Dr Adrian R Lloyd-Thomas  Consultant Paediatric Anaesthetist

I'm looking forward to meeting you in the Portland Hospital. These are simple guidelines to help you prepare your child for the forthcoming operation. I will explain further when we meet in hospital.

Before the operation

Food and fluids

Our theatre schedule begins at 12.30, your child should have nothing to eat after 06:00 on the day of operation. Clear drinks (e.g. water, apple juice or sparkling drinks) should be given up to 1 hour before the operation. No food (including milk) should be taken after 06:00 and drinks must not be given after 10:00, unless advised otherwise by Mr Albert, or the nurses on the ward. In the event that there is a long operating list Rosalind (020- 7390 8300) will advise you of the correct time to have a drink. It is most important, for your child's safety, that you follow the instructions above, unless you are advised to the contrary by the surgical secretary. When you arrive on the ward the nurses will have an estimate of the time of your child's operation and will arrange drinks accordingly. Breast fed babies may have a last feed 4 hours before surgery. Please read the general guidance here.

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Pre-operative assessment

We will meet on the ward before the operation which will allow me to assess you child and offer an opportunity to discuss their care.

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Premedication 

Daycases: No sedative premedication will be given unless in exceptional circumstances. If anaesthesia is going to be started by an injection, local anaesthetic ('magic') cream (EMLA) will be put on the hand two hours before the start of the operation, when the last drink is given.

Children staying overnight: Sedatives slow recovery and are usually avoided, but if you feel that your child is very anxious about their operation, a short acting medication may be taken by mouth. If anaesthesia is going to be started by an injection, local anaesthetic ('magic') cream (EMLA) will be put on the hand, when the last drink is given.

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The anaesthetic room

I would be very pleased if you would accompany your child to the anaesthetic room, both parents may come. You will be collected by the theatre porter and your ward nurse will accompany you to the anaesthetic room. Your child may walk (if they have not had premedication), be carried or sit on the theatre trolley for the journey down to the basement. I will have explained how anaesthesia will be started when we meet, but as a general rule infants and children less than 6 years old will be given anaesthetic gas to breathe, whilst older children will receive an injection. They may sit either on your lap or on the theatre trolley during induction of anaesthesia.

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What is anaesthesia?

Anaesthesia means being unaware and it allows operations to be conducted in safety. There are three components to anaesthesia, relaxation, analgesia (pain relief) and anaesthesia itself. Anaesthesia is not like natural sleep and there are two ways of commencing,  inhalational or intravenous. However anaesthesia is induced, if your child is on your lap, as they are going off to sleep my assistants and I will help you to lift them onto the trolley. I will look after them from then on. Some parents find the onset of anaesthesia in their child to be distressing, this is a normal and common reaction.

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Where shall I wait?

I will have given you an idea of the length of the operation when we meet, please remember this will be an estimate and it may take longer than anticipated to complete the surgery. If things seem to be taking longer than you expected don't worry - it doesn't mean that anything is wrong. There is a parents waiting room close to the recovery room and the nurses will take you to this room. Bring something to read with you, the hospital provides generous hospitality! You MUST REMAIN WHERE YOU HAVE BEEN ASKED TO WAIT, please do not wander around the theatre area distracting the theatre staff from their duties. Remember your child's well-being depends upon the theatre team devoting their whole attention to his or her care.

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The recovery room

After the operation your child will be cared for in the anaesthetic recovery area, the recovery nurses will be looking after your child at this stage. When your child is waking up and when it is safe to do so, the recovery nurses will come and get you if you are waiting downstairs. Once the recovery nurses are happy that it is safe for your child to return to the ward the theatre porter will help you return to your room.

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How will my child be in recovery?

In the very early stages of recovery your child will not feel 100%. Young children (6 months to 4 years) are often quite irritable and may cry - please prepare yourself for this. This doesn't mean that they are in pain, instead it is often due to confusion and disorientation. They will be re-assured by your presence and voice - please talk to them. When guided by the nurses you may cuddle you child. When it is safe to do so, the recovery nurses will arrange your transfer back to the ward. You will be accompanied by your ward nurse and a theatre porter.

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What should we do when we get back to the room?

All children need to have an additional sleep when you get back to the bedroom. Make the room dark and quiet, turn off all entertainment and use any tricks that you employ at home to get them to sleep. They will sleep for 1 to 2 hours, will then feel much better and they will be ready to start drinking. Your nurse will help you with this, if you are uncertain just ask!

Pain control for ENT operations

Children having grommets and or adenoidectomy, will have three painkillers given by injection during the operation. The next pain relief (paracetamol and ibuprofen) will be due when you are at home.

Children having adenoidectomy and/or tonsillectomy will have four painkillers given by injection during the operation. The next doses will be given at a set time by the nurses on the ward.