Health Topics

Approximately one to two days before the scheduled surgery, a nurse from our Same Day Surgery unit will call and obtain some information about your child. The nurse will ask if your child's pediatrician has completed a physical examination form.

In addition, the nurse will ask about any medications your child is currently or has recently been taking. The nurse will also want to know whether your child is allergic to medications or foods and whether there has been recent exposure to any contagious diseases.
We will inform you about when and what you will be able to feed your child on the day of surgery. We will also tell you the time you will need to arrive at the hospital and give you any additional directions necessary. Arrival time is usually 90 minutes prior to the surgery's scheduled time.

On the day of the surgery, you will register at the front desk of the surgical area and then be escorted to an individual waiting room. There you will be interviewed and examined by a nurse and a member of the anesthesia care team.

• History of medical problem leading to the surgery
• Other medical problems, especially those concerning the heart or lungs
• Allergies to any medications or foods
• A list of current medications
• A list of other medications your child has recently taken
• History of previous anesthetics, especially any problems
• History of any problems with anesthesia in the family
• Any current illnesses, such as colds or the flu

A member of the anesthesia care team will discuss with you how your child will be anesthetized. 

For all elective procedures, the current health of your child at the time of surgery is very important to minimize any risks associated with anesthesia. For this reason, the nurses and physicians will ask if there have been any recent illnesses.

Be sure to tell the medical staff whether your child has had any recent respiratory infections, such as pneumonia, bronchitis, croup, tonsillitis or colds. Symptoms of these illnesses include fever, shortness of breath, coughing, runny nose or decreased appetite.
These illnesses may increase the risk of complications such as noisy breathing, which would require treatment or the possibility of a longer stay at the hospital. The chance of these complications occurring will depend on the severity of the infection and the type of procedure being performed.

The anesthesiologist is also concerned about your child having any symptoms such as nausea, vomiting, and / or diarrhea. Anesthesia given under these conditions may worsen some of the symptoms. Nausea may also increase the risk of aspiration (vomiting contents of the stomach into the lungs) associated with anesthesia.

For these reasons, it is important to tell the nurses and the anesthesiologist of any recent illnesses. 

We will tell you the night before what your child should eat and drink -- and whether he/she may have solids or liquids -- before the surgery. The number of fasting hours required before surgery varies according to the patient's age.

A distinction is made between solids and clear liquids.

For your child's safety, it is very important that you follow these instructions exactly. If these instructions are not followed and anesthesia is administered, vomiting, aspiration and pneumonia may occur. To avoid these complications, your child's operation or diagnostic test may be cancelled or delayed.

Child less than 12 months of age

• No fatty foods after midnight
• 6 hours before surgery: stop solid baby foods, cereal, formula, milk and milk products (except breast milk)
• 4 hours before surgery:
• Stop breast feeding
• Stop clear liquids
• Do not give anything more to drink.

Patient 12 months of age or older

• No fatty foods after midnight
• 8 hours before surgery: stop solid foods, milk and milk products, citrus juice, candy, gum
• 4 hours before surgery 
• Stop clear liquids
• Do not give anything more to drink
• Supervise tooth brushing to be sure that child does not drink water

Clear liquids are fluids you can see through:

• Water
• Sugar water
• Pedialyte
• Gatorade
• Kool Aid
• Apple juice
• Pulp free juices
• Soft drinks
• Jell-O
• Popsicles
• Breast milk
• Fat-free broth

Orange juice, cow's milk, soy milk, and formula are NOT clear liquids.

If your child is having surgery in the afternoon, your child may have a light dry breakfast up to 8 hours before surgery. A light breakfast is cereal, toast, and a clear liquid. Do not give meat, fried or fatty food for breakfast. Your child should not eat any fatty foods after midnight.

Stop all solid foods at 8 hours before surgery.

If the fasting guidelines are not followed, the anesthesiologist will determine when the surgery will be performed.

If your child takes medication routinely, give the usual morning dose with a few sips of clear liquid or water (including seizure and cardiac medications).

Inhalers for asthma should be taken at the usual time.

Aspirin and nonsteroidal anti-inflammatory drugs (like ibuprofen), or products containing aspirin or ibuprofen, should not be taken for two weeks prior to surgery. If your child needs to take these medications on a regular basis, please consult with your surgeon before the operation. Acetaminophen products, such as Tylenol, may be taken up to the time of surgery.

There are two basic methods of induction (putting your child to sleep with anesthesia):

• Intravenous -- an IV is started before the induction of anesthesia
• Inhalation -- the patient breathes anesthetic gas through a mask

The anesthesiologist decides on the type of induction, based on the following considerations:

• What is most safe for the patient?
• What is the age of the patient? If a child is less than 10 months old or 12 years of age or older the induction room is generally not used.
• What is the least stressful for the patient?
• What is appropriate for the type of surgery being performed?

Often, a medication is given to the child before the surgery. This may be done to help reduce any discomfort after the procedure, to help avoid problems during the anesthesia or to help relieve the child's anxiety. These medications, ordered by a member of the anesthesia team, may be given by mouth or by shot.

In addition, to decrease anxiety, a parent may be allowed to come into the induction room with their child. Located next to the operating room, the induction room is where the anesthesia is administered through a mask. An inhalation induction takes about three to five minutes. As children become sleepy from anesthesia, some close their eyes and fall asleep smoothly. Some enter a stage of excitement. During this stage, children may move their arms or legs gently or more forcefully. Some appear dizzy, breathe noisily or cough. Some may have unusual eye movements such as eye rolling. Your child will become heavy as he/she relaxes into a very deep sleep. Once asleep, you may kiss or gently touch your child before you are escorted to the waiting room. After you leave the induction room, your child will be taken to the operating room.

• Fatigue, dizziness
• Shivering
• Pale, puffy, swollen appearance
• Nausea and vomiting
• Sore throat
• Congestion and cough
• A need for oxygen
• Skin rashes, swelling and itching
• Bruising and discomfort at needle sites

A restless or irritable wake up in which the child may cry, thrash, arch their back, reach out and seem inconsolable can occur. This is known as "emergence delirium" and can last between 10 minutes to an hour.

These usually last for a few hours and resolve on their own.

After the surgery, most children are taken to the recovery room. There, a nurse assigned to a single child will monitor vital signs and ensure the child is comfortable.

When the child is awake and aware of the surroundings, the parents will be informed. Two people will be invited to the recovery room to accompany the child. The average stay in the recovery room is about 45 minutes to one hour. During this time, additional medications for pain and/or nausea may be given. Clear liquids may also be given by mouth if the surgeon allows.
Once the child meets the criteria for discharge from the recovery room, he/she will either be transferred to a hospital room, to a room in Same Day Surgery for further monitoring or sent home.

Upon leaving the hospital, written instructions will be given to the parents. These instructions may include information about how to care for an incision, pain medication or other material the medical staff deems appropriate for the child's at-home care following surgery.

If the child has pain that can not easily be managed by the surgical team or if the child has a special medical need, the Pain Service may be called to help. This team of pain specialists commonly helps with pain relief with the following:

• PCAs are computerized pumps that can be set to deliver a specific amount of medication when a button is pushed by a patient. Children as young as four years old have used PCAs effectively, although generally we only offer it to children over the age of seven. Safety settings include limits on how often the pump will deliver the medication and how much medication is given. Several medications can be used this way. Only the patient is allowed to press the button, except when specially arranged by the Pain Service.
• An epidural is a length of thin tubing that is placed in a space between the bones of the spine and the spinal cord. Medications can be given as an infusion to keep people comfortable after surgery.

There are other ways of helping with pain. A professional from Pain Management can speak with you about the possibilities.