Department of Paediatrics Your Child is having an Operation Patient Information Leaflet This information leaflet explains what to expect when your child comes into hospital to have an operation or investigation procedure. Preparation There are many things that you can do to prepare your child for coming into hospital All children (except infants too young to understand) should be told: that they are going into hospital that they will be having an operation or investigation some basic information about what will happen to them when they are in hospital. Everything should be explained to your child in a way that they can understand. Many hospitals have play staff who can give explanations and encourage discussion through play Timing when to tell Children between 2 and 3 years of age should be told 2 3 days before and again on the day of admission. Children between 4 and 7 years of age should be told 4 7 days before the day of admission Older children will usually be involved in making decisions about the operation or investigation and discussion can take place a few weeks before the day of admission Some ideas of what to say. Explain that the operation or investigation will help your child to get better. Use simple words your child understands. Encourage your child to talk about the operation and ask questions. Books, games and stories can help. Tell your child about timing when he or she will have the operation or investigation and how long their stay in hospital will be. Concerning younger children, the child s preparation information on CUH website may be helpful to you and your child. It contains child friendly information and photographs of the Operating Theatre Department in CUH. http://www.cuh.hse.ie/patients_visitors/patient_leaflets/ If your child will be staying in hospital overnight, let them know if you will be able to stay too. If it is not possible for you to stay with your child, it is important that you explain to them when you will be able to visit. Your child can help pack their own bag and decide which nightclothes and toys to bring. Please let us know in advance any special requirements your child has and we will do whatever we can to help.
On the day of admission Only the child who is to have the operation, and the parent(s) or legal guardian(s) should come to the hospital Please inform nursing and medical staff of any relevant health concern or family history. Your child's theatre time is not booked for a particular time; this decision will be made on the day of the operation by the doctors and nurses in the Operating Theatre Department. Medications If your child is taking regular medication for any condition, please check with your doctor to see if they are to be taken on the day of the operation. The oral contraceptive pill should be stopped 6 weeks before a planned operation. You and your child will need to discuss this with your family doctor. Nothing to eat and drink fasting (Nil by mouth) Please note the following Hospital fasting guidelines if you have been advised by your doctor that your child will have to fast for an operation or investigation: Solid food should not be eaten for 6 hours before a planned operation in all age groups Cow s Milk and infant formula is considered as solid food and should not be taken for 6 hours prior to a planned operation Breast milk is safe up to 4 hours prior to a planned operation Clear fluids should be encouraged up to 2 hours prior to an operation e.g. water, pulp-free juice and tea or coffee without milk Hygiene/Jewellery/Make-up Give your child a bath / shower the evening before or morning of the operation. It is important to remove all jewellery and make-up, including body piercing and nail varnish before going for an operation. Clothing Usually your child will wear a colourful gown going to the operating theatre department, which is provided on the ward. However, your child may be able to wear their own clothes going to the operating theatre. They will be able to keep their underwear on (with exception of bras or clothing with metal parts). Underwear may need to be removed whilst your child is asleep if necessary for the operation. Pre-medication Occasionally children who are anxious may need special medicine called premedication or sometimes called premed to relieve anxiety before going to the operating theatre department. If this is needed for your child it will be discussed with you first.
What is anaesthesia? The word anaesthesia means loss of sensation. If your child is having an operation, anaesthesia will be required. It is also required for different investigations. A general anaesthetic ensures that your child is unconscious and free of pain during a test (investigation) or operation General anaesthesia is a state of controlled unconsciousness and freedom from pain Anaesthetics are the drugs (gases and injections) that are used to start and maintain anaesthesia. Anaesthetists are specialist doctors who give the anaesthetic and look after the health of your child during surgery. They are also closely involved with your child s pain relief after surgery A cannula is used to give an anaesthetic Cannula A cannula is a thin plastic tube that is placed under the skin, usually on the back of the hand. Sometimes this is inserted on the ward before the child goes to the operating theatre and sometimes it is inserted in the operating theatre. The doctor will decide. A needle is used to put the cannula in and the needle is immediately removed leaving only the soft cannula in place. Magic Cream is used to help prevent discomfort during insertion of the cannula. It is local anaesthetic cream that can be put on the hand or arm before injections so that they do not hurt so much. It works well for 9 out of 10 children. The more common cream used is also called Ametop. A cannula can be left in place for hours or days so that drugs and fluids can be given without the need for further injections. Delaying the operation or investigation Occasionally after examination the anaesthetist may learn something about your child that means it would be safer not to do the procedure on that day. This could happen if your child has a bad cold, has a rash or has eaten food too recently. It is recommended that your child does not have a planned operation for 4 weeks following the BCG or MMR and for all other vaccinations for one week after he/she has received the vaccine. If your child s operation is delayed the ward nurses will liaise with the operating theatre team with regard to the timing of the proposed operation on any given list in order to encourage oral clear fluids for the comfort of the child and the parent / guardian. For the safety of your child, the operation may need to be postponed or cancelled if he / she has had an infectious illness or has been in contact with an infectious illness (for example chicken pox, measles, mumps) in the 6 weeks before the planned operation. Cancellation of an operation is sometimes unavoidable due to other problems in the hospital such as an emergency alert.
Going to theatre Your child may travel to the anaesthetic room in a bed, on a trolley, walking or being carried. You will meet doctors, nurses and porters in the department. Everyone is dressed in blue theatre scrubs and wear hats. Reception room the check-in area of the department where you will meet a theatre nurse and all documentation is checked (e.g. consent form). Anaesthetic room the room next to the operating theatre where anaesthetics are usually started Operating theatre the room where surgery is performed. If your child is very small, or is having certain kinds of surgery, it may be safer to give the anaesthetic in the operating theatre rather than in the anaesthetic room Recovery room a place near the operating theatre where children go after surgery until the effects of the anaesthetic drugs wear off. In the reception room A nurse from the ward will accompany you and your child to the reception room. Your child will be able to take a toy or comforter. A number of safety checks are performed to ensure all documentation is in order (consent form, identification details etc). The nurses and doctors will answer any questions you may have. There may be a waiting period in the reception room. There will be other patients here waiting for their surgery. Only parents / guardians are permitted to accompany the child to the operating theatre department no other siblings/relatives allowed. The nurse will take your phone number and you will be contacted when your child s operation is finished. In the anaesthetic room You may accompany your child into the anaesthetic room, unless otherwise indicated by operating theatre staff. You will need to put a theatre gown on over your day clothes, a paper cap and shoe covers. These items will be provided in the reception room. It may be possible to give the anaesthetic while your child is sitting on your lap. Your child may have either an anaesthetic gas to breathe or an injection through a cannula. Reassure your child at all times by being positive, smile and be brave (even if you are not feeling very brave). Try not to get upset as this might upset your child. You do not have to accompany your child to the anaesthetic room. Once your child is asleep the nurse will escort you from the room and answer any questions you may have. The nurse will take your contact number and let you know as soon as your child is in the recovery room. What happens next? Your child will be taken into the operating theatre to have the operation or investigation. The anaesthetist will monitor your child s blood pressure, pulse, temperature and breathing closely throughout the procedure ensuring that he or she is safe and fully unconscious. Anaesthetic gases and/or drugs given into a vein will be used to keep your child anaesthetised. This is a good time for you to take a break and have some food / tea / coffee. There are coffee shops on ground floor near the emergency department, on the first floor in Cardiac Renal Centre and the hospital canteen.
After surgery Most children go to a recovery room. Each child is cared for by a specialist nurse until her or she has regained consciousness and is comfortable enough to return to the ward. One parent may stay with their child in the recovery room when deemed appropriate to do so by recovery nursing staff. Your child may be sleepy at this stage. Your child will be connected to a monitor. Your child may be tearful or crying. This may be because they are disorientated or hungry rather then being in pain. Pain relief will be given as needed. Continue to reassure and soothe them. Pain relief It is important to us that your child remains comfortable and pain free following an operation. Pain relief will be given in the operating theatre department. If your child is uncomfortable, further pain relief will be given on the ward. Please discuss this with your nurse. At home following the operation, you may also need to give your child pain relief medication. Going home Sometimes children do not sleep well after a stay in hospital. They may be a little more in need of your attention. This is a normal reaction and their behaviour usually returns to normal in 3-4 weeks. Before you take your child home the nurses and/or doctors will advise you about: what pain relief medication to use and for how long specific care if required related to the operation who to contact and what to do if any concerns at home Ref: The Royal College of Anaesthetics (2008) Your child s general anaesthetic, Information for parents & guardians of children, The Royal College of anaesthetics, London. INF-CUH-PED-11 Jun 13