Outpatient surgery for certain operations has become very common and can be performed without a hospital admission. This means that information about your child needed by the anesthesiologist will be obtained both before and at the day of surgery. Although outpatient or same-day surgery is usually performed for "small" operations, the anesthesia is never "small." It is just as important to follow preoperative directions for outpatient surgery as for operations when your child is brought into the hospital overnight. For example, it is very important for your child's safety to follow closely the anesthesiologist's instructions concerning food and liquid intake.

Children must refrain from eating or drinking for a certain period of time prior to surgery. This is done for safety reasons, so as to minimize the chance of pneumonia should a patient vomit just as they are receiving the anesthetic. This problem is fortunately quite rare nowadays, in large part because of these fasting guidelines. Children tolerate these restrictions on eating and drinking better than one might imagine.

Solid food is not allowed anytime on the day of surgery, although certain exceptions may be made for children who will not be having their surgery until late in the afternoon. Clear liquids may be taken up until two to four hours before surgery, depending on the age of the child. Clear liquids include any liquid which is clear enough to see through, such as water, apple juice, Gatorade, water, tea, bullion, popsicles, or Jell-O; the latter two are obviously solid when eaten but melt to clear liquids rapidly in the stomach. Please note that milk and juice with pulp are not clear liquids.

In the past, virtually every child received an injected sedative before being taken to the operating room. We now realize that many children need less sedation when calm, assured and confident parents help them through the stress of a procedure or hospitalization. It is our practice to offer the opportunity (it is NOT required) for one parent or guardian to enter the OR with the patient. This may help to reduce the child’s anxiety. Usually this is not necessary in mature children and teens.

Traditionally the initial anesthetic is usually administered via an intravenous infusion in adult patients. This approach requires starting an intravenous line (IV) while the patient is still awake. This technique would be quite unpopular with younger children; however in older children it is well tolerated and provides rapid access for medications which may be necessary as you go off to sleep. Most young children prefer to go asleep by breathing gas, a technique known as an "inhalation induction". This technique is used for almost all routine surgeries, but cannot safely be employed in certain rare situations, such as emergencies, regardless of the child’s age. Your anesthesiologist will make that determination when your child is assessed preoperatively.

An "inhalation induction" consists of the child breathing a relatively pleasant smelling anesthetic vapor using a facemask. In 30 to 60 seconds, the child loses consciousness while breathing the gas, and the IV can then be started painlessly. Generally, the child continues to breathe the gas throughout the surgical procedure. This is done with the facemask or through an endotracheal breathing tube. It is this breathing of anesthetic vapors which keeps the child anesthetized. At the end of the surgery, the anesthesia is discontinued, and the child begins to awaken.

Prior to awakening, children may be given pain medicines and/or drugs which reduce the likelihood of nausea and vomiting. The type of surgery will determine which of the many possible medications will be used for these purposes. To help with the recovery process we attempt to reunite the child with his or her parents as quickly as possible. We therefore encourage one parent to join their child in the recovery room as soon as the child is awake.

The anesthesiologist and the surgeon will do their best to make your child's visit to the hospital as pleasant as possible; however, you also have a key role to play in your child's care. It is important that you begin preparing your child for the operation as soon as a decision is made to perform surgery. Children tolerate surgery and anesthesia better when they are well-prepared. As with all of us, children have natural fears of the unknown. Anything you can do to relieve these anxieties and to inform your child about the coming events in the hospital and the operating room will greatly improve your child's experience.