An Interview with Our Kind Anaesthesiologists

Today, we have prepared an interview with one of our kind anaesthesiologists MUDr. Tomáš Bačkai (TB) and anaesthetic nurse Bc. Kateřinou Vymazalovou (KV). MUDr. Tomáš Bačkai is one of the specialist paediatric anaesthesiologists from the Motol University Hospital with whom we cooperate in our clinic. During the treatment in general anaesthesia, the closely-knit team of anaesthesiologist and nurse are the guardians and guides of you child through the procedure and they are always caring, helpful and in a good spirits

What does it actually mean to be a paediatric anaesthesiologist? Is it an official specialization? 

TB: The specialisation is the same for both "paediatric" and "adult" anaesthesiologists and you need to be board certified in anaesthesiology and intensive care medicine. Since Motol University Hospital is primarily a children's hospital, we deal with a wide range of paediatric patients, often with very complex conditions and demanding procedures. In a way, we are specialists in paediatric patients. In my case, I began focusing on paediatric anaesthesia and intensive care a year after graduating, and since then, I’ve been working exclusively with children.

So, paediatric anaesthesia isn’t exactly the same as adult anaesthesia? A child isn’t just a small adult? 

TB: Paediatric anaesthesia has its own specifics. Just think about the age range—we care for children from birth to the age of 19. Not everything can be explained to children, and cooperation is limited by age. Working with children requires patience and collaboration with their parents. It’s an advantage when an anaesthesiologist primarily focuses on paediatric anaesthesia, as they are more experienced and accustomed to handling potential complications in children.

How long have you been working in paediatric anaesthesia? 

TB: I’ve been working in paediatric anaesthesia and intensive care for over 15 years. As I mentioned earlier, my home hospital is Motol University Hospital.

Could you describe a typical day at work for us? What exactly do you do at Motol? 

TB: I work in the children's resuscitation unit, where we provide intensive post-operative and resuscitation care. Our department treats children after major surgeries that require sedation, continuous monitoring, and mechanical support of failing vital functions. We care for patients in very serious conditions and, with the help of the most modern medicine, we bring them back to life.

What would you say to parents who are worried about their child being put under general anaesthesia? 

TB: It’s completely understandable that parents are concerned about their children. Anaesthesia is a safe procedure that enables surgeries children wouldn’t be able to endure otherwise, either due to the length of time or lack of cooperation. In our case, it’s mostly dental procedures, where as many teeth as possible are treated within the available time (roughly 2.5 to 3 hours), and sometimes necessary extractions are performed. Under anaesthesia, the child doesn’t feel anything, experiences no pain, and is monitored and cared for by an experienced team of specialists throughout the entire procedure.

Could you walk us through the anaesthesia process? What should parents and children expect? 

TB: First of all, it’s important to follow the instructions regarding food and drink the night before the procedure. On the morning of the surgery, the anaesthesiologist examines the child and speaks with the parents. The induction of anaesthesia (putting the child to sleep) happens in the presence of the parents and lasts a few minutes. In most cases, it begins with inhalation (breathing in anaesthetic gas) using a mask. In some specific cases, intravenous induction (sedation administered via a vein) is possible.

It’s essential for parents to explain to their children that they’ll be wearing a mask on their face (they can tell them they are going to play a game pretending to be a diver or astronaut). After the child falls asleep, the parents leave the room and reunite with the child in the recovery room as they wake up. After the anaesthesia, the child may drool more, have slight bleeding from the mouth, or feel a mild sore throat (due to intubation). Nausea and vomiting are highly individual and can be managed with medication. The child remains under the anaesthetic team’s care for about 1.5 to 2 hours after the procedure, and then they go home accompanied by two adults.

Sometimes, premedication is used during the induction, meaning that about half an hour before the anaesthesia, the child may receive a sedative in the form of syrup or a nasal spray. Premedication isn’t necessary or appropriate for all children. It depends on the level of cooperation between the child, the family, and the anaesthesia team, and its use is at the discretion of the anaesthesiologist.

Is it advisable to prepare a child for the procedure in some way? 

TB: Absolutely. From experience, we know it’s not worth lying to the child. It’s crucial to follow the instructions regarding food and drink the night before the procedure. It’s also helpful to practice and explain the facial mask, as I mentioned, with a game pretending to be a firefighter, diver, or pilot.

KV: Exactly as the doctor says, the key is not to lie to the child. Once trust is lost, it’s very difficult to regain. That’s the real foundation. Everything should be explained calmly at home, in a way that’s appropriate for the child’s age. During the induction of inhalation anaesthesia, a mask will be placed on the child’s face, which is unusual for them but entirely painless. You can practice this at home by pretending to be a firefighter, diver, or pilot.

Of course, we strive for the most sensitive approach and a pleasant environment. The parent is present until the child falls asleep. Cooperation with the parent is absolutely key for a calm and manageable induction of anaesthesia and for the immediate post-operative care before being discharged home.

How long have you been working as an anaesthetic nurse? 

KV: Over 30 years now. I graduated in paediatric nursing—it used to be a specialisation right at secondary medical school. After graduation, I started working in the post-operative department of the paediatric cardiology centre at Motol University Hospital. The patients were all children, and the work was very demanding, dynamic, and I loved it. That’s why I later moved into paediatric anaesthesia, which I’m still dedicated to today. Over the years, I also completed the highest possible specialisation for our field, ARIP (Specialisation in Intensive Care).

Do you also work with adult patients in anaesthesia? 

KV: Yes, I currently also work as an anaesthetic nurse for adult patients, and I really enjoy that work too. But children are still my passion and priority.