PREOP Meds

GHGoonette, BSN, RN · Oct 22, 2011

I'm not quite getting this - are you referring to ward practice or the pre-op area in theater?

Versed (midazolam) tends to send a lot of kids somewhat crazy, so they should never be left alone. I sincerely hope there's a responsible person at the child's bedside after that premed's been given!

janpacs · Oct 22, 2011

I am speaking in the time period directly prior to going to the OR..They are not on the floor or "ward" if this is the tem for teh general care floor..Your terminology sounds British, so your practice may be different..Once our outpatients check in, they stay in a "spot" that is open and visual..I continue to check in other patients, but the patient is still visual to me or other staff..The new check in area will be in private rooms..I agree with you that they should not be left alone after versed, or that, the family is there, so "they can watch them"..I'm looking for other practices to support having them attended at least visually by a medical staff member..

brownbook · Oct 22, 2011

I don't know. We only occasionally do children, and with them only occasionally give versed. We don't have a medical staff watching them 1:1 but our area is kind of open. We don't keep them on O2 sat monitors. We tell the parents they need to carefully watch the child, hold them in their lap or sit with them in the gurney, etc., and have never had a problem.

But as I type this I keep thinking, "what if's" if a child fell, got hurt, banged their head, etc., due to the sedation effects of versed we could be in trouble!

GHGoonette, BSN, RN · Oct 22, 2011

No, not British, I'm in South Africa :)

Although parents accompany their kids to pre-op, and are present during induction, an experienced nurse must be present in the pre-op area as well. There are various excellent reasons for this:

1 - The patient may injure him/herself while confused.

2 - Possible unexpected reaction to the premed, which may include mild to severe allergic reactions, nausea & vomiting, excessive drowsiness and depressed respiration.

3 - Any patient scheduled for surgery is anxious; even if the child is too young to understand what is happening, it is extremely traumatic for the parents. Add to that the fact that most people have read or heard of horror stories involving anaesthesia and you realize that despite their outward calm, those waiting in the pre-op are in a state of suppressed fear. A professional, informed person should be at hand to answer questions and at least partially allay these fears. Where adult patients are concerned, it can even make a difference to their stay in recovery if they are less nervous going in than if they're left to stew in their own juice in pre-op.

As regards monitoring vitals pre-op, we don't commonly do it, but we have a sats monitor and dynamap in the room, and of course oxygen and suction equipment is close at hand. Strictly speaking, all pre-ops should be equipped with O2 outlets and suction points, but due to design flaws, we've had to make do with mobiles.

Glageman · Oct 30, 2011

Hiya,

In my PACU, after any sedation/pain meds are given, the patient is placed on a telemetry and sat monitor. This is regardless of age. Our pre-op area has bays ( partial walls with no doors - and curtains). If someone is alone, the curtains are open. All children need a responsible adult by their bedside ( whether they have been given a sedation or not). Sometimes this is not a parent - if the nurse feels that the parent is not reliable. ( like they are talking on their phone or working with their ipad).

Glageman · Oct 30, 2011

I is interesting to read how other PACUs handle under age patients. Children waking up are unpredictable.

sukiathome · Aug 12, 2012

I would NOT feel comfortable giving any child Versed in PreOp then not watching them. Even our adult patients are given Versed by the Anesthesiologist JUST prior to going back with them to the OR. I think you might want to speak up for the safety of the patients.