PREPARING
A CHILD FOR SURGERY:
NURSE ANESTHETISTS GIVE ADVICE ON REDUCING FEAR OF THE
UNKNOWN
Little else grips a family with greater trepidation than the
experience of sending a child to the operating room for surgery. The fear is
often compounded with the confusing combination of emotions of sadness, anger,
and in some cases guilt.
Families
who are preparing for this experience do not have to go through it alone. In
many cases, a Certified Registered Nurse Anesthetist (CRNA), the advanced
practice nurse responsible for administering anesthesia, serves many roles to
families throughout the surgical process. He or she will care for the child
preoperatively, in the holding area where the parents release the care of the
child to the anesthesia team. The CRNA then cares for the child
intraoperatively, during the administration of anesthesia and the conclusion of
the anesthetic. The child remains with the CRNA postoperatively, until the care
of the child is placed in the hands of the postoperative care unit nurses,
(PACU) formerly known as the “recovery room” team.
CRNAs do
far more than care for the patient’s physical comfort during the surgical
process. They are often involved during the intake stage and are available to
families throughout the patient’s recovery. To help families prepare for a
child’s surgery, the Pennsylvania Association of Nurse Anesthetists (PANA) has
prepared the following tips:
Preparing
Your Child
Some
hospitals offer a pre-admission program for children and families. Check to see
if yours does. If so, take advantage of this opportunity. Hospitals that do not
have such programs might allow patients to tour the facilities and become
familiar with the operating environment. See if your hospital will allow you to
visit at least a week prior to surgery. Becoming familiar with the hospital
will relieve stress for both you and your child.
Make sure you communicate with
your child. Learn his or her fears and concerns. Answer the child’s questions
honestly. Let the child know that there may be some discomfort when he or she
wakes up, but that many other children have had this experience and recovered
quickly and happily. Try to be calm when
giving your child facts. You need to be honest about what is going to happen,
but not overly detailed. Keep the
information you are providing both age and developmentally appropriate for your
child. If you need help in finding a
balance in this conversation, talk to your nurse anesthetist who may be able to
offer an accurate yet simplified “children’s version” of answers to the
questions posed. Keep in mind that you
are the parent. Your display of emotions and behavior can impact your child’s
perception of the event.
One
mistake parents sometimes make is telling their child that he or she is going
to take a nap. Though the intentions are good, this attempt at protecting your
child from fear could cause anxiety for real naptime in the future. Instead, be
up front, but be gentle. Tell your child, “The doctor or nurse anesthetist will
give you medicine to make you sleep so that it won’t hurt when the doctor fixes
your ____.”
Always be
positive. Do not inadvertently threaten with comments such as “If you’re bad,
they are going to stick you with a needle.”
Also note
dietary restrictions are crucial and you need to help your child with this
tough preparation. It is very important to discuss the “nothing by mouth” or,
NPO guidelines used by your anesthesia provider as there is variation in the
interpretation of these guidelines. The
guidelines differ from newborn to adolescents.
If the
guidelines are not accurately followed, a delay or rescheduling of surgery
could result.
Surgery is
a frightening experience for everyone, and particularly terrifying when your
child is involved. Nurse anesthetists understand this and are dedicated to help
parents throughout the process. Feel free to discuss the separation procedure
with your CRNA. Ask questions – At what point will you need to release your
child to the care of the anesthesia team? Can you hold your infant until the
sedative takes place? If there will be liquid sedation given by mouth in order
to smooth the separation process from the parent, will the parent be involved
in having the child drink the small amount of medication? Sedative medication is usually mixed in a
small amount of cherry or grape flavored acetaminophen and taken by children
without issue, but find out if you can be involved in this process. The
acetaminophen is important as it also acts as a pain reliever, which can last
until well after surgery is completed.
If the procedure is minor in nature, this may be all the pain reliever
that is needed.
Please be aware that each surgical facility will have its
own policies regarding the parent’s participation in the care of a child going
for surgery. Please explore your
particular surgical facility’s policies so you will be comfortable with both
the expectations of you and a clear vision of the role you will play on the day
of your child’s surgery. Also, the
needs and wants of children will differ based on the age and developmental
stage of the child. This article is
intended to be a wide palate which will evoke thought concerning preparing a
child for both anesthesia and surgery.
Some
specialized children’s facilities allow the parent(s) to be present to hold or
comfort the child at the beginning of the anesthetic phase of the
procedure. The parents are then
escorted out of the operating room after the child drifts off to sleep at the
hands of the nurse anesthetist.
A key
point made by Danielle Mullen, CRNA at Children’s Hospital in Philadelphia, PA
and active member of the Pennsylvania Association of Nurse Anesthetists (PANA),
is that many CRNAs are parents. “We understand the fear and pain other parents
go through when their child goes into surgery,” offered Mullen. “We take care
of each child like they are our own.”
In most
cases a calm and cooperative parent is a valuable asset to the anesthesia
team. They are appreciative of a strong
family unit that is supportive. Most
parents remain calm and supportive until the child exits with the anesthesia
team. They then turn to emotional
pudding, which is entirely understandable.
The key point here is that the parent remained strong, positive, loving,
and supportive until the care was turned over to the professionals – a great
help to the emotional well being of the child.
Now is the
time to let out your tears, hug your significant others, and gather the
strength and composure your child needs from you when you rejoin him or her in
the post surgical area. Each hospital
will have its own unique area for parents to reunite with the child freshly
emerged from anesthesia. Sometimes this
is the PACU immediately after surgery.
In other facilities, it will be a lounge type area and more time has
elapsed since the conclusion of surgery.
Here, the children are more awake from their anesthetic, and that much closer
to going home, (if day surgery patients) or that much closer to their hospital
bed, (if staying over night). Sit at
the child’s bedside and if appropriate, hold and touch your child.
Many
parents who take steps to prepare both themselves and their child find that
they are strong and composed on the day of surgery. Nonetheless, both parents
and children will need support throughout the process.
Build your support network for the day of the operation.
Have close relatives and/or friends join you in your wait for the surgery to be
completed. Their support will give you strength and comfort. If no one is able
to join you at the hospital, bring your cell phone and have several people
ready to take your call throughout the procedure. Prior to the day of surgery,
make sure your cell phone gets a signal at the hospital. Also, keep in mind
that some hospitals do not allow cell phones in certain areas of the hospital
as they may interfere with wireless signal transmission of clinical information
such as cardiac monitoring devices. Find out in advance if this is the case,
and if it is, come prepared with a calling card to use with a payphone.
Duration
of surgery varies widely. Ask for an estimate ahead of time from the surgeon so
that you can be there for your child as the postoperative phase begins.
In conclusion, be aware that the recovery period has its
challenges. Like adults, children will feel weak for a while and their
activities will need to be monitored. Talk to your child about his or her
experience and feelings after the child returns home. Strong, open
communication is a key component to the healing process.
Remember, Certified Registered Nurse Anesthetists are highly
trained advanced practice registered nurses and in many cases, parents. They
are there for you and your child from the beginning to recovery, ready to
assist your family with advice and comfort.
The
Pennsylvania Association of Nurse Anesthetists is an organization that promotes
responsible, ethical and prudent health care practices to benefit Pennsylvania
patients in matters of anesthesia. The hallmark of nurse anesthesia is patient
safety. Over 2,300 CRNAs practice in the state of Pennsylvania, consistently
administering safe, high quality anesthesia care. For more information on PANA
and issues related to anesthesia, visit the association’s web site at www.pana.org.
Editor’s Note: To schedule an interview with a certified registered nurse anesthetist
or PANA representative in your area, contact the Communication Solutions Group
at 215-884-6499.