CORONAVIRUS (COVID-19) NOTICE – James L. Rothschiller MD
SARS-CoV-2 (Severe Acute Respiratory Syndrome COronaVirus 2) is the coronavirus that is causing the ongoing pandemic, COVID-19. COVID-19 is an acronym for the novel (new to humans) coronavirus “COronaVIrus Disease 2019” previously known by the provisional name “2019 novel coronavirus” (2019-nCoV).
Due to the global spread of COVID-19, we are taking all necessary precautions and recommendations of the Centers for Disease Control and Prevention (CDC), American Society of Anesthesiologists (ASA), and the Anesthesia Patient Safety Foundation (APSF) to address patient and healthcare worker’s needs during the COVID-19 pandemic.
If you or any household member have experienced any respiratory illness or flu-like symptoms including fever, dry cough, difficulty breathing, diarrhea, or abdominal pain please call your doctor’s office to ascertain whether or not your elective anesthetic and surgery can be done.
The author, owner, and webmaster of this website is James L. Rothschiller MD.
SARS-CoV-2 has close genetic similarity to bat coronaviruses, from which it likely originated. An intermediate animal reservoir such as a pangolin is also thought to be involved in its introduction to humans. From a taxonomic perspective, SARS-CoV-2 is classified as a strain of the species severe acute respiratory syndrome-related coronavirus (SARSr-CoV). Hensxe, it is labeled a novel virus, that is a new virus to humans.
Please follow these preoperative instructions carefully to avoid cancellation of your procedure. Your anesthesiologist will attempt to call you the night before surgery to discuss the following instructions.
General instructions unless instructed otherwise by your anesthesiologist:
- No food is allowed after 10 PM the night prior to your procedure.
- Clears are allowed until 4 hours prior to the procedure.
Preparing For Anesthesia
Eating, Drinking and Preadmission Instructions
You may hear “NPO” instructions, Nil per os or NPO is a medical instruction meaning to withhold oral food and liquids from a patient. The preoperative fast is an attempt to avoid regurgitation and possible aspiration of food and liquid from the child’s stomach during the induction of anesthesia. If your child was prescribed a bowel-prep for a procedure (colonoscopy), please follow your doctor’s instructions carefully.
Adults and Children Age > 6 Years
No solid food, cow’s milk, gelatin (Jell-O®) which contains protein, liquid thickeners, gum or candy after 10 PM. (procedures may start as early as 6AM)
Clear Liquids are allowed until 4 hours prior to the scheduled procedure. Clear liquids include water, coffee, tea, energy drinks, apple juice, Pedialyte®, Gatorade®, clear sodas, and Popsicles® without dairy or food particles.
Children Age ≤ 6 Years
Solid low-fat food is allowed until 6 hours prior to the scheduled procedure for children 6 years or younger. Solid low-fat food includes infant formulas, non-human (cow’s) milk, cereals, bread, Jell-O® and fruit juice with pulp.
Breast milk is allowed until 4 hours prior to the scheduled procedure.
Clear liquids are allowed until 2 hours prior to the scheduled procedure. Clear liquids include water, Pedialyte®, apple juice, Gatorade®, and Popsicles® without dairy or food particles.
Is Coffee, Tea and Energy Drinks a Clear Liquid?
Caffeine Withdrawal Headaches After Anesthesia: The question posed is dairy free coffee or tea a clear liquid allowed prior to anesthesia? Black coffee, tea, caffeinated energy drinks and carbonated beverages are considered clear liquids. Patients, pediatric and adult, who have high daily intakes of caffeine may drink black coffee or other clear caffeinated beverages 4 hours before anesthesia to prevent the onset of caffeine withdrawal postoperative headache.
All patients should take their medicines in the morning with a sip of water unless otherwise directed. Do not take ibuprofen (Motrin, Advil) within 2 days of the procedure. Acetaminophen (Tylenol) is fine. Please stop taking herbal medications and diet drugs at least one week prior to surgery.
Inhalers or Nebulizers for Asthma or Reactive Airway Disease (RAD)
Patients on prescribed inhalers or nebulizers should begin treatment 3 days to 24 hours before the procedure even if they are not symptomatic.
If your child’s surgery has been canceled once before due to wheezing, it is recommended that you consult your pediatrician and consider a dose of steroids a few days prior to surgery.
Does your child have symptoms of wheezing (bronchospasm)?
Most patients with asthma complain more frequently about chest tightness (in combination with shortness of breath or a cough) than wheezing. Thus, any patient with chronic or episodic respiratory symptoms or who presents with a history of asthma or other chronic airway disease should consult their primary care physician a few days before their procedure.
Nasal Decongestant Spray – Afrin® (oxymetazoline)
Patients with nasal congestion due to seasonal allergies will benefit from administering nasal decongestant Afrin® (oxymetazoline) sprayed into each nostril the evening before and the morning of the procedure.
For patients having sinus surgery, nose surgery, turbinate reduction, or nasolacrimal duct surgery, it is highly recommended that you use “Afrin” (oxymetazoline) the evening before and the morning of the procedure.
Please wear loose fitting clothing, short sleeve shirt, and avoid one-piece outfits on children.
Comfort and Warmth
Pack a favorite stuffed animal, toy or book to comfort your child. Bring a blanket to keep your child warm.
Bed Wetting (Nocturnal Enuresis)
Pediatric patients may benefit from wearing pull-up diapers if they wear one while sleeping. Bring an extra set of clothes for children who are at risk for bed wetting. For infants, bring a small supply of diapers and bottles.
Go To Bed Early!
Some of the best advice is to have your child or teenager get a good night’s sleep so they are well-rested on the day of their procedure. We recommend an early bedtime by 10 PM (especially teenagers), and turn off all lights and electronic devices.
The current research literature dealing with patient preparation for anesthesia and medical procedures suggests preparation for anesthesia is important for young people and their parents. Preparing your child for anesthesia and surgery has demonstrated to help your child feel less anxious, cope much better and get through the recovery period faster. Research also shows that when both parents and kids know what to expect, children have:
- Less Anxiety
- Earlier Discharge
- Less Pain Medication Requirement
The extensiveness and style of psychological preparation for children should be guided by each child’s age and developmental level. In general, specific discussion about the sedation and procedure has more relevance for children >2 years of age.
Psychological preparation for children should have at least three components:
- What will happen (where, how long it will last and what will be done)
- How it will feel (pressure, temperature, and level of discomfort to be expected)
- Strategies to cope with the stressor (which may be related to the sedation technique and/or procedure)
Age-based Psychological Preparation
- Separation anxiety and behavior regression is more common in children between 6 months and 6 years
- School aged children are concerned with the surgical procedure and awareness under anesthesia
- Adolescents fear loss of control
Pediatric Anesthesia Emergence Delirium Behavior
You may have heard of or have experienced a child waking up “wild” from anesthesia. It is not unusual to see children awake from anesthesia with delirium and agitation. Pediatric anesthesia emergence delirium is most frequently observed in preschool aged children and males are more affected than female patients. The delirium occurs around 15 minutes after a general gas anesthetic and usually resolves within 30 minutes.
- Lack of eye contact
- Head tilting
- Holding their head backward
Please do not be alarmed, emergence delirium does not cause any long-term side effects. The PACU nurses will not wait to reunite you with your child because it may require your help to keep your child from pulling out IV catheters, dressings, and to ensure that the child doesn’t injure himself on the bed or harm the surgical site.
Our Mission is to improve the medical well-being of infants, children, adolescents, and adults through offering personalized and comprehensive medical care by the most experienced physician anesthesiologists in the community.
VIDEO: How to Prepare Your Child for Anesthesia and Surgery
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