Last week we explored anaesthesia, surgery, and what to expect in the days leading up to your child’s procedure.

Now that you are aware of the basic expectations, let’s move to the big one — surgery day.

At the Bustamante Hospital for Children, we ask that you arrive to the operating theatre (OT) by 7:00 the morning of the surgery. When you arrive, a nurse will check your child’s weight and vitals (rate of breathing, pulse, blood pressure and oxygen level). The surgeon and anaesthesiologist will do a quick reassessment to make sure all is well. They will ask (again) about any cold, cough, or fever. If your child is sick on surgery day, the procedure will be postponed. Depending on the type of procedure, the surgeon may use a pen or marker to sign the body part for operation. This prevents confusion and possible mistakes.

Your child will change into a surgery gown, cap, and booties. At most hospitals, every patient on the day case surgery list is given the same appointment time. Of course, not everyone’s surgery is done at the same time. So expect that there will be a waiting period — some patients longer than others. This helps the medical team to work effectively. While patient A is getting vitals done, patient B is talking to the surgeon, and patient C is talking to the anaesthesiologist. We appreciate this may be less than convenient, so we ask you to remain patient.

The first patient brought into OT is usually the youngest baby, followed by the patient closest in age, and so on. While you wait, your child won’t be allowed to eat or drink anything.

When it is your child’s turn for the surgery, a medical team member (doctor or nurse or porter) will take the baby from you and escort him or her into the operating room. The anaesthesiologist will place a mask over the baby’s mouth and nose, and allow the baby to breath in anaesthetic gases to put the him or her to sleep. Once baby is completely asleep, the surgery can begin.

During the procedure, the anaesthesiologist monitors the baby’s vitals continuously. After the procedure is over, the baby will be transported from the operating theatre to the recovery room, where we continue to monitor the vitals as well as the bandage covering the surgical cut. Once he wakes up, you can visit! the baby will be groggy or sleepy for a little while as the anaesthesia wears off. When the baby is fully awake, all vitals are normal, and he or she can drink sips of clear fluids without vomiting, the baby will be allowed to go home. You will be given a prescription (usually pain medications and any other medication the baby may need) with instruction of when and how long these should be administered. You will be advised about the possible complications to look out for, and to bring the child back if you are concerned. You know your child best, so call the doctor/hospital or come in if you are concerned. It is better to come in and be told everything is fine than to stay home and a complication worsens. Depending on the procedure, you will likely also be given a follow-up appointment to be reviewed in clinic.

As with every medical intervention, there are possible complications. The most common complications are nausea and vomiting, sore throat, being sleepy for longer than usual, and confusion after waking up. If you’ve never seen a video of a child waking up from anaesthesia and saying weird and wonderful things, do yourself a favour and do an internet search right now.

Some other possible complications from anaesthesia are:

– Damage to teeth or cuts/bruises to mouth (lips, tongue, gums, throat)

•nerve injury arising from how child was positioned during a long surgery

•being aware/partially awake during anaesthesia

• allergic reaction to the anaesthetic medications

•dangerous high body temperature as a side effect of the anaesthetic drugs (malignant hypothermia)

•spasm in the throat — the muscle of the throat closes up

-•wheezing

• organ damage

• death (This is very rare, but unfortunately still possible)

All the above also applies if your child requires admission to the ward before and after surgery, for example, for brain or heart surgeries, or your child may need to be admitted to the Intensive Care Unit after surgery — but we’ll talk about that in another article.

Dr Tal’s Tidbit

Knowing what to expect on surgery day can help to alleviate some of your concerns. The important roles of anaesthesiologists cannot be overstated. Their work creates the foundation for successful surgeries, promoting better overall outcomes for our little ones.

Dr Taleya Girvan has over a decade’s experience treating children at the Bustamante Hospital for Children, working in the Accident and Emergency Department and Paediatric Cardiology Department. Her goal is to use the knowledge she has gained to improve the lives of patients by increasing knowledge about the health-care system in Jamaica. Dr Tal’s Tidbits is a series in which she speaks to patients and caregivers, providing practical advice that will improve health care for the general population. E-mail: dr.talstidbits@gmail.com IG @dr.tals_tidbits.