Preparing for Surgery

How and when should I prepare my child for anesthesia and surgery?

• Be honest with your child about where they are going. Do not lie to your child.

• Reassure your child that they will be asleep during surgery and will wake up after surgery.

• Reassure your child that a family member will be with them when they wake up after surgery.

• Younger children (about eight years and under) should have things explained in terms they will understand. For example, you might tell your four-year-old that they will have an operation to "fix their tummy" or to "make their tummy better" and that they will be asleep when they have their operation. It may also help to have your younger child pick one item, such as a favorite toy, blanket or stuffed animal, to bring to the hospital for security.

• You can begin to prepare your younger child a week or so before surgery by giving information about what will happen. If your child is 3 years or under or very anxious, you might wait until the week of surgery or just a few days before surgery to start talking about it. 

• Older children and teenagers (about 9 years and older) should be given as much detail and information as they can handle. Try to encourage your child to ask questions. Help your child to think of ways to make waiting for surgery easier, such as bringing a book to read or music to listen to through headphones.

• Older children and teenagers can usually be prepared before surgery at about the same time you prepare. However, if he is very anxious or has a developmental delay, you might wait until the week of surgery to talk to your child in more detail.

These age ranges, and guidelines are suggestions. All children are different. You know your child best, and you should use your judgment about how and when to prepare your child.

Pre-operative Phone Call

• Approximately three days before your child's surgery, a nurse will call to ask some questions to prepare for the upcoming surgery. Please expect about 20 minutes total for this phone call. You will be asked about previous surgical history, medications, medical history, recent illnesses, or any airway issues (like asthma, for example) we need to know about.
• Your nurse will also discuss our visitor management policy and how many guests you can bring. You will also be reminded to arrange childcare for your other children during this time since no children under 18 years old are allowed.
• A caregiver or guardian must stay on campus to drive the patient home after anesthesia. If you are arranging transportation, this is the time to arrange for drop off and pick up.
• Although unlikely, unexpected admissions do sometimes happen. Bring a bag with extra clothes and toiletries, just in case. 

Before your child's surgery, they need to stop eating and drinking for a specific period of time, which can vary based on their age. It's very important to follow these fasting instructions, because not doing so can lead to serious complications, especially if your child needs anesthesia. Please make sure to stick to the fasting schedule discussed with you.

If you believe your child may be catching a cold or flu or becoming ill in some other way before his surgery, please contact the Arkansas Children’s Surgery Department at 501-364-1336. Your surgery may be canceled on the day of if you do not notify us of your current illness.

Who Can Come

Patients may be accompanied by as many as two adults, who are over the age of 18. If your child is under the age of 18 or cannot consent for themselves, at least one legal guardian with consenting privileges must be present. Your child needs your full attention on the day of surgery. No other children under the age of 18 are allowed to come with you on the day of surgery. Please make childcare arrangements for other children.

Waiting Room

After passing visitor management at the main entrance of the hospital, you will walk straight past the gift shop and go up the orange elevator to the 2nd floor. After getting off the elevator, take a right and go through the double doors. Here, you will be greeted by staff to get registered for surgery and meet with financial aid if needed.

Pre-Operative Room

• After registering, you and your child will go to a surgery waiting area called a pre-operative room.
• You may encounter a lot of different doctors and nurses here. This will be where your child gets their height/weight, vital signs, and obtain consents for the surgery. Before anesthesia is administered, you will also meet with anesthesia staff to discuss your child's health and medical history. You will also meet with the surgeon to discuss the procedure and ask questions and/or let them know about any worries or concerns that you or your child have.
• Before surgery, females aged 10 and above are required to have a urine pregnancy test completed at this time.
• Your care plan will be discussed before surgery if your child needs additional accommodations. Sometimes, your child may be given a medicine (called "premedication" or "premed") to help them relax before surgery. Premedication is often given in a liquid for your child to drink, but it can also be given in other ways, such as an injection. If your child will receive a premedication and how it will be given will depend on your child's age (older children and teenagers may be less likely to need a premedication), medical condition and whether there is time for the medicine to work.

Going to the Operating Room

• Your child may be taken to the operating room on a stretcher or in a crib.
• You may give your child a kiss in the pre-operative room and tell him that you will see him or her in a little while.
• Although care is taken to avoid making your child upset, separation may still cause some nervousness or anxiety.
• Medical staff will take good care of your child!

Anesthesia Induction

There are three major ways that your child may have anesthesia started (called "induction"):

• By mask, where anesthetic gas is given that your child will breathe (usually for smaller and younger children),
• By an intravenous ("IV") line, with anesthetic medicines (usually for older children) or
• By an intramuscular (IM) injection, (usually used when a child will not accept the mask or IV)

Your child’s anesthesiologist will decide the best method of anesthesia induction for your child.

Recovery Room

• After surgery your child will be taken to the PACU (Post Anesthetic Care Unit or the recovery room) to awaken. Two parents or caregivers over the age of 18 will be called to the PACU to be with your child, when he awakens.
• Your child may be groggy or sleepy from the anesthesia. Sometimes children do not behave like their typical selves when they recover from anesthesia. For example, your child might be fussy, cranky, crying and/or difficult to comfort.
• If your child will be admitted to the hospital after recovery, he will go directly to a hospital room from the PACU.
• If your child is going home that day, the nurse will monitor the patient’s pain and nausea until they have met the criteria for discharge.

Preparing to Go Home

Before you go home, we will give you surgery discharge teaching information. This may include several pieces of paper. Please let your nurse know if you need a school or work excuse note. On our your child's postoperative care instructions, there will be phone numbers listed for you to call if you have any problems, questions, or concerns about your child's health.

We will explain:

• What you need to know about taking care of your child after surgery. 
• What you need to do in certain situations such as fever, vomiting, pain, etc.
• How to contact someone for questions or concerns.
• Follow-up appointment(s).

“Teach Back” is a special way of teaching our patients and families to ensure that we are teaching the information in a way that makes sense to you.

• We may ask you to show or tell us how to care for your child at home after surgery. 
• An example question: “What did I say to you about fever after surgery?” 

What can I do to help make my child’s surgery go smoothly and safely?

• Arrive at your child’s scheduled appointment on time to avoid delays and delaying other surgeries.
• Follow all instructions carefully, especially NPO instructions.
• Remain flexible since emergencies or other uncontrollable factors may result in unexpected delays.
• Take care of yourself! Do not fast with your child- get up earlier than he and eat a good breakfast so that you are physically ready to provide emotional support for your child.