thatcan bring up a lot of anxiety
for families. Anesthesia,whether it's for ear tubes,
dental work or more involvedprocedure, the idea of your
child going under can be scary.
But what if there was a way toprepare your child and yourself
(00:41):
that felt empowering instead ofoverwhelming. My guest is Dr
Jacqueline Drummond Lewis,better known as Doc JC, she's a
pediatric anesthesiologist andthe author of a beautiful new
book, adventures with Doc. JC,the unseen planet. Her book is a
wonderful tool for helpingchildren prepare for anesthesia
by using imagination instead offear. In this episode, you'll
learn how anesthesia works, whatparents should know about safety
(01:03):
and why preparing kids inadvance can make such a big
difference in their experience.
Whether you're facing aprocedure next week or you
simply want to be informed forthe future, this conversation is
packed with calm, clear andpractical guidance. And before
we get started, if you'reenjoying this episode or other
episodes from the past, pleaseconsider sharing your child is
normal with a friend, sharingepisodes and leaving a review is
the best way to help thispodcast grow so I can continue
(01:25):
my mission of helping parentsenjoy their parenting journey.
Now on to my conversation withDoc. JC, Dr Lewis, I'm so
excited to have you here.
Welcome to your child is normal.
Tell us about yourself and whatdo you do for work?
Jessica, thank you. It's been anhonor to be here. And I am a
(01:46):
pediatric anesthesiologist, andmy passion is really to help
children come to us, trying toimagine us as friends, and
that's the reason my bookadventures with Dr, JC, the
unseen planet is now here I seethat curiosity and their
(02:07):
imagination, and we are nottapping into that, so I want
this book to open that for them.
And my passion is anesthesia.
Why? Because I like to help themto go through procedures that
are super painful, but they gowith zero pain and zero anxiety,
and at the end, they just goback to their normal
(02:28):
life. For many families, Iimagine they must experience
anxiety before they have aprocedure that might require
anesthesia for their child. Soit sounds like you wrote a book
to utilize the naturalimagination of children to make
them more comfortable.
That is correct. And I feel thatthe reason anesthesia creates
(02:51):
such an anxiety, not only inlittle ones, but in big ones
too, is because when it'sportrayed in movies like for
example, there was one that camethat is just like, yeah,
horrific stories aboutanesthesia, right? And we don't
have the chance, because wedon't have an office, per se, to
establish communication with thefamily until they walk into the
(03:15):
procedure place, either a clinicor a hospital, and at the same
time, it's a very intenseconversation to have. So
anesthesia is seen like, yeah,that unseen planet that my kid
is going to go but I don't knowanything about it. Nobody has
talked to me. So I think that'sthe bridge that I want to create
(03:35):
asa pediatrician. I do find that a
lot of parents come to me whenwhen their child is recommended
to have a procedure that mayrequire anesthesia. Many parents
come to me with questions andconcerns. They're nervous that
anesthesia might pose some harmto their child. Can you speak to
that at all? Are there any harmsfrom general anesthesia that
parents should be aware of fortheir
(03:56):
kids? Yeah, and I will start byjust reassuring like I'm going
to quote here that back in 20,24 million procedures in
pediatric care has been donesuccessfully through general
anesthesia. And when I talkabout pediatric anesthesia, I'm
(04:17):
talking from neonates. Those arethe ones that are from zero to
30 days of life they have, thenthe toddlers and then the teens,
all of them are really beingcare by pediatric
anesthesiologists. And back in2016 the FDA created this
(04:39):
announcement or warning aboutthe effects of anesthesia in
children that are less thanthree years of age, but it's
also related with that durationof the procedure, and it's
longer than three hours ormultiple procedures, and
especially in those cases, isnot a one. One to One, but has
(05:01):
been cases reported thatdecreases learning or affect the
learning of the child, but justin general, those are not the
typical procedures that thechild are going to have. So to
answer to your question,anesthesia has been really,
really safe, and I heard in oneof your podcasts with one of my
(05:24):
favorite ENT physicians to workwith, Dr Nina Shapiro, she said
surgery in children is muchsafer because anesthesia is
safer. And I 100% agree on that.
I feel very grateful that welive in an era when anesthesia
exists, that's for sure. Yes,but I I find it very helpful to
(05:47):
hear from you that when it comesto risk, which I think is what
is on the forefront of all ofour minds when we have a child
that's about to have aprocedure, that if it's a
shorter procedure, it seems likethat risk is much lessened.
Yeah, the explanation of therisk was mainly about the side
effects that anesthesia can havelonger term for the learning
(06:11):
disabilities that the FDA wassaying so short procedures for
sure, we can say confidentlythere's nothing to worry about.
So the numbers are less thanthree years of age and longer
than three hours or multipleprocedures. So if that's not the
category, I will say, feelconfident that there's really no
(06:32):
effect long term. And even inthose one in those categories,
there's still studies to reallymake sure, because it's not a
one to one.
Now, a lot of parents, they getnervous just by hearing the word
anesthesia. Can you explain whatanesthesia really is, and how is
it different from childrencompared to adults?
(06:53):
And I will say to the parentsthat are listening, is
completely normal to feelnervous about anesthesia. The
word itself is so clinical andso serious, but I have to say,
as I mentioned, it's prettysafe. And if I want to break it
down to simple words, anesthesiais the medication that we
(07:14):
administer to our patients, inthis case, to your children, so
they be able to go to procedureswithout feeling anxiety, no
recollection and no pain? Is itdifferent from adults? Yes, it
is because we take inconsideration that children has
(07:34):
different way of metabolizingthe anesthetics that we give so
all of that takes inconsideration before we
administer the medication, theirage, their weight, their medical
history, and their developmentand their anxiety.
Now I get many phone calls fromparents that will mention a type
(07:56):
of anesthetic that is going tobe used in a future procedure,
and they ask me, in particular,if that medication is safe for
children. Can you explain thedifferent types of anesthesia
that may be offered and explainalso, maybe, how you may decide
which one is safest for eachchild? Yes,
we have four main groups, butthat decision has to be
(08:19):
determined with the type ofprocedure, and then we take in
consideration the age of thechildren and if it's going to be
an outpatient procedure, or isgoing to be procedure that is
going to be done in thehospital. And last but not least
is the level of anxiety of thechild. For example, I'm going to
(08:41):
start with the simple one is thelocal anesthesia. It's an
injection that is used for veryminor procedures like stitching
someone. The second one is whatwe call regional anesthesia, and
this is when we injectmedication in a bigger area,
like, for example, for an arm, ahand, a leg. So it's really
(09:03):
specific areas, and specificallyin pediatrics, this is something
that we use to decrease theamount of pain medication used
during the procedure and afterthe procedure, they will require
less because the pain medicationis already given. The third one
we call monitor anesthesia. Wecall it also Mac. It's not a Big
(09:26):
Mac, it's Mac, MS, monitorAnesthesia Care. And with that
one we will administer throughan IV medications that will
decrease their pain or theirlevel of anxiety. This one is
used for very minor procedures,not for real big, involved
(09:47):
procedures. And the third one iswhat people have in mind when
they hurt anesthesia is reallygeneral anesthesia. What is
that? That medication is reallyputting your kid in a. Deeper
level of sleep. During that deeplevel, the child is not going to
be experiencing any pain,remembering anything, and not
(10:12):
having any anxiety. So anyprocedure as painful as they can
see, is going to be reallyseamless on their general
anesthesia. All of theseprocedures are really taking
care by specialized team andbeat to beat, bread to bread,
moment by moment, we areadjusting whatever is needed to
(10:35):
keep your child safe.
And let's say somebody findsthemselves with their child at a
hospital where the child maybenefit from having anesthesia
before a procedure. Does it haveto be a pediatric
anesthesiologist, or could it bea general anesthesiologist?
That's a topic of discussion,but I will say not all the
(10:57):
hospitals have pediatricanesthesiologists, but as a part
of our training, we havepediatric anesthesia training as
well. So it's just a matter ofcomfort, and what is the
practice of the hospital that istaking care of that for the
parents? I will say, when youhave that conversation, you can
(11:17):
ask, you can ask, howcomfortable you are with doing
children like the age of mychild, and depending on that,
you can assess and make thatdecision.
I think that's great advice. Ireally do, because you can get a
lot from ascertaining theconfidence from the
anesthesiologist by asking thequestion, do you feel
(11:39):
comfortable giving my childanesthesia and see what they
say, I agree with that, becauseunfortunately, I find there are
not a ton of pediatricanesthesiologists. I
agree with that, yeah, yeah. Butthat doesn't mean that they are
not other generalanesthesiologists that are very
confident doing pediatrics, Iwill say, for the majority, less
(12:01):
than one year of age or twoyears of age, they really have
to be a pediatricanesthesiologist, because the
physiology, you have to be moreconfident with that. I'm not
saying not with the other ones.
But if I have to make adistinction, I will say to the
parents, really ask about thebackground of the anesthesiology
(12:23):
that is going to be involved andmake that decision.
In my experience, there havebeen many situations where I've
seen it can go both ways, wherea child, for example, could get
stitches without being underanesthesia, and also, I've seen
them get stitches underanesthesia. And one big benefit,
(12:43):
I think, to using anesthesia isthe child does not remember at
all, because the kids that we'vehad to use purposes for to hold
them down to put stitches in, Ican tell that subsequent visits
to our office, they're a lotmore nervous where when they
don't remember what happened.
That's to the child's benefit.
In a lot of ways,I agree with that. And in that
term, I think the preparationalso takes time, if it's only
(13:06):
stitches, if you can reallyexplain, you can have them to
participate and not forsomething. And that's number
one, we have to take the childto be the center of the care and
not the procedure. So if thechild is really not prepared,
even when you talk, he's notreally interested in being
(13:27):
participant, why you going toimpose something like Apple
post? It's not going to work.
It's just going to increase hisanxiety or her anxiety. So in
that sense, I think it's betterjust to talk to them in their
own language and see where theyare and meet them and provided
(13:47):
what they need so they can havethe better experience that they
can have in thatprocedure. So do you have any
unique tricks up your sleeve asan anesthesiologist to help kids
feel more safe and feel calmerbefore having a procedure,
personallythe night before, when I talk
with the parents, I talk to themand I ask them, I assess, how is
(14:11):
the family being prepared forthat? Not surprisingly, the
majority, no, we haven't sayanything, and I say, No, no,
this is the moment that you'regoing to have a conversation.
And take that conversation asyou're going to Disneyland on a
ride. Is really frightening, butyou are excited about it. So
(14:32):
that's what you need totranslate to your child. Your
child is very intuitive, andregardless you don't mention
anything, they feed on yourfear, but if they hear that,
okay, it's gonna be like a ride.
Is really nerve wracking, butthe benefits are this and this
(14:53):
and this, that makes adifference. And I will say it
doesn't have to be the nightbefore you. So if your child is
someone that really wants toknow more, why not start the
conversation early? And there'san article showing that that
perioperative time doesn't startright when you walk into the
hospital. It starts way before,and that way before, only you
(15:17):
and your child will know howlong you need to prepare. And
that's why I think thisadventure with Dr C to the
unseen planet is a tool, becauseit's going to help you get an
idea, in a magical way, aboutwhat is anesthesia. So hopefully
the parents or the adults of thefamily will be able to get more
(15:42):
relaxed and will open theconversations
for you. Dr Lewis, do you haveany special tricks that you use
on kids to help them feel moreat ease and more comfortable?
It depends is really, I thinkthat's part of the of the job
that I really love, is to meetthem where they are. Some of
them bring a toy, and they talkto me about the toy, so I engage
(16:06):
through the toy. What is goingto happen? And they really love
it that way. Other ones they arecoloring, so we just talk about
coloring. So it's really to meetthem where they are, but it's
not only meeting the child, it'smeeting the parents as well. And
my trick is, I start by, are yousure they are your parents,
(16:26):
like, Are you sure you're withthe right team? And I start from
there. We have magic doors. Sothey get to open the magic doors
when they want it. But it's notone tool fits everyone. They
have their own and unique way,and I love it. Their imagination
is amazing.
That is for sure. I amconstantly inspired by the
(16:48):
imagination of children. Now, Ifind that the real concern that
parents ask me when it comes toanesthesia with their kids, they
ask, how can you guarantee thatmy child will wake up? That's a
big, dark fear that I notice alot of parents have. What is
your answer to parents, when youhear that question, I
say, we gonna be giving themedication even though he's
(17:12):
going into deep levels of sleep,we have all these monitors that
are telling us if the medicationis a lot a little or is just
right? So by knowing that, webecome like this pilot that is
reflecting on the informationthat is receiving from the
(17:33):
corporate to really tell howmuch they have to tweak. So we
tweak the whole time. Is notlike we just put them to sleep,
and we wait until the procedureis done, no B to B, bread by
bread, we look into how is theresponse to the medication that
we are giving, and we know thatevery child have different
(17:53):
responses to differentmedications, and we have the
tools to treat them dependingwhat needs to be done
that's a very helpful way tounderstand it. I think one of
the most common scenarios whereparents are considering
anesthesia and they havequestions and concerns are
children who have sensory issuesanxiety, or a lot of kids with
(18:16):
autism, for example, have a hardtime with especially I find
dental procedures, yes, anddentists will recommend to them,
we do have, we do have apediatric anesthesiologist. I
would consider using using thistool to make the procedure
easier. And parents are quitenervous. And what I find is a
lot of parents will ask me, Howimportant is it that we fix this
(18:39):
cavity? For example. You know,they'd almost rather leave the
cavity in than consider usinganesthesia sometimes. So how
would you reassure parents thatare particularly nervous with
using anesthesia?
So I say in general. So that'stwo points that you have. But
let's, let's go back to thechild with special needs, right?
(19:01):
For those, I think thatconversation needs to start, not
the night before, but way, waybefore. Once they are scheduled
to have a procedure, you canreach to the physician who's
ordering to say, how can I getin touch with the team that is
going to do it? Because you havethe right to say, This is what
(19:22):
makes my child more comfortable,like, for example, bright lights
really disoriented. So we candeem the lights, we can deem the
lights in the operating room,and it's still efficient. And in
that sense, the child knows thathe or she being respected by
keeping what makes them morecomfortable hearing? There's a
(19:44):
lot of different sounds, a lotof different smells that there's
no way to prepare them. But ifthat's something that is
triggering for especially withsounds, we can decrease the
amount of stimulation or findthose headphones. Phones to
cancel the noise. So there's alot to be creative about that,
(20:05):
and especially for those child Ireally think are there is in the
power of the parents to speakfor them, to let us know what
works for them, what doesn'twork. And especially there's
some words right that we can saythat make them comfortable. And
in my book, I have theseinteractive section, and that's
(20:27):
where I give the whole familythe power to create their own
adventure. In your adventure,you want to bring this, you
bring it, and that's how youpresent to us. Okay, this is my
adventure, and this is who I'mcoming and bringing to my
adventure. In that sense, itdoesn't feel that we are
imposing something. And forautistic children, I think
(20:51):
knowing what is there ahead oftime will give them at least the
chance to refresh it. I thinkit goes back to what you're
saying about meeting familieswhere they are, because I do
find for many parents where kidssuffer from severe anxiety, for
example, when you offer them theoption of anesthesia, I find
that that gives families a lotof relief. And
(21:15):
just going to finish with theanxiety of the parents, I will
say the majority of the time isnot knowing what is going to
happen with the child. Andagain, this tool gives you an
idea what is anesthesia. And Iwant to make clear that even
though I'm showing one way ofgiving anesthesia, that doesn't
mean that when you go to thehospital, you demand. This is
(21:37):
the way that needs to be done.
This is a story based on truefacts, but he's making it a
magical adventure so parents andchildren have an idea of what is
to visit planet anesthesia, andthat will decrease your anxiety.
If you have known to this storymore, you're going to be able to
be open and again, children andtheir home team, they really
(22:01):
need to speak the same languageso they can really to a
storytelling learn together andcommunicate what they feel is
going to be more empowering forthem.
I'm very much looking forward toyour book making its rounds,
because it seems like it's goingto be a very helpful tool for
(22:22):
many families. Yes, thank you.
Now when it comes to theanesthesia wearing off, can you
give parents some awarenessabout what to expect in terms of
recovery from anesthesia?
Well, I have to start by sayingevery child metabolized
anesthesia differently, but justgeneral tools. We expect to have
(22:46):
them in the recovery room 45minutes to an hour. But that
conversation goes back and forthbetween the nurse taking care of
the child, looking at the vitalsigns, looking how he's waking
up, and what is the plan if thechild is going to be discharged
to a hospital room, or he'sgoing to be discharged home,
(23:07):
those things are in conversationbetween the surgeon, the
anesthesiologist, and the nursetaking care in the pacu, or how
I call the recovery station.
I'm reflecting on parentsstories. In the past, I've had
some parents that will tell methat it would that it frightened
them, because when their childwas coming out of anesthesia,
(23:29):
they seem to have a bad dream,or they yelled out loud. Is that
something common that you canspeak to so that if parents hear
this from their child, that theyknow that it is normal?
Yes, and yeah, I always say tothem, the child that you brought
today is not the same thatyou're going to meet in the
recovery room, and that'sabsolutely normal, and how it's
(23:51):
going to be different. Can begroggy, can be really agitated,
and especially when they haveprocedures like ear tubes, those
procedures, they go into a deepstate really fast and come out
of that really fast as well.
Plus their hearing is augmented,right? So it's very disoriented.
So there's no way to feel badthat they are feeling really
(24:16):
agitated, because it's a lothappening on them, but rest
assured, is gonna wear off. Soby the evening, you might have a
child that looks a little bitsimilar to the one that you
brought us, but for sure, afterthe following day, you will get
your child back. So work withyour child, try to keep the
(24:40):
environment as quiet as possibleand really give them the time to
process because it's a bigprocedure that has happened.
Another thing that helps isthings that they really like, a
blanket or a toy that is reallymeaningful to them to when they.
Wake up to have it near. So it'sa sense of familiarity in the
(25:02):
midst of all the things that arehappening after anesthesia.
Yeah, and I think that's a greatexplanation, because I think for
parents, the more that they knowahead of time what's normal,
what what they might expect fromtheir child, what might be
different after they recoverfrom anesthesia, I think will
relieve a lot of anxiety. Sothat's a great explanation,
(25:22):
and especially the ones thathave siblings, because they come
with the idea, oh yeah, she didgreat, fantastic. And I say,
totally fine. But every child,even siblings, will have a
totally different experience. Sobe prepared. Might be similar,
might be completely theopposite, and both are normal.
(25:44):
Out of curiosity, have younoticed an improvement in
anesthetic procedures sinceyou've been in the field of
anesthesia?
Oh, tremendously, really? Yeah.
It's fascinating how we arereally more child centered
approach. And I love that I amfrom Guatemala, and I did some
rotations, and unfortunately,during my medical training, we
(26:08):
were just the doctors doingwhatever was best for the child.
We were not the doctors doingwhat's best for the child with
the child. We were for thechild, but not with the child.
And that, to me, is a big, bigbonus, educating the public,
empowering the family to Yeah,you need to be the center. And
(26:31):
because we do X amount ofprocedures, that doesn't count
is one procedure at a time,I'm sure what must make a
tremendous difference in easingthe family's nerves. I'll bet
when they meet you, you havesuch a calm, relaxing,
informative presence that I'msure after they talk to you,
(26:53):
they feel much more reassuredand much better about their
child having anesthesia.
Thank you. Thank you. It's partof the passion. I think, in
general, I have not yet found apediatric anesthesiologist that
is not is working with childrenreally keep us that child like
(27:14):
attitude that we want toinspire, right? So I think is in
general, that's my bias that'sis because of them.
And I'm curious how much, howmuch more training does a
pediatric anesthesiologist haveto have compared to a general
anesthesiologist?
So after you complete your threeyears of general anesthesia, is
one or two years depending foryour training. So I did one year
(27:38):
and six months of pediatric ICU,wow. Well, on behalf of all the
children that you take care ofand the families that you that
you care for, thank you so muchfor thank you so much for
putting in that extra time.
Thank you. So if there was onefinal message that you could
leave with families, if they'reconsidering anesthesia for their
kids, what would itbe? Yeah, yeah, anesthesia,
(28:00):
especially in children, is notonly the child is the whole
team, and that's how I call it,the home team. So the more
prepared you are as a team, andespecially for the adults in the
home team, please make sure thatyou get answers that you speak
with people that are going to betaking care of your child so
(28:24):
your anxiety level doesn't getfeed to your child. But really,
I want children to be safe, soin order to do that, the adults
and especially the home team,needs to do those questions and
make sure that your child isbeing seen and taking care from
where the child is, andtell everybody about your book.
(28:48):
Where can they find it? BecauseI think that will be a great
help to families if they'repreparing for their child to go
under anesthesia.
This is called Adventureswithout JC, the unseen planet
has been available since June 3,and you can find it in Amazon.
There's also in Spanish. As aSpanish speaker, I think it's
(29:11):
important for the child tochoose the language of choice,
so it's aventuras con dog. JC,el planeta no vedoso and
felicidades si equista,aventuras el planeta no vedoso
on my website, WW, adventureswith Doc. JC, you have more
(29:34):
information, and you can reachme and post your questions, or
also on Instagram, at.jccable. It took a case to libro
as despondible, and lost andlost those English that is,
gracias a guy Los Angeles,tenemos ESA riqueza cultural
(29:58):
porque no Explora LA.
Amazing. Well, thank you somuch. Thank you for
thank you for doing what you'redoing. It gives me a lot of
comfort to know that childrenthat are in our community will
have you as a potentialpediatric anesthesiologist. So
thank you for the work that youdo. Thank you. Bye. Bye. You
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