nursing student traumatized by the PACU

  1. Hi all you wonderfully informed PACU nurses!

    I spent exactly 8 hours rotating through pre-op, OR, and PACU and I had an experience that left me completely cold to working in the PACU. An 8 y/o was having some kind of dental surgery (not sure on the specifics, it wasn't my case) but when she came out of anesthesia she started screaming and thrashing. It took one RN and 3 nursing students to hold her down. (I think they said it was from the Sevoflurane)

    This went on for half an hour before the anesthesiologist came out and gave her fentanyl and something else. It was A LOT of medication (the nurse said the doc gave her enough to put down three grown men). Her vital signs were fine but the medication did not help. She only stopped screaming when her mom was brought back. The nurses were making comments about how this child was just bratty. As a parent, I was horrified and I felt like I would do ANYTHING to keep my kid from having surgery if this is what it is like!!!

    Anyway, is this the normal experience of children and anesthesia or is it something else? What are your experiences like with kids in surgery?

    Thanks for reading this,
    Linda
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  2. 16 Comments

  3. by   HelenofOz
    As in the rest of life, some children are amazing, and some ARE brats, but anaesthesia and pain doesn't bring out the best in anyone.

    I have found that most children wake up with absolutely no idea of where they are, regardless of how much they are warned and educated before hand, and a child's motto is "when in doubt-scream" I tend to remind the parent that it is a similar state to those times when the child wakes up during the night and you can tell by looking in their eyes that they are not awake at all, but rather are in another place far, far away. After a while the child comes too, and if you're lucky, falls into a sleep for a while, and the next time they wake up things are getting better.

    Another consolation is that if the anaesthetist has done the job right the child has very little recollection of the whole event-Mum & Dad on the other hand are "blessed" with the memory for ever after, especially if they are responsible for bringing in a healthy, well, child and making the decision for the child to then be in pain (ie T's & A's)-a hard decision to make and live with. (I work in a small private hospital, so most of the children we see are T's & A's)

    Also, were you upset by the nurses' reactions, or by the child screaming, which is distressing at the best at times? I have to admit that some children have left me shaking my head in amazement, both the really well behaved ones, and the others! And as to the amount of analgesia given-I have given a little old lady a total of 28mg of morphine IV after a shoulder repair, and she was still talking to me!

    So basically, nearly everything that happens in the PACU is normal!
    Last edit by HelenofOz on Apr 2, '07 : Reason: (I missed a bit)
  4. by   traumaRUs
    I would hazard a guess that perhaps this child was developmentally delayed or mentally ill? Since you don't know all the specifics, you can only go on what you could see. The fact that the child settled down when Mom came back indicates to me that it was an emotional issue versus a medical one (like a reaction to a med).

    I have (unfortunately) been involved in some tantrums from the older kids and it is very hard to watch, let alone know this Mom has to tolerate it daily (perhaps).
  5. by   heartICU
    Quote from labcat01
    Hi all you wonderfully informed PACU nurses!

    I spent exactly 8 hours rotating through pre-op, OR, and PACU and I had an experience that left me completely cold to working in the PACU. An 8 y/o was having some kind of dental surgery (not sure on the specifics, it wasn't my case) but when she came out of anesthesia she started screaming and thrashing. It took one RN and 3 nursing students to hold her down. (I think they said it was from the Sevoflurane)

    This went on for half an hour before the anesthesiologist came out and gave her fentanyl and something else. It was A LOT of medication (the nurse said the doc gave her enough to put down three grown men). Her vital signs were fine but the medication did not help. She only stopped screaming when her mom was brought back. The nurses were making comments about how this child was just bratty. As a parent, I was horrified and I felt like I would do ANYTHING to keep my kid from having surgery if this is what it is like!!!

    Anyway, is this the normal experience of children and anesthesia or is it something else? What are your experiences like with kids in surgery?

    Thanks for reading this,
    Linda
    Sevoflurane can cause emergence delirium. In most cases, kids wake up screaming and crying. Sometimes its pain, sometimes its emotional distress, and sometimes its none of the above or a combination of the two. Sounds like the anesthesia/PACU team tried to take care of the child's pain first, and then the emotional needs. What traumatized you? The child's reaction? Any PACU nurse who has recovered kids would be able to tell you that they typically wake up this way.
  6. by   labcat01
    I was traumatized by the child's reaction. I guess because it went on for so long and I didn't mention it but she was trying to bite and kick anyone who came near her. I was just really unprepared and I guess that is what traumatized me. They had a few screamers in the PACU that day but none were as bad as this little girl.

    A few weeks later we were at a children's hospital and none of the children there woke up screaming. I guess I just wanted to know how do kids normally behave when they come out of surgery?
  7. by   labcat01
    Quote from HelenofOz
    Another consolation is that if the anaesthetist has done the job right the child has very little recollection of the whole event-Mum & Dad on the other hand are "blessed" with the memory for ever after, especially if they are responsible for bringing in a healthy, well, child and making the decision for the child to then be in pain (ie T's & A's)
    Thanks...I guess that is what is hardest for me to deal with- thinking that these poor kids will be scarred forever from being at the hospital for T&As. Maybe I should take this as a sign that i'm not meant to work with kids
  8. by   PANurseRN1
    Kiddo probably won't even remember it. You were probably more traumatized than the pt.

    Don't let it discourage you completely.
  9. by   Marie_LPN, RN
    I tell ya though, it seems like the child has a MUCH better experience if they receive pre-op sedation. If it were my child, i'd want the pre-op sedation, based on what i've seen.
  10. by   Laurel RN
    Pre-sedation does help a lot, the kids do wake up calmer. We only pre-sedate kids having bigger/longer/more painful surgeries, like T&A (which hurt a ton!). Most dental procedures don't hurt as much (if there are no extractions) and they don't want the kids too sleepy afterwards so they can go home more quickly.

    Also, I've had grown adults wake up screaming, yelling, kicking, hitting, and biting - yes, biting. Usually it is emergence delirium and it passes when they are through that stage of anesthesia. Definitely not easy to deal with at the time, but fortunately, it passes.
  11. by   txspadequeenRN
    gosh this is great to read about since my daughter is having dental surgery in the am.....
  12. by   Marie_LPN, RN
    Pre-sedation does help a lot, the kids do wake up calmer. We only pre-sedate kids having bigger/longer/more painful surgeries, like T&A (which hurt a ton!). Most dental procedures don't hurt as much (if there are no extractions) and they don't want the kids too sleepy afterwards so they can go home more quickly.
    Same here.

    We've had a few parents who say "i don't want my kid all 'drunk' on medicine," but then the alternative has wound up being a kicking and screaming 4-5 year old . Not saying all kids are that way without sedation, but in my experience a kid under 9 years old that is CALM about surgery is RARE.
  13. by   Mimi2RN
    Quote from txspadequeen921
    gosh this is great to read about since my daughter is having dental surgery in the am.....
    t's not unusual to have kids crying or screaming following surgery. i used to do peds ambulatory care, and they would be brought back to us asap, as they were too disruptive for pacu. they figured that any kid awake and screaming was better off in a room with mom. this was always part of my pre-op teaching, and the parents appreciated being forewarned.
  14. by   PANurseRN1
    Quote from Laurel RN
    Pre-sedation does help a lot, the kids do wake up calmer. We only pre-sedate kids having bigger/longer/more painful surgeries, like T&A (which hurt a ton!). Most dental procedures don't hurt as much (if there are no extractions) and they don't want the kids too sleepy afterwards so they can go home more quickly.

    Also, I've had grown adults wake up screaming, yelling, kicking, hitting, and biting - yes, biting. Usually it is emergence delirium and it passes when they are through that stage of anesthesia. Definitely not easy to deal with at the time, but fortunately, it passes.
    I see this a lot with ketamine. Man, do I hate that stuff! Pts. wake up screaming and thrashing...it's a horror.

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