15 month old having a GA.. a few questions.

DD2 is having grommets inserted next monday under GA, the ENT said its a light GA (gas?) mainly to keep her still, does that mean she wont need to be intubated or need a canula?
will she be sleeping that day or just bounce back!

I was wondering how your little one was going Olive!
DS2 has had two lots of grommets. He was the same age as your DD2 when he had his first lot.
I was in the theatre only until he was out. I am pretty sure they don't intubate, and he didn't have a canula (I think?).
The anaesthtist DS2 had was wonderful...I held onto Ben and he had someone blow bubbles which Ben was fascinated with and then he waved the mask over his face and then put it on him and Ben pretty much fell asleep straight away, he did have a little struggle just before he fell asleep. Then I was escorted out :)
The procedure took only 20mins or so and I was called down to the recovery room when he was stirring.
We were not allowed home until he was all ok and had something to eat and drink. We were given some drops we had to put in his ears for a couple of days and that was all he needed. He was fine later that day and bounced back no problems.
They are very resiliant at this age and cope well.
The grommet itself is tiny..the size of those really really tiny beads, quite amazing!
She and you will notice the difference straight away and may solve any sleep issues she is having.

When my 15 month old had a GA, he had a cannula in place first, then they used the gas which made him gag and go purple, at which point I was rushed out the room and he was intubated. I spent the whole time panicing that he was dying but apparently his was a common reaction, so please don't panic if it happens. Boytwin bounced back very quickly after his GA and his grommets have caused him no problems.

I have no idea hun but just wanted to send hugs xxxx

Sorta.
They don't use a traditional tube per se, they use a larangeal mask, which means she'll still have a tube in her throat but it stops at the larynx as opposed to a regular tube that goes between the vocal cords and into the lungs.
The anaesthetic is generally gas only instead of IV. She probably won't have an IV before or after but usually one is put in while they are under just in case.
Hard to say how she'll react as all kids are different, but for most it's a pretty quick recovery.

Where I work they usually use a larangeal mask like Kim said (also known as a fanny on a stick) the fanny part fits over the laranx and then air via a syringe is inserted into it to form a nice soft seal to keep the airways open. The stick part is where the oxygen/gas goes down. Usually they use a type of gas in with air or oxygen to keep the kidlet sedated if its a short procedure like grommits so no IV sedation is needed. Where I work most have a cannula for IV fluids although for grommits that probably isn't neccessary depending on how long your DD has been NBM. They sedate them with the gas and if an IVC needs to be inserted it is done when they are under GA as it is not traumatic when they are asleep. My daughter had grommits also (but was 3) and she was in and out in recovery within 15minutes. It was very quick.
DD was not sleepy at all after her grommits. Working in recovery we are usually looking for a parent very quickly as waking up in a strange place with strange nurses often sends them off as soon as they wake up. I am sure it will be very quick for you and your DD.

thanks everyone, i feel much better knowing more about what will happen!!

she is first up at 8am, NBM from midnight, though im going to speak with the anesthatist about that as she still night feeds (alot some nights :rolleyes: )

My DD was 5 when she went under a ga, so older, but she also had a reaction to it.
She had gas, not sure if she'd have had the tube since they did tonsils & adenoids as well as grommits, but if a canula is needed, most will do it while they are under.
Just wanted to drop in & say be prepared. Most kids are fine, but some will react differently after. DD wasn't sleepy at all & came out of the OR awake & very juttery & freaked out.
I just wanted to warn you & let you know that it is ok. Be strong, coz it can be scary (I failed I they had to tell me to get a grip before I went in), but she will be fine.
I'm sure your DD will be perfect :) The going under can be scary too. A friend's DS went under a bit younger than your DD & she said when he went to sleep it was scary how limp he went.
I know its not the nicest post, but just a warning, just so you can be prepared.
Good luck :)

Olive - where are you having it done?

Just to re-iterate the others. Yes she will have a type of tube down her throat but it is only a little one. At worst, she may have a sore throat afterwards throughout the day but fluids will help or if it is very distressing for her, some panadol.

Yes she will have a cannula. This is incase she requires extra medication during the proceedure or afterwards. A cannual means they don't have to traumatise her with intra-muscular injections if she requires any anti-chuck medication after the surgery. Many anethetists will give some gas through the mask to send them off to sleep. This will often happen in the anesthetic room and you will most likely be allowed to stay for that. Be warned that many parents find this an emotional time as one second their child is chatting away and the next they go limp and cease talking. This is purely the anesthetic. After that you will be asked to leave.

It is usually now that most anethetists insert the cannula. Your DD will be unaware of it happening. Then she will go into the theatre and given further sedation. Most use suxamythone (except I STILL can't spell it!) and propofol. This simply relaxes the muscles and sends them off to a deeper sleep so they are unaware of what is happening.

After the surgery, she will go to the recovery room. Depending on the hospital policies, you may (or may not) be allowed in recovery with your DD. If you are allowed, you will only be allowed in there once your DD is awake and stable. She may be appear to be distressed but this will most likely be a reaction to the anesthetic (very common for children to wake appearing to be having a tantrum - it is a common reaction to the drugs and there is no real way to prevent it unfortunatley. They do settle fairly quickly and usually have no memory of it). The other common reason for children to act out of sorts is because it is scary for them. They've woken in a strange bed, in a strange room, with strange people around them, and they might feel a little funny after the surgery. Because of this, I always recommend parents send a comforter for the child to take into theatre. Most staff are very good about ensuring it is with the child after surgery.

If your DD is being done as a Day Case - she will need to be able to keep food down before she can go home. In some cases, they also want the child to have passed urine before discharge.

In relation to the BFing - def chat to the anethetist. If you are going through the public system - request WRITTEN instructions and follow them to the tee. I have known an anethetist at the RCH to cancel patients because they gave broth despite the written instructions stating it was ok. For the record, he was repremanded. If you are going through a private hospital and KNOW which anethetist you are having, talk to them before hand to get firm instructions.

Since DD is BFing, we often recommend to Mum's in this situation that they limit their physical contact with the child during the fasting period if they believe the child will struggle. I know this sounds cruel but the rationale is that the child (especially very young infants) can smell the milk and become distressed wanting it. Studies have shown that they are less likely to search for feeds or demand them if they can not smell the milk.

Good luck for Monday - I know everything will go fine. I'll be sending you loads of positive vibes. Let me know if you have any more questions.

MG

thanks clover :hug:

, im reallu worried about not feeding overnight :( and i hope like made im allowed in recovery :(
thanks for the fantastic rundown!! will get DH to read this too

The blanket rule is that she will need to fast from midnight - nothing to eat or drink - until after the surgery. We say this because we need the stomach to be empty to avoid aspiration. However, what we don't usually tell people (because there are a great many nitwits out there who are unable to follow instructions or think they don't apply to them!) is that you can have SIPS of water until about 4 hours before the surgery. So, if at 1am she is really struggling, give her 20ml of water. If at 4 am she is really really struggling (and I mean you are at a point of desperation), give her 20ml of water. THIS IS SAFE TO DO. BUT, it needs to be water - not milk. You could give her watered down APPLE juice at 1 or 2am (but no more than 20ml total). Do not give her an accumulation of 20 ml drinks - I wouldn't do it more than three times before 4am. Does that all make sense?

Most hospitals are good with young children and letting parents into recovery. But don't panic if you aren't - they will take good care of her. Not being allowed in does not mean there is something wrong with DD - it may be that they have a very sick patient in the recovery area and can't have extra people around (for loads of reasons). And don't panic about the length of time she is in theatre/recovery. Recovery can take a while because they can't send patients out until they are as pain free as possible and have almost no nausea. And some children take a while to wake up. It will also depend on how much anesthetic they have had. We have an anethetist at work who totally bombs patients out in the room but then gives them a reversal drug so that they are wide awake when they come out to us! Also be prepared that most hospitals will only allow ONE parent into the anesthetic room and recovery (doesn't have to be the same parent). Many recovery room nurses will also let you feed in recovery but make sure you check with them first. I know at RCH it is encouraged in the Day Surg Unit that parents feed in recovery.

If you do go into recovery, don't be concerned by the little peg like thing on her. It will either literally look like a peg and be on a finger or toe; or like a miniture peg and be attached to her ear. This is simply to tell us what her heart rate is and how much oxygen is in her body. She may also have an oxygen mask on - this just helps them wake a little quicker. She may also have a bandage around her hand (or foot) which is how many nurses ensure the cannula stays in place ;) if your DD becomes agitated by it and tries to pull it out - try to distract her. It is best it stays in until the nurses are ready to take it out just in case she requires any medication (pain relief or anti-chuck. It is much nicer for the child and parents if we give it via the cannula as opposed to a needle in the leg or bottom).

When you dress her for the day - dress her in something that buttons down the front if possible. Some hospitals will allow you to send them into theatre in their own clothes - but only if they have buttons down the front so we have easy access to the chest if we require it.

You will be fine. Try not to stress about it and try to remain calm - DD will pick up on it if you're not. Try chat to the anethetist and remember - she will be ok. At the risk of sounding off, rude, or non-caring... there are many younger children that do this (fasting) every day and are ok. It is heartbreaking because you just want to feed them... but you have to stay strong. :hug:

My little guy bounced right back after his GA.
I think it was harder for me. I held him while they put him under and it was absolutely shocking when he went limp because he was so very floppy and heavy, far more so than in a normal sleep.
They let me sit by him in recovery so that when he woke up I was there.

:hug:
I'm sure she'll be a much happier girl when her ears feel better.

hun- just wanted to say good luck
and also check with doc about when last b/feed
boof had a GA at 6 months for the snip and it was no breasfeeds for a shorter time- i think it was like 6 hours! Heaps easier to manage
my biggest fear was how he was gonna go without a feed during this time- but he was good
if it is 6 hours- i would be doing a dream fed just before this window starts so that it will keep her going - then maybe take her to hossy half asleep and in her PJ's - might help her settle
good like and positive thought for mon!!
mwah

My DD was a few months older than yours when she had a GA and she bounced back the same day (actually she was on a bit of a high all that afternoon). She was uncharacteristically whingy when she first came out from under the GA, and that lasted about an hour while she gained her bearings etc.

MG the hospital rang today and told me NO fluid, but im going to ring the anesthetist and ask him what the go may be. i will ge glad when this is all over with!!

I'll be norty and say yes, that is exactly what I tell MY patients... but I also know that small sips of water totally no greater than a small cup of water up to 4 hours before the surgery will not have an impact on the patient during surgery. it will not increase their chances of aspiration and poses little increase in possible negative side effects. As I previously mentioned - blanket rule because some people just can not (or won't) follow basic instructions or don't believe they apply to them. But we regularly operate on people who have consumed liquids 4 hours pre-surgery and every anethetist I've ever spoken with (bar the one at RCH who got reprimanded) do not consider it an issue...unless it is milk which is why I say water or diluted apple juice.

Def speak to the anethetist though. They will tell you what they are happy to work with and what they consider too risky. Let me know if you have any questions.

MG

When my Daughter had a GA I was told small sips of water were fine. I was also told the main reason is to prevent vomitting.

I kept my girl up late gave her the last snack at 10pm then let her sleep in right up until I was ready to go - luckily we were 2nd on the list so once we arrived we didnt have to wait long for her op so although she did ask for something she didnt get too distressed when I said no.

Good luck with it. Make sure you have someone with you on the day to distract you. I went into RCH on my own and I was pacing the whole time she was gone- I needed someone who could of distracted me and passed the time faster (her op took longer than grommets take).
Sjl