An operation or investigation under anesthesia or sedation

On this page you will find general information about the necessary preparations for an operation or investigation (called a procedure) under anesthesia or sedation. Your child’s care-team will discuss any special preparations necessary for the procedure when you meet them in the outpatients clinic.

General preparations for the anesthetic or sedation uitklapper, klik om te openen

Fasting

It is very important that your child does not eat anything immediately before the anesthetic or sedation. 

Why must my child be fasted?

Your child’s stomach needs to be empty before the start of the anesthetic or sedation to reduce the risk of complications. 

What can happen if my child is not properly fasted?

Your child can then choke. If you child is sick under anesthesia or sedation the stomach contents can get into the air passages which is very dangerous and can lead to pneumonia or even life-threatening situations. As a result your child might have to go to the intensive care. We all want to avoid this.

What will the anesthesiologist do if my child is not properly fasted?

We will then have to cancel or delay the procedure – sometimes until later the same day, but more often until another day.

Is it safe for my child to be fasted for so long?

This is completely safe for most children. Sometimes the amount of sugar in your child’s blood can fall such that they feel unwell. To prevent this from happening your child is allowed to drink a limited amount of clear fluids (containing some sugar) until they go to for the operation or investigation (see below for details of how much they may drink).

What are the advantages of drinking clear fluids before the operation or investigation?

Children generally feel better if they are allowed to drink and it is comforting and reassuring if a parent or carer offers the child a drink. A drink helps to keep the blood sugar level and the blood pressure normal during the anesthesia or sedation. It also reduces the risk of nausea and vomiting when you child wakes up.

Help you child by staying fit

Fasting can be a challenge for some children. We advise you NOT to fast yourself. You will feel better and be better able to support your child if you eat and drink yourself. You will probably want to do this out of sight of your child.

* Your child should stop drinking when called for the operation or investigation

What is a light meal?

A light meal consists of:

• Bread, crackers or biscuits with a sweet topping such as jam
• Dairy products such as milk or yogurt, breast-milk, formula feeding, oatmeal or cereal with milk
• The following are NOT ALLOWED: meat, cheese or eggs or foods fried in oil or fat, because these foods stay too long in the stomach.

What are clear fluids?

These are transparent (‘see-through’) fluids that are NOT fizzy

• The best clear fluids are those which contain some sugar, such as:
  • Water with a little sugar added,
  • Tea with a little sugar but NO milk,
  • Orange squash or fruit cordial (but NOT orange juice),
  • Clear apple juice,
  • Soft drinks that are not fizzy,
  • An ice-lolly such as a Rocket (Raketje) but NOT ice-cream.

If your child gets sick before the operation

Please read the instructions in the admission letter carefully and phone the admissions office (het opnamebureau) in the Wilhelmina Children’s Hospital on 088 75 54445 if:

• your child is sick or has recently recovered from an illness such as a cold, diarrhea or fever, or
• if they have had a recent vaccination, or
• if they have been in contact with an infectious disease such as chickenpox, measles, mumps, rubella or jaundice/hepatitis.

The care team will then decide whether to postpone the procedure in order to reduce the risk of complications.

Numbing cream or plasters

If your child is going to get an intravenous cannula (i.v. or drip) before anesthesia we will put a plaster or cream on the skin where the i.v. will be placed about 30 to 60 minutes before the procedure. This will numb the skin and reduce the pain of the i.v..

Special clothing for the operating department

In order to improve safety and hygiene in the operating department children are not allowed to wear their own clothes there. We will give your child a special jacket and trousers. Jewelry and nail varnish are also not allowed in the operating department.

The operating department “Dromedaris” uitklapper, klik om te openen

There is a waiting area in front of the operating department called the “holding”. A nurse and/or specially trained childcare practitioner will take you and your child to the holding where the anesthesiologist or anesthetic nurse will come and pick you up for the procedure. They will ask you a few standard questions. The surgeon or the doctor who is responsible for the investigation will also ask a few questions, usually in the operating room. They will also mark the location of the operation if appropriate – for instance if the operation is to be performed on an arm or a leg. These procedures are necessary to ensure that the right operation is performed on the right child on the correct side. One parent or carer is allowed to accompany the child to the operating room.

App: WKZ-maatje

There is a WKZ-app called WKZ-maatje (WKZ-friend) which has been specially designed for children between 4 and 10 years of age. In the app a monkey and a tiger guide your child to the operating room. The app is available in Dutch only.

The operating room

In the operating room your child will sit or lie on the operating table, which looks like a long narrow bed. The anesthetic team will attach a sticker with a red light to your child’s finger or toe which measures the amount of oxygen in your child’s blood. They will usually also attach stickers to your child’s shoulders and flank for the heart monitor.

• If the anesthesia or sedation is to be given through an intravenous cannula (i.v. or drip) the anesthesiologist or anesthetic nurse will insert this and make sure it is securely taped to the skin. The anesthetic will then be injected and your child will fall asleep within about 10 to 20 seconds.
• If the anesthesia is to be given through a mask the anesthesiologist or anesthetic nurse will place this over your child’s mouth and nose. Your child will then fall asleep in about one minute.
• In both cases, but particularly with the mask, your child will probably make involuntary movements as they fall asleep, like rolling their eyes, or stretching and bending their arms. Your child will not be aware of these as they will already be asleep. Soon after your child will sleep more deeply and will lie still.

After your child has fallen asleep the childcare practitioner or the nurse will accompany you out of the operating room. If your child is having a short procedure you will get a buzzer and be asked to wait in the so-called “Buzzhalte” just outside the operating department. For longer procedures the ward your child was admitted to will let you know when the operation is over, usually via your mobile phone. 

Sedation

General anesthesia is not necessary for short, simple procedures, which can be done under sedation. Your child will be asleep, but less deeply than under anesthesia and not require assistance with their breathing which is often part of anesthesia. Sedation is always given through an intravenous cannula and it is not possible to put your child to sleep through a mask. In the WKZ sedation is given by an anesthesiologist or by a specially trained and qualified sedation practitioner under the supervision of an anesthesiologist.

University Medical Center Utrecht

The Wilhelmina Childrens’ Hospital is part of the University Medical Center Utrecht, which is large teaching hospital. This means that various health professionals are trained in the operation department and this is extremely important for the healthcare of the future. Your child’s treatment will be supervised at all times by experienced professionals who keep a close eye on the quality and safety of their care.

The recovery ward and intensive care uitklapper, klik om te openen

After the procedure your child will usually go to the recovery ward (uitslaapkamer) and you will be called to be with them as they recover from the anesthesia or sedation. Only one parent or carer is allowed in the recovery ward.

In the recovery ward we will make sure that any unpleasant effects of the operation – such as pain or nausea – are quickly detected and treated. When your child is sufficiently awake and comfortable they will be transferred back to their ward.

For some long or complex procedures it is necessary to observe your child more closely after the operation and this usually takes place in the intensive care – either the NICU  - the intensive care for newly born and premature babies, or the PICU – the intensive care for all other children and teenagers, which is also known as Pelikaan ward.

The anesthesiologist will make a plan to prevent and treat any pain and nausea your child might otherwise have after the operation and will prescribe the necessary medication. Pain relief in the form of drinks, tablets, suppositories and/or intravenous medication can be used. For many operations the best way to provide pain relief is to also use local anesthesia via a catheter (a small tube) placed near the appropriate nerve(s) in your child’s back or limb, which can be left in for several days after the operation.

Admissions in day-care uitklapper, klik om te openen

Many procedures can be planned as day-care which means that your child will go home the same day. Before you child goes home we will check that they are sufficiently awake and that pain and nausea are well under control. You will receive instructions from the care team about the necessary care at home in the days following the admission, and we will usually also receive an appointment for a check-up in the outpatients’ department.

At home

On the day of the operation it is best to give your child small portions of easily digestible food and to avoid fatty or strongly flavored foods. Make sure that your child has plenty to drink. You child can be a little sleepy and lack energy. Some children may find it difficult to sleep or be more timid than usual in the first few days after the operation or investigation. These symptoms usually disappear with time. If you are worried or have questions about this you can contact our team – see the below and the discharge letter for contact details.

Admission overnight uitklapper, klik om te openen

For some operations it is necessary for your child stay in hospital overnight or for several days. Usually this is planned in advance and has to do with the need for additional pain relief, the early detection and treatment of complications and special care or treatment following the operation which sometime has to be given through the intravenous cannula. Sometimes a child has to stay overnight following a procedure which was planned in day-care, for instance in the case of complications or the need for additional pain relief or treatment of nausea.

App: WKZ-maatje uitklapper, klik om te openen

Many children are a little frightened of the admission, the operation and/or the anesthetic or sedation. To help them we have made an app in which a digital friend guides your child through what is going to happen around the time of the operation or investigation. This is often a good way to occupy your child’s thoughts before and during the admission.

Contact

You will be sent additional information in the form of (digital) brochures. If you still have any questions before the admission you can telephone us on 088 75 540 15. For less urgent matters it is a good idea to make a list of your questions which you can ask the nurse or doctor when you come to the hospital.