After your surgeon has determined that a procedure is indicated, the procedure will be scheduled at a time that is convenient for both you and your surgeon. Depending on the specific procedure planned or other health conditions that your child may have, you may be asked to visit the preoperative clinic prior to the day of surgery. If this is not required, a nurse will call you the day before the scheduled procedure in order to review your child’s history and go over instructions. It is important that you notify the preoperative clinic or the nurse who calls you of any allergies or any prior problems with anesthesia that your child has experienced. Please also notify us if your child is not currently in their optimal state of health (for example the common cold or vomiting). Sometimes it is best to postpone elective procedures to a later date if your child is not well.
It is important to follow appropriate guidelines for eating and drinking prior to surgery. Failure to adhere to these rules may result in your child having food or liquid in his or her stomach at the time of surgery. A “full stomach” would put your child at risk for having stomach contents leave the stomach and travel up to the lungs when they go to sleep. This is called “aspiration.” Aspiration can be potentially life threatening. It can lead to breathing difficulties, pneumonia, prolonged hospitalization, and/or ICU admission.
Please ensure that your child stops eating or drinking the following:
Upon arrival to the hospital on the day of surgery, your child will be checked in prior to moving to the preoperative (“preop”) area. In preop, your child will be weighed and have vital signs checked, including blood pressure, heart rate, temperature, and oxygen level in the blood. You and your child will then be brought to a room where you will meet your preop nurse. Your nurse will ask you additional questions and will ask that your child change into a hospital gown. The anesthesiologist and surgeon will come visit with you and your child in this room. Children are often anxious on the day of surgery. In order to help relax your child and make the experience less anxiety provoking, your anesthesiologist may order an oral medication called midazolam to be given to your child prior to surgery. This medication is often referred to as “silly juice” or “giggle juice.” After talking with the surgeon and anesthesiologist, you will meet the nurse who will be with your child in the operating room. Your child will then accompany their nurse to the operating room for their procedure.
During the procedure, you will wait in the surgical waiting room. If you should wish to leave the area while your child is in surgery we ask that you please leave a contact number with the waiting room concierge. When your child arrives in the operating room, he or she will be assisted to move to the bed that they will be on for the procedure. Then, special stickers and a blood pressure cuff will be placed so that your anesthesiologist can monitor your child during the procedure. Your child will likely go to sleep with a mask that smells like bubble gum. This method allows your child to fall asleep quickly without the need for IV placement while he or she is awake. An IV will be started after your child is asleep, so he or she will not feel pain. In older patients or in specific circumstances we may prefer to start your child’s IV prior to going to sleep. Your anesthesiologist will likely place a breathing tube to support your child’s airway while they are asleep. When the procedure is completed, your anesthesiologist will remove the breathing tube.
You will meet up with your child in the postoperative area (PACU – post anesthesia care unit). This area is often referred to as the “wake up room.” Your anesthesiologist and operating room nurse will bring your child to the PACU from the operating room when the surgery is over. Frequently, your child will still be drowsy during this time period. As your child wakes up, he or she may be a little fussy or disorientated. This is normal and will resolve as your child wakes up more. The nurses in the PACU are registered nurses who specialize in the care of children after surgery. They are extremely competent in evaluating postoperative patients and helping to usher them through the wake up period. Your anesthesiologist and PACU nurse will work together to ensure adequate pain control as your child wakes up. When you leave the hospital, the surgical team will provide instructions for pain medications at home. Sometimes children can have nausea after surgery. We generally do our best to prevent this; however, if your child experiences nausea and vomiting it will be treated in the PACU. We prefer that patients are able to drink liquids prior to going home after surgery. However, this is not an absolute requirement. We will work as a team to determine the best approach for your child's particular needs.