General Preoperative Instructions

So your child is undergoing surgery in the near future and you are worried and anxious! I too, would be in your place! In our anxiety and fear we tend to imagine the worst things happening to our child and these negative emotions, then prevent us from acting in the best interests of the child. We have to overcome them and work constructively to help our child through a difficult period.

Ignorance and imagined fears are our worst enemies. SO DO NOT BE AFRAID TO ASK! Your fears may well prove to be unfounded in most circumstances but I may not even begin to imagine that you have a particular concern unless you voice it.

I will try and address some of the common questions and fears which plague the mind of the anxious parent in the question and answer format.

COMMON QUESTIONS IN THE MIND OF PARENTS

Doctor, will anything happen to my child during surgery?

This seemingly innocuous question hides the biggest fear of the parent. What you are really asking is whether my child can die during surgery or anesthesia apart from having myriad of minor problems? Pediatric surgery and Pediatric anesthesia are very safe given the current state of skills, knowledge, equipment and monitoring facilities.

We have heard so many mishaps during surgery. What is the possibility of this in my child?

Everyday tens of thousands of operations are performed. What makes the headlines are only those cases where there has been an untoward result. The risk of developing an untoward mishap in proper hands is less than 1:100000 surgeries (The equivalent risk is half that of having an accident while crossing a road).

The untoward reactions are mostly in the form of allergic or unexpected reactions to anesthetic drugs and very little can be done to foretell which patient is likely to have an unforeseen event. But practically, just as the possible risk of an accident does not prevent us from crossing roads, we cannot avoid necessary surgery and we cannot do it without giving anesthesia.
Our anesthetists are extremely skilled and I would gladly allow my own children to be anesthetized by them, so please be assured you are in good hands.

My child had a lower respiratory tract infection last week. When can we schedule her surgery?

In general, I prefer not to do elective operations if the child has had any illness requiring hospitalization in the preceding three weeks. Planned surgeries must be done, when the child is healthy and free from any intercurrent infections.
If the child has had any of the following illnesses within ten days of proposed operation then please inform me:

  • Upper respiratory tract infection
  • Any intestinal infection
  • Fever > 101° F due to any cause
  • Any childhood infectious disease like chicken pox, measles, mumps etc

You must also inform me if the child has any major illness like

  • Tuberculosis
  • Asthma
  • Convulsions
  • Cardiac conditions
  • On any sort of long-term medications for any of the chronic illnesses
  • Any personal or family history of bleeding disorders wherein the blood does not clot readily or even clots too readily
  • Known allergy (hives or asthmatic episodes) to any drugs or foods

Can I give my child anything to eat or drink prior to surgery?

Well, there is a 2-4-6 rule! (everything to eat and drink up to six hours prior, breast milk up to four hours prior, and clear liquids like water, coconut water or lemon juice up to two hours prior to surgery) In adults and older kids, nothing is given by mouth for six hours prior to surgery. Doctors realize that children become extremely irritable, and even unmanageable if starved for long periods of time and after many studies that have examined the emptying time of stomach in response to different foods, have come up with the above guidelines.

But doctor that is cruel! How will my child manage?

In normal circumstances, we are able to keep food out of our breathing tubes by a very well co-ordinated system of reflexes and muscular actions. However, during anesthesia, both muscles and reflexes are depressed and if the child should vomit during anesthesia (possible due to many factors), the vomit may find its way into our lungs. This is akin to drowning in your own fluids and can even prove fatal! Nothing serious happens to children if starved for the prescribed time, excepting of course, if they have some metabolic disturbances.

Why do we have to come in to the hospital two hours prior to surgery?

There is the ubiquitous paperwork to be done. Some medications are usually given to the child about an hour prior to surgery and time is required for them to be effective. These medicines help prepare the child for surgery and also sedate him. After taking these medications, the child may feel sleepy and her body may feel warm and may appear flushed.

In most major hospitals that I go to, you need to come in for admission much earlier than that.

What should I get with me when we come in to the hospital?

Most major hospitals do not allow the patients to get any food or clothing from home. However, even they are more considerate when it comes to children. Do check with the hospital that your child is getting admitted to. In smaller hospitals or nursing home, do carry with you:

  • Two extra sets of clothing
  • Milk (that will be required after surgery) or other non-spicy, non-oily foodstuffs that your child likes.
  • Most of the other stuff is easily available at chemists and general stores nearby.

Doctor, please do not remove the band around her waist. It has a taveej (sacred object) that we believe brings good luck to our child?

While I respect your sentiments and beliefs, I am sorry, but this will have to removed prior to surgery. The most important reason is that these harbor many germs, that greatly increase the chance of wound infections. Wound infections cause a lot of pain and trauma to the child and may sometimes require an additional surgery to drain out all the pus. In addition, metallic objects can cause contact burns when the electrocautery is being used during surgery.

What is the care required after surgery?

I will be explaining this in great detail after the operation. In the meantime, please visit this page for further information.

If I still have questions after this, what should I do?

Well, you can always contact me.

2 Replies to “General Preoperative Instructions”

  1. Doctor my child ia suggested a circumcision and.hydrocele surgery..but he has had a prolonged cough for a month and still coughs during the day..can I opt for his surgery.next week??

    1. In general, before any planned surgery, we prefer that the child does not suffer from any major surgery for at least 3 weeks prior to the surgery. We also prefer that the child does not have any minor illness like cough, cold, fever (< 100° F), loose motions or vomiting for at least 10 days prior to surgery. Having said that, and the fact, that most of our patients live in highly polluted Mumbai, and prone to repeated bouts of cough and cold, and if the anesthetist also feels likewise, then we are OK if the child has a minimal cough and cold at the time of surgery. The final arbiter is the anesthetist and his/her decision is respected.

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