General anaesthetic for children having CT or MRI scans

What is an MRI?

An MRI scanner uses a big magnet to take pictures of the inside of your child’s body. The MRI scanner looks like an open-ended tunnel with a bed that slides in and out.

Something we call a coil is placed around the area we want to scan and collects messages from your child’s body to make into a picture. We have lots of different sizes and shaped coils for different areas of the body.

Why does my child need an anaesthetic for a scan?

Having a scan involves your child lying very still on a moving table, which carries him or her inside the scanner. This is sometimes for over an hour.

Many children (and most adults) have their scans done while they are awake without any problems. This includes newborn babies who can be fed and wrapped; they will often fall asleep long enough for the scan to be done. Some children are able to lie still for the CT or MRI scan while they listen to a CD playing.

It can be frightening for some children to lay in the scanner as it is very noisy. It is less distressing for children to have a general anaesthetic so that they are asleep throughout the scan. If the child is asleep the radiologist will be able to get the best pictures from the scan.

The consent process and consent form

Before the scan, the doctor will discuss the procedure with you and answer any questions that you may have. You will then be asked to sign a consent form. By signing the form, you are agreeing that you understand the reason for the scan and the need for your child to have a general anaesthetic.

In most cases, the scan will be looking for important information about your child’s condition and for their care. This will be either to make or rule out an important diagnosis which may or may not affect the treatment your child is receiving.

What is a general anaesthetic?

General anaesthetics are medications used to cause a loss of consciousness (asleep). The word ‘anaesthesia’ means ‘loss of sensation’. A general anaesthetic will make sure that your child is asleep during the scan which will mean that they will not move, allowing us to get the best possible pictures.

The Anaesthetic Team

The Anaesthetic Team is made up of an anaesthetist, a nurse or an operating department practitioner and a recovery nurse.

Anaesthetists are specialist doctors who are responsible for the wellbeing of your child during the procedure and their recovery from the anaesthetic.

The nurse or operating department practitioner are trained to help the anaesthetist look after patients during the procedure.

The recovery nurse is the member of the team who will be responsible for looking after your child when they are waking up from the anaesthetic. Your child will wake up in the recovery room. When they are well enough, they will return to the ward.

The CT / MRI Team

The CT / MRI Team is made up of radiographers and a Radiology Care Assistant.

The radiographer will be the person taking the pictures of the inside of your child’s body and making sure that they are safe in the scanner.

The Radiology Care Assistant will ask you questions to make sure that it is safe for your child to have the scan. They will also remove any metal items, such as jewellery, glasses and watches before your child’s scan goes ahead.

The Paediatric Day Unit Team

This team is made up of nurses and assistants who will look after your child before and after their scan.

There will also be Play Specialists around for any support that may be required.

Before the scan

It is important that your child (except infants too young to understand) is told that they are going into hospital and that they will be having a scan. They should also be given some basic information about what will happen to them when they are in hospital. Please download the ‘Little Journey’ app to share with your child – the details are at the end of this page.

If your child has any special requirements, please let us know before the date of the scan appointment.

Nothing to eat and drink (fasting)

You will be sent a letter giving instructions about your child fasting before the scan. It is important that you follow these instructions carefully.

If there is food or liquid in your child’s stomach during the anaesthetic, it could come up into the back of the throat and damage his or her lungs.

On the day of the scan

Please arrive at the Paediatric Day Unit in the Children’s Centre at the time stated on your child’s appointment letter. You and your child will arrive at the same time as others who will be having the same procedure.

When you arrive, you will be shown to your child’s allocated bed. The nursing staff will go through their paperwork and may ask many of the same pre-assessment questions that you have already been asked. This is important to confirm that the details we have are correct.

They will then take some observations. This will include measuring your child’s blood pressure, heart rate, respiratory rate, temperature, height and weight.

The anaesthetist will come and see you and have a chat about the anaesthetic. You will have the opportunity to ask any questions or discuss any concerns that you have during this time.

Sometimes, the anaesthetist may learn something about your child that means it would be safer not to go ahead with the procedure on that day. This may be frustrating but if the decision is made, it is for your child’s safety.

Once the order of the procedure list has been decided, you will be told so you are aware when to expect your child to have their anaesthetic and scan.

When the CT / MRI department are ready, you and your child will be taken to the Radiology Department.

Timing of the scan

Planned scans can take up to 1 hour. If your child has to wait more than 2 hours for the scan, they may be offered some water to drink.

Pre-medication

Pre-medication (a pre-med) is the name for the medicines which are sometimes given before an anaesthetic. Pre-meds can be used to help a patient to relax.

Not every child will need a pre-med but if they have one, the pre-med may make your child drowsier after the procedure. This may mean that going home will be delayed.

In the CT / MRI Department

On arrival in the Radiology Department, you and your child will be greeted by the Anaesthetic and Radiology teams.

You are welcome to stay with your child until they are unconscious (asleep) if you wish to do so. However, there are a few circumstances when this will not be possible. This will be explained before the procedure.

If it is appropriate, the anaesthetic may be given while your child is sitting on your lap. This will be either by gas to breathe or an injection in the area that has been numbed.

If an injection is used, a local anaesthetic or ‘magic’ cream called LMX4 is usually put on to the area of your child’s skin where the injection will be given. This will make the skin numb before a cannula is inserted into a vein in your child’s arm for the anaesthetic injection to be given. The cream will take at least 30 minutes to work, so please do not remove it. The anaesthetic given through a cannula will work very quickly.

If the anaesthetic is given by gas, it will take a little while for your child to fall asleep and they may become restless as the gases take effect. Anaesthetic gases smell similar to felt-tip pens.

Some parents/carers may find all this frightening and upsetting, but your child is safe in the care of the skilled anaesthetist and the rest of the team. Once your child is asleep you will be guided, by one of the team, to where you need to wait while the scan takes place.

Your child will be transferred onto the MRI scanner to have their scan. As mentioned earlier, a coil will be placed around the area that we are going to scan. When your child is transferred to the MRI scanner, the area to be scanned will be in the middle of the scanner.

The anaesthetist will closely monitor your child’s blood pressure, pulse, temperature and breathing during the procedure, making sure that they are safe and fully unconscious. Anaesthetic gases and/or drugs given into the vein will be used to keep your child anaesthetised.

The scan may require an injection of dye. This will be decided by the Radiologist. Using the dye will give more detail on the scan. The dye is completely colourless and will be given through the cannula already inserted into your child’s arm.

What happens next?

After the scan, your child will be moved to the recovery cubicle until they wake up. Some children wake very quickly, while for others, recovery from the anaesthetic takes longer. Your child will usually be awake within 15 minutes after the scan. You will then be called through to the recovery area to be with your child.

How will my child feel when he/she wakes up?

Many children are a bit confused and tearful when they first wake up after an anaesthetic. It is common for children to feel dizzy for a few hours afterwards. Most children can have fluids to drink as soon as they feel like it and then food a bit later.

How soon will I be able to take my child home?

The ward nurses will advise you, but most children are ready to go home about 11/2 hours after returning to the Paediatric Day Unit.

Risks and safety

In modern anaesthesia serious problems do not happen very often. Most children recover quickly and are soon back to normal after their anaesthetic.

Listed below are the possible risks of having an anaesthetic:

• 1 child in every 10 has a headache or a sore throat.
• 1 child in every 10 has sickness or dizziness - medicines to treat sickness are often given.
• 1 child in every 5 is agitated (restless, anxious) when waking.
• Around 1 child in every 10,000 develops a serious allergic reaction to the anaesthetic.
• The risk of death from anaesthesia for healthy children having minor or moderate non-emergency surgery is less than 1 in every 100,000.

The figures are quoted from the Royal College of Anaesthetists ‘Your Child’s General Anaesthetic’.

What if my child has special medical problems or a serious health problem?

The likelihood of a serious risk or complication is higher if your child has a serious illness.

Children with significant illness have particular risks associated with the anaesthetic. The anaesthetist will discuss this with you before the scan.

Modern equipment, training and medication have made having an anaesthetic very safe, although all risks cannot be removed completely.

Going home

Your child’s scan will be carried out as a ‘day’ case. This means that they will go home on the same day as the scan.

Some children may be sick (vomit) after they have left the hospital, this might happen in the car on the way home, so be prepared.

Sometimes, children do not sleep well after a day in the hospital. Their behaviour might be a little bit more clingy or difficult. This is a normal reaction to the experience and will usually return to normal within 3 to 4 weeks.

Results

The results of the scan will be sent to the doctor looking after your child. This can take a few weeks. The doctor will call you or arrange an appointment to see you and your child.

Contact information

If you have any further questions or concerns about your child’s scan, please contact one of the departments listed below:

Anaesthetic Department

Gloucestershire Royal Hospital

Tel: 0300 422 6812

Monday to Friday, 8:00am to 4:00pm

Paediatric Day Unit

Gloucestershire Royal Hospital

Tel: 0300 422 8452

Tel: 0300 422 8453

Monday to Friday, 7:00am to 7:00pm

Radiology Department

Gloucestershire Royal Hospital

Please use the telephone number printed at the top of your child’s appointment letter.

MRI Appointments Office

Tel: 0300 422 6757

In addition, the hospital’s Patient Advice and Liaison Service (PALS) is there to provide help and support so that you get the best from NHS services.

Patient Advice and Liaison Service

Gloucestershire Royal Hospital

Tel: 0800 019 3282 (Free phone)

E-mail: ghn-tr.pals.gloshospitals@nhs.net

Further information

Little Journey

The Little Journey app supports families through every step of their healthcare journey. We help to reduce anxiety by preparing families for what to expect in their hospital visit. You can download the App for free on your phone and have a look around the different pathways.

Website: www.littlejourney.health/

The Royal College of Anaesthetists

Patient Information Resources, Churchill House, 35 Red Lion Square, London WC1R 4SG

E-mail: admin@youranaesthetic.info

Website: https://rcoa.ac.uk/patient-information/patient-information-resources/information-children-parents-carers

The website above gives you more information about your child’s anaesthetic. You will also find information, with pictures, that you can download and read with your child.