People come to the hospital for surgery for many different reasons. We ask all our patients to get ready for their surgery by reading this guide. Before you come to the hospital for surgery You can take action to improve your safety during 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 are very overweight, losing weight will reduce many of the risks of having an anaesthetic. If you have loose teeth or crowns, treatment from your dentist may reduce the risk of damage to your teeth if the anaesthetist needs to put a tube in your throat to help you breathe. If you have a long-standing medical problem such as diabetes, asthma or bronchitis, thyroid problems, heart problems or high blood pressure (hypertension) you should ask your GP if you need a check-up. Tell us about any pills, medicine, herbal remedies, or supplements you are taking. Include prescribed medicines and anything you have bought over the counter. It will be useful to write a list to bring with you to show to your doctor. If your child is coming to the hospital for an operation 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 child and 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 Children’s Play Team can help give explanations and encourage discussion through play. 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. Tell us about any changes which might affect your surgery If you’re having a general anaesthetic, in order to avoid the last minute cancellation of your surgery please inform the Surgical Pre-Assessment team of any: changes to the information that you gave at Pre-Assessment. 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-Assessment appointment. Contacting the team To inform the team of any changes or for more information, call 01226 432795 during normal working hours. On the day of your surgery If you are a smoker, you should not smoke on the day of your operation. This will help avoid breathing problems during your anaesthetic. If you are taking medicines you should continue to take them as usual unless your anaesthetist or surgeon has asked you not to. For example, if you take drugs to stop you getting blood clots (anticoagulants), aspirin, drugs for diabetes or herbal remedies, you will need specific instructions. If you feel unwell on the day of the operation, please telephone the admissions unit for advice. Contact numbers are provided on your appointment letter. Fasting before your surgery under general anaesthetic Nothing to eat or drink – fasting (‘Nil by mouth’) Clear instructions will be given with regards to fasting. It is important to follow these, as food or liquid in your stomach during your anaesthetic could come up to the back of your throat and damage your lungs. You should stop drinking clear fluids at least 2 hours before your admission Clear fluids include: water diluting juice black tea black coffee Do not drink milk and drinks containing milk within 6 hours of admission. Milk and drinks containing milk curdle (become semi solid) in the stomach and are treated as solids. Your operation can be cancelled if you drink even a small amount of milk in your tea or coffee within 6 hours of surgery. Non-clear fresh fruit juices containing pulp (e.g. fresh orange juice) should be avoided within 6 hours of admission. If you do not comply with this guidance, your surgery may be cancelled. You may not be offered any further dates for surgery and you may be referred back to your GP. You should stop eating all foods and stop drinking some fluids 6 hours before your admission This includes: All foods All non clear fluids Tea or coffee with milk Fizzy drinks Fruit juices with pulp Sweets, chocolate or chewing gum Milk You can eat normally on the day before your surgery but it is a good idea to avoid large or fatty meals. This is because fat and dietary fibre tend to remain in the stomach for longer than other foods. Most people will not eat after midnight and this can be a convenient cut off point. Children can be given a snack before bedtime. If you do not comply with the fasting guidance, your surgery may be cancelled. You may not be offered any further dates for surgery and you may be referred back to your GP. How long do I need to fast for? Food and Drinks Minimum Fasting Period Clear fluids including water, clear juice, dilute cordial, black tea or coffee 2 hours Babies can have breast milk 4 hours Non-clear fluids including tea or coffee with milk, milk or fizzy drinks 6 hours Snacks including toast, pastries, chocolate, sweets, crisps, or chewing gum 6 hours Full meals 6 hours Your anaesthetist will meet you before your operation Your Anaesthetist will meet you for a Pre-Operative Visit to discuss your general health, whether you are taking any medications, and whether you have any allergies. They will also discuss types of anaesthetic that can be used, and all the benefits and risks before advising on what would be suitable. You might find it helpful to bring a written list of any questions you want to ask. Nothing will happen to you until you understand and agree with what has been planned for you. You have the right to refuse if you do not want the treatment suggested or if you want more information or more time to decide. 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 Your child may be able to wear his or her own clothes to the operating theatre, but if not we will provide a gown to wear, your child will be able to keep their underwear on. Your child may travel to the anaesthetic room in a bed, on a trolley, walking or being carried and will be accompanied by a nurse from the ward. 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 from the ward to go with them. After your operation After the operation, you may be taken to the recovery room. Recovery staff will be with you at all times. When they are satisfied that you have recovered safely from your anaesthetic you will be taken back to the ward. After your child’s operation 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. Some children may need to go to the Intensive Care Unit after their operation, if this is planned it will be discussed with you beforehand. 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.