AWAKE Information Guide

What is AWAKE?

AWAKE is a program to reduce the use of general anesthesia during some scans and medical procedures.

AWAKE stands for “Achieving Care With Less Anesthesia Keeps Everyone Safe.”

The goal of AWAKE is to reduce general anesthesia by increasing education and availability of alternatives for St. Jude patient families for certain scans and procedures.

The AWAKE team includes subject matter experts and representatives from many different disciplines including Anesthesia, Child Life, Pharmacy, Psychology, Diagnostic Imaging, Radiation Oncology, Patient Education, and Nursing.

Your care team will talk to you about the anesthesia options that are appropriate for your child. Staff will also help you know what options are available depending on the type of scan.

If your child cannot stay still the first or second time, that's OK. Your child can always try again during a future visit. Keep in mind that your options may be different for each visit, so ongoing communication with your care team is very important.

What are the benefits of staying awake for scans?

When possible, health care providers try to limit the use of general anesthesia in children. This is because too much general anesthesia could affect brain development, especially for children under age 3.

Benefits of staying awake during a scan include:

Fewer risks and side effects: Anesthesia is generally safe, but there are potential risks and side effects. You avoid these risks if your child stays awake. Some research suggests that repeated exposure to anesthesia may cause changes in the brain that are associated with learning problems.
Shorter appointment times: Without general anesthesia, less time is needed for tests and exams before the scan. Your child will not have to spend time in recovery after the scan and will feel less groggy after the scan or procedure.
Fasting (NPO) guidelines may not be needed once your child is able to complete scans successfully while awake. This means your child may not have to follow the fasting (NPO) guidelines for anesthesia and could eat and drink normally, depending on the scan or procedure. Your care team will let you know if your child cannot eat or drink before a scan. Always follow the instructions given by your care team to avoid a delay or schedule change.  
Sense of control and accomplishment: Using coping strategies successfully can help your child feel more confident and in control of their environment. These skills can help them manage stress and cope with other medical procedures.

What are non-medicine strategies that can help my child during scans and procedures?

Ways to help your child get ready for scans may include:

Explain what to expect including what they will see, hear, and feel.
Have your child practice being still at home; make it a game and have them try for longer times.
Use coping strategies like deep breathing and relaxation exercises.
Plan for entertainment during the scan, like listening to music or watching a movie.
Bring a comfort item like a stuffed animal or blanket.
If a scan is early in the morning, have your child stay up a little later than normal the night before. If the scan is late in the day, have your child get up early or avoid napping before the scan time. Your child is more likely to fall asleep during the scan if they are tired.

Your care team will work with you to develop a plan for your child based on their age and medical needs. The available options will also depend on the type of scan or procedure. Ask your care team about the options for your child.

Each patient is different. You and your care team will work together to figure out what works best to help your child be successful. A child life specialist or psychology team member may help your child practice in a mock scanner and learn coping and relaxation strategies.

Staff will also help you know what options are available depending on the type of scan.

If your child cannot stay still the first or second time, that's OK. Your child can always try again during a future visit. Keep in mind that your options may be different for each visit, so ongoing communication with your care team is very important.

What medicines may be used instead of general anesthesia?

Your care team may recommend medicines that can help your child stay calm and still during imaging scans as an alternative to general anesthesia. These include sedation medicines that make your child feel sleepy or relaxed. Other medicines include medicines to decrease pain or reduce anxiety. 

Common sedation medicines include Versed (midazolam), Precedex (dexmedetomidine hydrochloride), Ativan (lorazepam), and Benadryl (diphenhydramine). These can be given through a vein by IV or by mouth, depending on the procedure and your child’s needs.

What is the difference between general anesthesia and sedation?

General anesthesia causes a complete loss of consciousness. It is often described as a “deep sleep.” But unlike normal sleep, your child will not feel sensations such as pain. Your child may breathe in the medicine through a mask or breathing tube. Or they may get medicine through a vein by IV.

There are different levels of sedation: mild, moderate, and deep. With mild sedation, your child may feel sleepy or relaxed.

When under deep sedation, patients are usually unaware of their surroundings, but they might respond to stimulation, such as being asked to open their eyes.

The goal of AWAKE is to help reduce the use of general anesthesia when possible. Sedation medicines are one option that your care team might recommend.

What if my child needs general anesthesia for scans?

Many children will need general anesthesia for some of their scans and procedures. It is also OK for your child to have anesthesia for some scans and not others.

Care team members are here to support your child and provide the best possible care.

The goal is to help educate you on different options available and support your child at every step.

What happens if my child tries to stay awake, but can’t complete the scan?

If your procedure is booked with anesthesia, an AWAKE anesthesia provider will be readily available to assist, as long as fasting (NPO) guidelines have been met.

It is also important to keep in mind that your child can try again another time if they are not successful at first.

How will my child’s care team tell me about my options for staying awake?

If your care team thinks your child might be a good candidate for AWAKE, you will receive a phone call so you can discuss your options with someone from the anesthesia team.

You can also ask questions regarding your options in any anesthesia pre-clinic assessment.

A child life specialist is also available to speak with you about options. You can also talk to your anesthesia care team the day of your procedure.

Ask questions and discuss your options with your care team for all care-related decisions. Ongoing communication is important. You can change your mind or choose different options at a later date.

How does AWAKE impact my child’s schedule while on campus?

If your child is participating in AWAKE for MRI scans, you will have 15 minutes of extra time to attempt awake. This time is already built in to your child’s appointment time.

If your child is not successful with their awake attempt, they can get general anesthesia or sedation medicines, as long as they followed fasting (NPO) guidelines.

For radiation therapy and other procedures, the extra time is not built in to your appointment. Ask about your options ahead of time so that you can work with your care team to develop an awake plan for your child based on the type of procedure.

How will the care team know if my child is able to stay awake for a scan or procedure?

Your care team will work with you to know if your child has a good chance of staying awake.

Questions your care team will consider include:

What is your child’s age?
What are the features of the scan (length of time, position)?
Has your child previously completed a scan without general anesthesia?
Does your child have a condition that might affect their ability to stay still or follow instructions, such as ADHD, autism, intellectual disability, or sensory processing disorder?

Can my child eat and drink before sedation?

Until you have been given other instructions, please follow all fasting (NPO) guidelines as instructed. Once your child has been successful awake and does not need anesthesia or sedation medicines, they may no longer need to fast before scans.

However, until that time, it is important to follow fasting (NPO) guidelines in case your child is not successful in their awake attempt. If they need anesthesia and have not followed fasting (NPO) guidelines, we will have to reschedule their scan.

Can my child take medications before general anesthesia or sedation?

Yes, in most cases. Always ask your provider which medicines your child should take. There are a few medicines that are not safe to take before anesthesia. Be sure you know the timing of the medicines and how to take them.

Contact a member of the AWAKE team at 901-612-1256 to learn more.