Preparing for your Surgery and Anesthesia

• Please arrive at the hospital at least 30 mins before your appointment time so that you can park, get directions and check in before your scheduled surgery.
• Please note you cannot drive for at least 24 hours after any anesthetic and you must feel fully recovered. So even if you are going home on the same day of surgery, you must have someone with you to escort you home.
• You cannot operate any heavy machinery or sign any legal documents for 24 hours either.
• Surgery can be shorter or longer than expected as it is sometimes hard to predict how long things will take. Please ask your chaperone (friends or family) to not worry if things take longer than expected.
• If you are late for your appointment, we may not be able to do your surgery as it could affect other patients.

• Normally you must have no food for 8 hours before your anesthetic.
• Normally you must have no water for 2 hours before your anesthetic.
• Juice, milk, smoothies and tea/coffee count as food.
• Note - If your fasting times are different to this (for example weight loss surgery or endoscopy), then you will have been informed of this by your team.
• It doesn't matter what type of procedure or what type of anesthetic you are having, all patients need to fast. This is to protect your lungs from stomach contents when or if you need to go off to sleep.

• In order to ensure your safety and prevent the spread of COVID-19, you will have to undergo a COVID-19 ("PCR-type") test within 7 days of your surgery.
• This can be displayed on your Al Hosn app.
• You can also present the result of the test on paper or on your mobile device.
• Any chaperone must also hold a green Al Hosn.

• Please tell all staff if you have any allergies to food or drugs
• Please bring your list of medicines to any appointment at the hospital (both in clinic and if you are having an operation). This list must include anything you have been prescribed and anything you chose to buy and take yourself such as herbal remedies.
• On the day before surgery and the day itself, most of your medicines should be taken at the time you would normally take them. If you need a small amount of water to take them before your surgery, this is allowed.
• However, some medicines need to be stopped before surgery.
• Some examples of medicines that need to be stopped are listed below but if you have any questions or want clarification, please contact the hospital and ask for your team.
  • Diabetes medicines - because you are fasting, you may not need to take all your sugar tablets. Your anesthetist will tell you about these as long as you have your medicine list with you.
  • Any medicine that causes the blood to not clot properly (aspirin, warfarin, plavix/clopidogrel, heparin etc) will usually need to be stopped for a defined period of time before surgery. Your surgeon will inform you about this at your clinic appointment.
  • Most blood pressure tablets should be taken as normal but some may need to be stopped. Your anesthetist can inform you about these in your clinic.
  • If you are taking steroids, thyroid medicine or use inhalers, you must almost always take these as normal. This is important as omitting them can cause problems around the time of surgery.
  • Any very specialist medicines such as ones that affect your immune system, will need a special plan. Please ask your anesthetist.
• Please call us if you have any questions about what to do with your medicines around the time of surgery.

• If you smoke, giving up for several weeks before your operation reduces the risk of breathing problems and makes your anaesthetic safer.
• The longer you can give up beforehand, the better. If you cannot stop smoking completely, cutting down will help.

If you’re having a general anaesthetic, in order to avoid the last minute cancellation of your surgery please inform your surgical team of any:

• Changes to the information that you gave at Pre-Anesthesia Clinic.
• changes to medications or existing medical conditions.
• coughs/cold or chest infections.
• cuts, sores or open areas to skin.
• recent antibiotic treatments.
• changes to urinary symptoms that may suggest a urine infection.
• flare ups of eczema or psoriasis.
• diarrhoea or vomiting 48 hours prior to admission for surgery.
• blood transfusion you received after your Pre-Anesthesia appointment.
• likelihood that you may be pregnant

Your wishes and those of your child are very important and we want to work with you to provide the best possible care for your family.

It may be possible for you and your child to choose how anaesthetic and other medicines are given. Sometimes there are medical reasons why things have to be done in a certain way, these will be explained to you. Nothing will happen unless you understand and agree with what has been planned.

Talk to your child about why they have to go to hospital, when they are going to go in, and what they can expect to happen.

Everything should be explained to your child in a way they understand. If you find it difficult to communicate with your child, members of our nursing team can help give explanations and encourage discussion through play. They are very experienced in caring for children around the time of surgery.

Use simple words your child understands to explain the operation or investigation will help them to get better. Tell them how long their operation or investigation could last, and how long they will have to stay in hospital. If they will have to stay in overnight, let them know if you will be able to stay too. If it’s not possible for you to stay with your child, it is important you tell them when you will be able to visit.

Encourage your child to talk about the operation and ask questions. Books, games and stories can help.

Your child can help pack their own bag and decide which clothes and toys to bring. Please let us know in advance any special requirements your child has and we will do whatever we can to help.

Fasting

Children must have empty stomachs for the anesthetic. This is very important to protect their lungs from any stomach contents when they are asleep.

Your child must have no food for 6 hours before the anesthetic.

Your child must have no water for 2 hours before the anesthetic.

Your child must have no breast milk 4 hours before the surgery.

We will do our best to minimise the fasting times for your child as we understand it can be difficult for them but it is key to having safe surgery.

Before your child has a general anaesthetic

Occasionally the anaesthetist may learn something about your child that means it would be safer not to do the procedure on that day. This could happen if your child has a bad cold, has a rash or has eaten food too recently.

Delaying the operation or investigation

Occasionally the anaesthetist may learn something about your child that means it would be safer not to do the procedure on that day. This could happen if your child has a bad cold, has a rash or has eaten food too recently.

Premedication

Premedication (a premed) is the name for drugs which are sometimes given before an anaesthetic. Some premeds help your child to relax, and some are given for other reasons.

Not every child needs a premed, depending on the kind of surgery and your child’s condition, you will often be able to help decide, with the anaesthetist, whether your child needs a premed or not.

If your child does need a premed, this will usually be given as a liquid, however, an injection is essential occasionally. Premeds are given some time before the anaesthetic and they may make your child drowsier after the operation or investigation. If this is the case and you plan to take him or her home on the same day, this may be delayed.

The drugs that can be used as a premedication can be:

• Sedatives to ease your child’s anxiety.
• Pain relieving drugs such as paracetamol that can help at the end of the procedure.
• Medicines to protect your child from side effects of the anaesthetic (for example, nausea).
• An extra dose of treatment for illnesses like asthma.

Going to the Operating Theatre

We will provide a gown for your child to wear but your child will be able to keep their underwear on. Your child may travel to the operating room in a bed, on a trolley, walking or being carried and will be accompanied by a nurse at all times.

Your child will be able to take a toy or comforter.

If you wish, you will usually be welcome to stay with your child until he or she is unconscious. However, there are a few circumstances when this will not be possible. Your child may have either an anaesthetic gas to breathe or an injection through a cannula (small needle), it may be possible to give the anaesthetic while your child is sitting on your lap.

You do not have to accompany your child to the anaesthetic room. If you prefer, you can ask a nurse to go with them.

Each child is cared for by a specialist nurse until he or she has regained consciousness and is comfortable enough to return to the ward or to go home.

Pain relieving drugs are given during the anaesthetic to ensure that your child is as comfortable as possible after surgery. The type and strength of pain relief given will depend on the procedure. You will have a chance to discuss and help plan the kind of pain relief (analgesia) your child will get after their operation. This will be with the anaesthetist, the surgeon or the ward nurses.