Before and During Surgery
What time should I arrive at the hospital before surgery?
Your surgeon’s office will contact you to inform you of the surgery time and when to arrive at Orlando Health Arnold Palmer Hospital for Children. You will be asked to arrive at the hospital two hours before the scheduled surgery. After completing necessary registration paperwork, you will be directed to the third floor surgical area for preoperative preparation.
How long can my child eat and drink before surgery?
Generally, we ask most children to stop eating and drinking eight hours before surgery; this often means that most children will stop eating and drinking at midnight to be prepared for early morning surgery. Your doctor may make exceptions for infants and patients with diabetes.
Can my child chew gum or have candy on the day of surgery?
We ask that you stop all food, candy, and gum eight hours before surgery in order to maximize safety.
Can my child brush their teeth before surgery?
Children are encouraged to brush their teeth before surgery, as long as they can brush without drinking any water.
My child takes medicine on a regular basis. Can she have it the morning of surgery?
We ask that you especially continue all medicine to treat seizures, breathing problems (such as for asthma), transplants, and for behavioral issues. Please limit your child to a sip or two of water with these medicines if it is more than four hours before surgery. Instructions for blood pressure medicines and diabetes medicines should come from your child’s doctor. Most other medications are not required the day of surgery, but specific concerns can be directed to your child’s doctor or our pre-admission department.
Can I be there when my child falls asleep?
We encourage parental involvement in the preoperative area while children are getting ready for surgery. If your child is anxious, he or she may be given a mild sedating medicine before leaving you to go to the operating room. Parents are not allowed in the operating room because of the need to maintain a sterile operating room environment and to allow us to focus all our attention on your child.
Where do I wait while my child has surgery?
The preoperative nurses will direct you to the surgical waiting room located on the third floor. If you decide to visit our cafeteria, please leave a working cell phone number with our receptionist so that we can contact you if any issues arise. You will be informed in advance if the EASE smart phone app is available for real-time updates depending on your child’s surgery.
Are interpreter services available if English is not our first language?
For our families that are more comfortable communicating in languages other than English, we have Interpreter Services available 24 hours a day. If a Medically Certified Translator isn’t physically available, we always have telephone interpreter services at our fingertips. In addition, our newest translation technology utilizes iPads for live video translation for any language, including sign language.
Can I receive physician updates during my child’s surgery?
Many of our surgeons use the EASE program to communicate securely and efficiently with patients’ families. This app was created by physicians at Orlando Health Arnold Palmer as a HIPAA-compliant texting platform to open a window into the operating room. Our staff can use smartphone technology to update and inform families from a procedure’s beginning to end. Our data has shown that 99 percent of families say EASE reduces their anxiety, improving overall patient satisfaction. More information about EASE.
Can we meet with an anesthesiologist before the day of surgery?
Yes.If you or your surgeon require additional information for anesthetic planning in the days or weeks prior to surgery, you may have an appointment in our PreAnesthesia Testing clinic. You may meet with our staff for lab work as well as to determine if any additional testing (such as echocardiograms, pulmonary function testing, etc,) would be beneficial prior to surgery. You may also meet with one of our pediatric anesthesiologists to discuss any particular anesthetic concerns specific to your child’s medical condition. Please call (321) 841-3787 with any questions.
Are there ways to ease my child’s fear of surgery?
Child Life Specialists are available in our peri-operative area as a wonderful resource in comforting anxious children during the surgical process. They can help prepare a child or teen to cope more positively, and make surgery and hospitalization a smoother process for the entire family.
In addition, to help understand what to expect before surgery, families can attend a “Project P.L.A.Y.” educational program. This special tour and teaching session was created to help reduce children's fears before their surgery and hospital stay, and is available free of charge if you are being scheduled for surgery at Orlando Health Arnold Palmer. Please call (321) 841-1203 to register at least one week prior to surgery so that we can make sure to get your tour scheduled.
Who can I call if I have more questions?
Our pre-operative nurses will try to call you as a courtesy to remind you of the surgery time, eating instructions, and to answer any questions you may have. They can be reached at (321) 841-2080 or (321) 843-8099 during business hours.
What paperwork do I need?
You should bring your identification (such as a driver’s license) and insurance information, as well as any relevant custody/ guardian paperwork, if applicable. You will be asked to complete a pre-anesthesia questionnaire regarding your child’s health history. You will be given the form during registration at the hospital.
Post-Operative Pain Management
What are some of the post-operative pain management options you offer?
Our pediatric anesthesia team at Orlando Health Arnold Palmer offers several options for post-operative pain management. These newer alternatives offer children better pain relief while allowing lower doses of general anesthesia and narcotic pain medication. This, in turn, minimizes the negative side effects children often feel from pain medication: nausea, vomiting, sleepiness, itching and constipation. In other words, our kids feel better faster after surgery.
Our post-operative pain management options include an established service of placing nerve catheters where patients can be discharged home with a pump of local anesthesia. We also offer pediatric epidurals. Both of these options can be used to control pain after surgery.
Can you explain how and why a nerve catheter is placed?
A nerve catheter provides a way to numb the nerves that provide feeling to the part of the body that is undergoing surgery.
While general anesthesia affects all of the body and is used to put your child into a deep sleep, a nerve catheter uses a local anesthetic that works only in the part of the body where it is needed.
A nerve catheter is placed with a needle and threaded under the skin with the tip near a nerve and is connected to tubing and a pump. The pump infuses local anesthesia medicine over the course of approximately 48 hours. The purpose of a nerve catheter is to minimize post-operative pain and maximize recovery time.
When are nerve catheters used?
Nerve catheters are used in patients having surgeries that are known to have significant post-operative pain and when a nerve can be safely accessed by a needle to inject numbing medicine.
Is this the same as a nerve block?
A nerve block is simply a single shot of local anesthesia medicine near the nerve that will wear off after several hours. A nerve catheter provides ongoing pain relief over the course of a few days during the post-operative recovery.
What are the benefits of nerve catheters?
One benefit of a nerve catheter is that it provides much longer relief than a single shot nerve block. When nerve catheters are placed at the beginning of the surgery, we can begin infusing medicine right away and throughout the surgery. This allows for less narcotic medicine to be given during and after surgery and results in less side effects from narcotics such as nausea, vomiting and constipation. In general, regional anesthesia reduces the stress reaction to surgery and allows for less post-operative pain and faster recovery.
What are the risks?
Like any procedure, regional anesthesia has risks: accidently injecting medicine into a vein can cause seizure, cardiac arrest, chronic pain or nerve damage. However, these risks are very low as our pediatric anesthesiologists are trained in two techniques to minimize risks. One technique is to visualize the nerve and blood vessels under ultrasound guidance and view exactly where the medicine is being deposited. The second technique ensures correct placement with motor nerves by using a stimulator that illustrates to the doctor how close in proximity the needle is to the nerve. The third safety technique we employ is the use of a pressure manometer, which is a gauge placed on the injecting syringe that notifies the provider if there is any increased pressure while injecting. This allows the anesthesiologist to know how close in proximity the needle is to the nerve.
How have kids fared with nerve catheters versus other means of pain relief?
We follow up by phone daily on all patients who go home with nerve catheters and nerve blocks, and we personally visit all patients who stay in-house. Patients consistently tell us that even after the block has worn off they have minimal or well-controlled pain. This is because it reduces the body’s stress response to surgery, especially when an anti-inflammatory medication is added, and promotes healing at the surgical site.
Can you explain what an epidural is and why it is used?
An epidural catheter is placed in the lower back in the epidural space near the nerves that provide sensation and movement to the lower extremities. A local anesthetic and/or narcotic is infused to provide numbness and relief of post-surgical pain. Children will be sedated or asleep at the time the epidural is placed to aid in comfort.
Is it common for kids to get an epidural for pain relief? Is it available in other hospitals?
Regional anesthesia is considered a best practice and is common in pediatric hospitals that specialize in pain management. Epidural use in children has lagged behind its use in adults because of the specialized training and experience needed to perform epidural catheters safely in children, which is not available at all facilities.
Why do you choose an epidural over other types of pain relief?
Epidural catheters provide superior pain relief by providing a multi-modal approach to pain management. It allows for a lighter level of general anesthetic with less narcotic use needed to control pain during and after surgery. This minimizes adverse side effects from narcotics such as nausea, vomiting and constipation.
Are epidurals safe for kids? What are the risks?
The use of epidurals in children has been well studied and is a common procedure in pediatric hospitals that specialize in pain management. As with any procedure there are risks, which are very rare, but can include infection, bleeding, local anesthesia toxicity, nerve damage, and spinal headache.