Post op care for 4 yr old-Is this normal?

  1. Hi, I ran into an old friend today and she told me her 4 yr old boy just had double hernia surgery. They did the surgery as a same day procedure at a free standing surgery center, under general anaethesia. She told me that after the surgery, he was wheeled out into recovery, they d/c his IV, BP cuff, etc and they let her take him home before he was completely awake from the meds. She was telling me that she had a wrestling match going on as he was dead weight and she was trying to dress him. She told me she finally got him home and put him to bed on the couch while sending Daddy after pain meds and abx. My friend is an experienced Mom but no RN and neither is Dad. My question is: is it normal to send a small child home from same day surgery that fast? Aren't we supposed to wait until they are at least fully awake and aware? She is more the type to not question anything medical people tell her, but I think I would have thrown a fit. (I have my own issues r/t anaesthesia and complications, I developed ARDS after a similar "routine" surgery. If my surgeon had done this I would be dead)

    Laura
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  2. 8 Comments

  3. by   J Lynn
    That is a troubling thought to know that a child was sent home while not fully awake from anesthesia. Before I went to nursing school, I probably wouldn't have known it was strange. I hope he's ok now.
  4. by   obeyacts2
    Quote from J Lynn
    That is a troubling thought to know that a child was sent home while not fully awake from anesthesia. Before I went to nursing school, I probably wouldn't have known it was strange. I hope he's ok now.
    He is okay now but she had her hands full with the restrictions on activity they gave him......he is 4, he thinks if there is no pain (due to med) he is fine...wanted to try leaping of porch the next day

    Maybe Im a cynic, but I kept getting the thought maybe they (staff) didnt want to ahve to look after a hyper 4 yr old overnight.

    Laura
  5. by   NotReady4PrimeTime
    Ooh, that is too soon for this young man to be discharged. In my experience, kids aren't sent home until they're really awake, responsive, drinking well and not vomiting, and are able to void. That said, I wouldn't be too concerned if this guy was running around and getting into things. That's his job. Hernia surgery isn't usually a major undertaking and recovery is swift. The incisions are usually only about an inch long and are well-sutured. He might find that he's more sore when the meds wear off but he should be fine.
  6. by   traumaRUs
    I work in an ER where we consciously sedate kids and the ALL have to be back to pre-op or pre-sedation baseline. Good head control, ambulatory, able to drink po and able to talk. This is the standard of care and clearly - it sounds like that wasn't adhered to in this case!
  7. by   uk_nurse
    i work with paeds daycases and yes you can go home same day after hernia op but the child comes back to ward after op and observations are done regularly. If the child has op in morning and they are usually discharged no earlier than mid afternoon to early evening.
    I find it very frightening that a child was allowed to go home so very soon. Im glad he is ok tho.
  8. by   obeyacts2
    Quote from traumaRUs
    I work in an ER where we consciously sedate kids and the ALL have to be back to pre-op or pre-sedation baseline. Good head control, ambulatory, able to drink po and able to talk. This is the standard of care and clearly - it sounds like that wasn't adhered to in this case!
    This is what I thought! I am still a student, but I know this much. I just listened, didnt want to frighten my friend with what could have/might have happened, based on MY personal issues (see original post). She did say that he spent the rest of the day sleeping off the anaesthesia, and that he was thrashing around as he came out of it, she was scared to turn her back on him and spent the day next to him on the couch in the rocker.

    In case like this, should I talk to my friend about it, in case this ever happens again, or should I just drop it and be glad the kids OK?

    I would have refused to take home anybody in that state had it been me, but what about people like my friend who don't question medical authority and will accept whatever they were told?


    Laura
  9. by   catz
    i know this is old but i wanted to reply, i worked on a paed daycare ward. we discharged our kids as soon as they were fully recovered from surgery/anaesthia/epidural/premed effects etc. the child was required to come back to the ward from recovery, normally fully conscious and ready for a drink ( the wake up so quick). some would have a drink and go back to sleep, some would have a drink want food, want to play. once back on the ward we had to keep them a minimum of two hours during which they need to stay awake and alert, they must have drank and kept down at least two separate glasses of fluids and ideally something to eat. they must be up and moving relatively normally again esp if had epidural or blocks. they must have pain controlled well, with analgesia if needed. and for some surgeries (circumcision, hyspadius) they must pass urine. also vital signs must stay stable at half hourly intervals and no problems with wounds.

    if they meet all that criteria they can be discharged after two hours. if the nurses were not happy to discharge and parents were not willing to stay at just the nurses discretion we got drs to come down. we had an average of maybe one child a day that needed admitting to an inpatient ward though if afternoon surgery lists ran late we admitted more kids since we closed at 7pm.
  10. by   Mimi2RN
    I used to peds ambulatory care, they all had to be awake, able to drink, and they had to go pee before they went home.

    That little boy went home way to early, glad he's ok now!

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