From Therapy to the OR: How OTs, PTs, and Anesthesia Providers Collaborate in Pediatric Care

As a therapist, you build deep relationships with your patients. You know their triggers, their strengths, their communication style, and the strategies that help them thrive. Then one day, a parent tells you their child has been referred for surgery — and suddenly your patient is entering a world you may know very little about.

What happens in the operating room? Who manages the anesthesia? How do decisions made during surgery affect the rehabilitation timeline you’ll manage afterward?

The Patient Journey: Where Therapy and Surgery Intersect

Consider a common scenario: a seven-year-old with autism and low muscle tone is referred for hip surgery to correct a progressive subluxation. As his physical therapist, you’ve been working with him for two years. You know he panics when strangers touch his legs. You know he calms down when someone counts backward from ten in a slow, rhythmic voice. You know he communicates primarily through a picture exchange system.

Now imagine that information never reaches the surgical team.

The anesthesia provider doesn’t know about the touch sensitivity, so standard monitoring placement triggers a meltdown before the child even enters the OR. The recovery nurse doesn’t know about the picture exchange system, so the child wakes up disoriented and unable to communicate pain. The surgeon doesn’t know about the low tone patterns you’ve been tracking, so post-operative rehab expectations are set without your baseline data.

Much of this can be prevented. Anesthesia guidance for autistic patients calls for an individual plan, covering communication, how the child shows pain, and sensory needs, to be shared with the whole team before surgery.⁠¹

What Anesthesia Providers Actually Do

Many therapy professionals have a general sense that “someone puts the patient to sleep,” but the reality is far more nuanced. Understanding these roles helps you communicate more effectively with the surgical team.

The Providers

Certified Registered Nurse Anesthetists (CRNAs) are advanced-practice registered nurses with at least a master’s degree, and sometimes a doctorate, who specialize in anesthesia. They give anesthesia and provide care before, during, and after surgery and other procedures.⁠²

Anesthesiologists are physicians (MDs or DOs) with 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training. They manage complex cases, perform regional anesthesia techniques like nerve blocks, and often supervise anesthesia care teams.⁠³

Certified Anesthesiologist Assistants (CAAs) work under the supervision of anesthesiologists and are trained at the master’s degree level. CAAs can practice in 22 states, Washington, DC, and Guam, and work within the anesthesia care team.⁠⁴

What They Manage During Surgery

Anesthesia providers do far more than administer medication to induce sleep:

• Airway management: Securing and maintaining the patient’s airway throughout the procedure⁠⁵
• Hemodynamic monitoring: Continuously tracking heart rate, blood pressure, oxygen saturation, and other vital signs⁠^5,3
• Pain management: Administering medications to prevent pain during and after surgery, including nerve blocks, which affect what the child can feel and move afterward⁠^3,6
• Fluid management: Maintaining proper hydration and blood volume
• Emergence management: Carefully bringing the patient back to consciousness while managing pain, nausea, and agitation⁠⁵

How Your Expertise Directly Impacts Surgical Outcomes

Here’s what many therapists don’t realize: you may hold critical information that can change how anesthesia is delivered and how surgery is performed.

Sensory Profiles Inform Anesthesia Planning

The sensory profile you’ve developed through months or years of therapy is invaluable to the anesthesia team. When you document that a child:

• Cannot tolerate anything touching their face → The anesthesia provider can plan for an IV induction instead of a mask induction, or let the child hold the mask or keep it just off the face⁠¹
• Is calmed by deep pressure → The team can offer a weighted blanket⁠¹
• Becomes agitated with auditory stimulation → The team can keep the room quiet, dim the lights, and turn monitor alarm volumes down or mute them as appropriate during induction and recovery⁠¹
• Has a specific calming routine, such as counting or singing → The team can build it into induction, with a familiar supporter present and one person doing the talking⁠¹

This isn’t soft information — it directly affects medication choices, induction technique, monitoring strategies, and recovery planning.⁠¹

Functional Assessments Set Realistic Recovery Benchmarks

Your pre-operative functional assessments give the surgical team critical baseline data:

• Range of motion measurements that set expectations for post-operative gains
• Strength and tone assessments that inform weight-bearing protocols
• Functional mobility levels that determine appropriate discharge criteria
• Endurance and fatigue patterns that shape the rehabilitation timeline

Without this information, post-operative goals have to be set without a baseline for this child, which matters most for a child with underlying neuromuscular differences.

Communication Strategies Prevent Post-Operative Distress

If your patient uses augmentative and alternative communication (AAC), sign language, or picture exchange systems, the recovery team needs to know this before the child wakes up from anesthesia. Children can wake from anesthesia groggy and restless, and anesthesia guidance for autistic patients calls for a familiar person in recovery and a plan for the child’s communication needs.⁠^5,1

Provide the surgical team with:

• The specific communication method your patient uses
• Key phrases or signs for “pain,” “scared,” “want mom/dad,” “yes,” and “no”
• Whether the AAC device should be present in recovery (and charged)
• How the patient indicates pain (behavioral cues, facial expressions, body language)

How Anesthesia Decisions Affect Your Therapy Outcomes

The collaboration isn’t one-directional. Decisions made during anesthesia directly impact the therapy plan you’ll execute afterward.

Regional Anesthesia and Nerve Blocks

When an anesthesia provider performs a peripheral nerve block — numbing a specific nerve or group of nerves — it can profoundly affect early rehabilitation:

• Benefit: Effective pain control with much less need for opioids and their side effects⁠⁶
• Consideration: The blocked area stays numb, and with some blocks weak, until the block wears off, which affects initial PT assessments; how long that takes depends on the drug, any additives, and whether a catheter was left in⁠⁶
• What to ask: “Was a nerve block placed? Which nerve? What’s the expected duration?”

Pain Management Protocols

The transition from surgical pain management to functional rehabilitation is one of the most critical handoffs in pediatric care:

• Multimodal protocols (combining nerve blocks and non-opioid medications) aim to keep opioid use low, the approach enhanced-recovery pathways after surgery are built on⁠⁶
• Patient-controlled analgesia (PCA) can empower older children but requires cognitive and motor skills that some patients may not have⁠⁷
• Children who cannot easily report pain are at higher risk of undertreated pain: after spine surgery, children with cognitive impairment were assessed for pain less often and received less opioid, and autistic children may not show typical signs of pain — your behavioral pain assessment skills are essential here⁠^8,1

Medication Effects on Cognition and Coordination

Some anesthesia medications have residual effects that can last for hours:⁠⁵

• Sedation and drowsiness may reduce therapy participation on post-operative day one
• Some anti-nausea medications can cause drowsiness or restlessness; metoclopramide, for example, can cause both⁠⁹
• Muscle relaxants used during surgery are monitored and reversed to keep any lingering effect to a minimum, but some children may feel subjectively “weak” afterward⁠¹⁰

Understanding these effects helps you distinguish between surgical side effects and genuine functional changes.

Building the Bridge: Practical Steps

Before Surgery

Send a one-page sensory and communication summary to the surgical team. Include triggers, calming strategies, communication method, and behavioral pain indicators. Keep it concise — surgical teams are information-overloaded, so bullet points work best.

Share your most recent functional assessment with the surgeon and the therapy team who will manage post-operative rehabilitation (if it’s a different provider). Include baseline range of motion, strength, functional mobility, and endurance.

Connect with the child life specialist if the hospital has one. They’re your natural ally in the hospital setting and can reinforce the preparation strategies you’ve been using in therapy.

After Surgery

Request the anesthesia and surgical report (through the parent or referring provider). Knowing what nerve blocks were placed, what pain management protocol was used, and whether there were any complications helps you adjust your therapy plan.

Reassess early and set adjusted goals. Post-operative function is not the same as pre-operative function. The child may have new sensory experiences (surgical site sensitivity, cast or brace intolerance, scar tissue) that require updated sensory strategies.

Communicate with the prescribing team about pain management as therapy progresses. If a child is too sedated to participate in PT, or if pain is limiting functional progress, that feedback loop is essential.

Why This Matters More Than Ever

Anesthesia guidance for autistic patients already calls for advance planning by multidisciplinary teams, with each child’s plan shared with everyone involved. Understanding each other’s roles isn’t just professional courtesy — it is how that plan reaches the people who need it.⁠¹

The more you understand about what happens in the OR, the better you can prepare your patients for it — and the better you can rehabilitate them afterward.