infants & toddlers
 
Preparing Parents and Children
for Surgery and Anesthesia

Anticipation of a surgical procedure can be very stressful for a family. From the time that you are informed that your child requires a surgical procedure you may meet with many doctors, nurses and health care providers who will try to make this experience as pleasant as possible. Your pediatrician usually refers you to the surgeon who schedules the surgical procedure to be done in a hospital or surgery center.

Know What to Expect

In order to help your child get through this experience it is important that you as a parent understand what to expect throughout the process, starting with the surgical procedure and why it needs to be done. Your child's surgeon should explain the operation and what to expect during the recovery period.

The need for general anesthesia during an operation is a concern for most people. Anesthesiologists are medical doctors who care for people throughout the surgical experience. Before the surgery an anesthesiologist will perform a history and physical exam that will direct your child's anesthetic care. In the operating room the anesthesiologist vigilantly monitors your child while he is asleep during the surgery. After surgery is completed, the anesthesiologist is responsible for supervising care until your child is discharged from the recovery room. Anesthesiologists are sensitive to the individual needs of each child and family and some have special training in the anesthetic care of children.

Prepare Your Child by Being Completely Honest

The most important thing a parent can do is to be completely honest with your child about the surgery and anesthesia. You can help your child by preparing him for the operation as soon as you know that the surgery is scheduled. Children do much better when they are well prepared and know what to expect. You should explain the operation to your child in a way that he will understand. The hospital environment has a lot of activity with strange noises, large open areas and medical equipment. It is important to familiarize your child with the hospital setting by telling him what to expect.

It is normal for you to be anxious when your child is having surgery, but try not to allow your child to see your anxiety. If you stay calm and reassuring with your child, he is more likely to stay calm and have a positive experience at the hospital.

Prior to Surgery

Your doctors will give you specific guidelines to follow the night before surgery. Surgery may be postponed or canceled if these guidelines are not followed. Because your child is at risk for vomiting while under anesthesia, your child will be instructed to stop eating at midnight the night before surgery. If your child has food in his stomach and vomits, food can go into the lungs and cause serious problems. Normally, we can prevent food from getting into the lungs because we can cough. When under anesthesia, you are completely relaxed and unable to cough, so an empty stomach before surgery is essential to your child's safety.

The Day of Surgery

Your child will be admitted to the hospital by a nurse who will ask you some questions, take vital signs, and have your child change into hospital pajamas. An anesthesiologist will then meet with you to ask questions regarding your child's health and discuss the anesthetic plan.

Anesthesia may be started a number of different ways. In adults, anesthesia is started by intravenous injection of medications, which cause the patient to fall asleep very quickly. This method may also be used in children, however, it requires that the intravenous catheter be placed with the child awake. An alternative technique often used for children is called the mask induction. Children fall asleep while breathing the anesthesia medicine through a mask. The actual method used will be chosen by the anesthesiologist based on your child's history and what is safest for your child. After the surgery is completed you will be reunited with your child in the recovery room.

Resources:

* Some hospitals have initiated preoperative evaluation programs where the patients are seen prior to the procedure day. These programs are beneficial to parents and children as they allow them to be exposed to the hospital environment in a less threatening manner. During these visits children are allowed to touch and play with the equipment which may allow them to be more accepting of the mask and monitors on the day of surgery.

A Hospital Story by Sara Bonnett Stein, a particularly good book addressing the importance of honesty with children.

The American Society of Anesthesiologists Web Site at http://www.asahq.org

Sesame Street Goes to the Hospital Big Bird's feeling sick with a bad cold and has to go to the hospital; a good video to help prepare your child for hospitalization.

Lisa Caramico, MD, is a practicing pediatric anesthesiologist at Yale-New Haven's Children's Hospital and the mother of a ten-month-old. NOTE: This information is not a substitute for the medical care and advice of your personal health care provider.

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