If your child needs to have a general anaesthetic or sedation, special preparation is necessary for the procedure to be performed safely. This involves stopping your child eating and drinking before the anaesthetic or sedation.

All food and milk, including breast milk, must stop before the general anaesthetic/sedation time. This time may differ dependent on which procedure is being carried out and your local hospital fasting guidance. Fasting guidance will also vary dependent on the age of your child.

Please confirm all fasting guidance with your local hospital

Fasting advice for a patient with Diabetes/Steroid Induced Diabetes:

Children and young people with diabetes, or on insulin, will be advised by the diabetic team as to when and how much insulin to have prior to a general anaesthetic. If you are unsure of what to do when your child is having an anaesthetic please contact the diabetes team or oncology team for advice. If, whilst fasting for an anaesthetic, your child has a low blood glucose level (‘hypo’, blood glucose below 4 mmol/L) this should be treated with a STILL (not fizzy) glucose-containing drink such as pure apple juice.

Who needs a lumbar puncture and why?

Lumbar punctures are tests to examine the fluid that goes round the brain and spinal cord. This fluid is called cerebrospinal fluid (CSF) and its examination is important in:

• Detecting tumour cells (such as leukaemia) which may have got into the brain area
• Detecting infections like meningitis in children who are unwell

How is a lumbar puncture done?

The anaesthetist puts your child to sleep using medicines. We position your child on their left hand side with their knees bent and the doctor inserts a special needle into the space in between two backbones in the lower back and collects the CSF. Sometimes, the procedure may be difficult and the doctor may have to repeat the test. The picture below shows where the doctor places the needle.

Image copyright https://curesearch.org/

Anti-cancer drugs like methotrexate can also be given through the same special needle that is used to get CSF. These drugs are called intrathecal drugs. A plaster will be placed on the site following the procedure, this should be removed later the same day.

What are the side effects of having a lumbar puncture?

Some children may develop a headache after a lumbar puncture. If this happens, please inform your nurse or doctor.

Who needs a bone marrow aspirate and why?

Bone marrow aspirates and bone marrow trephines are tests which may be needed in children and young people for the following reasons:

• To find out why a child has had an abnormal blood test result
• To help diagnose a tumour somewhere else in the body when the bone marrow test has shown there has been a spread (metastases) to the bone marrow.
• To monitor the effect of treatment (chemotherapy) in children and young people who have leukaemia or other cancers.

What is involved in the tests?

Bone marrow is the name for the blood-forming cells that live in the centre of the bones. A bone marrow aspirate is a test that removes a small amount of bone marrow for further tests. An anaesthetist puts your child to sleep using medicines and a local anaesthetic is injected into the skin over the back of the hip. A small needle is inserted into the bone and about half a spoonful (2mls) of bone marrow is drawn into the syringe. The sample of bone marrow is then sent to the pathology department for further investigations. The picture below shows the the position and where the needle is placed.

Image copyright https://curesearch.org/

A bone marrow trephine is a test where a small cylinder of bone marrow is removed with a thick needle. It is the same as a tiny ‘apple core remover’. This is commonly performed at the same time as a bone marrow aspirate using the same hole in the skin. This is particularly useful in the case of lumpy hard tumours.

Where are these tests done?

The tests are normally done on the Day Care Unit on a set day depending on the hospital.

They can, however, be performed on the intensive care unit or main theatres if an operation is required or the patient needs intensive care.

What will happen afterwards?

After the bone marrow aspirate or trephine a small plaster is put on the site of the injection, this plaster must be removed by the following day; it is also common to have a small bruise there. There may be some pain over the site, so regular painkillers are given before and during the test. If your child experiences any other problems please contact the ward for advice. The results of these tests are usually available within a week and are given to parents by a senior member of staff.