nursing student traumatized by the PACU

[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

[PANurseRN1]

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.

[PANurseRN1]

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.

One thing's for sure...if they're screaming, they're ventilating.

[RN34TX]

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.

And I'm a PACU nurse who recovers kids and this is all true.

Sevo is the dirty culprit in many of these emergence delirium cases. Although every kid is unique and I couldn't say that most will wake up this way as many are just fine, I have seen trends with anesthesia choices and their wake up results and I believe that Sevo and kids are rarely a good mix (regardless of what they've been sedated with pre-op as was earlier stated by Marie).

Just my experience with peds cases.

[debthern]

I am a pediatric pacu nurse and I have noticed that in the general adult hospitals that do a few peds cases that the children wake up much differently then when they have a pediatric anesthesiologist do the case, part of the reason is that in the adult hospitals, kids make the staff nurses and so they are not treated with narcotics in the or so they wake up screaming cause they hurt.

I did have a patient one time who would scream like Tarzan if I was looking at her but would stop when I looked away

[BigDog]

A screaming child is a breathing child most of our pedi cases calm down when mom comes in ,so we let mom and only mom come as soon as we're sure the kids got an airway.