Anesthesiologie

This text provides information about your child’s admission to Amsterdam UMC, location AMC, Ambulatory surgery department and explains the rules relating to the admission. For example, read about the guidelines on fasting before a procedure, information about preparing your child for the procedure and what you should expect once your child is home.

The Day Care Centre

Your child will shortly be undergoing a procedure at the Ambulatory surgery department. The department is located on the ground floor of D-building in Amsterdam UMC, location AMC. You can reach the department via the outpatient main entrance. Enter through the revolving door and follow the ‘Dagcentrum’ signs past the reception. The entrance to the department is on your right, just before you reach the square. You may also use the entrances from the parking lots. The department, is open from Monday to Friday from 7:30 until 20:00 hrs. It caters to both adults and children.

Pre-admission examination

Before being admitted to the Ambulatory Surgery department you will receive a phone call by an anesthetist. He/she will speak to you about the most suitable type of anesthetic for your child. Please feel free to ask questions.

Important!

If your child is to be admitted at the Day Care Centre for Surgery, Plastic Surgery, Surgery, Orthopedics or Urology the secretary is going to contact you by letter or telephone with regards to the date of the surgery. For further questions we can be contacted between 10:30-12:00 hrs at 020-5664117. Other specialized surgical categories will contact you later by phone, letter or email.

The day before admission, you should receive a phone call by our department between 14.00 and 16.00 p.m. You will then be told when you should arrive the next day. This is not the time that the procedure is going to take place. We work according to a tight operation schedule and this is why you must arrive at the Ambulatory Surgery department on time.

You may have to wait if the operation schedule is running late, but if a preceding procedure is cancelled, your child may receive surgery earlier than scheduled. This is why you should not leave the department once you have signed in. Please realize that you will be in the hospital for the whole day, possibly until late in the afternoon/evening.

AMC rules for admission to the Day Care Centre

• A maximum of two people (parents or carers) may accompany your child. Brothers, sisters or other children may not be admitted to the ward. Childcare facilities are available in the corridor of the main building.
• Visitors are not allowed.
• Parents or carers will be given tea or coffee on request.
• Amsterdam UMC is a no-smoking area; this includes the Ambulatory Surgery department.
• Mobile phones are allowed in Amsterdam UMC but should be switched off on the ward. WIFI is available but the reception on the department is generally poor.
• Leave all valuables at home; we accept no liability for loss or theft.
• Do not forget to bring your proof of identity.
• Please bring your child’s medication list. If necessary, inquire about this list at your local pharmacy.

Preparing for a general anesthetic

Due to receiving anesthesia, it is important that you observe the following rules when preparing for admission to the Day Care Centre and for the procedure:

1. Fasting before the procedure is very important (all ages included)

It is important that your child does not eat or drink before the procedure so that he/she can be taken to the operating room with an empty stomach. This means:

• Until 1 hour before the operation: your child may drink normal amounts of clear fluids such as water, apple juice without pulp and carbonated soft drinks. No other drinks, milk or milk products are allowed!
• Until 4 hours before the operation: only breast milk.
• 6 hours before the operation: all other types of milk (including formula), tea (with milk and sugar) and a light snack (e.g. crisp bread).
• 8 hours before the operation: all foods are allowed, including large meals with fatty or fried ingredients.

Some children will be given medication an hour before the procedure. A sip of water with these pills will do no harm. Your child may also clean his/her teeth as usual.

2. Medication

If your child is taking medication, please inform the nurse and bring it with you to the hospital. Do not give Aspirin or any drug that contains Aspirin. If necessary, use Paracetamol (Panadol, Finimal) as an alternative painkiller. You can buy Sinaspril with Paracetamol for children instead of Aspirin.

Before the procedure, the anesthetist may make other arrangements with you regarding fasting or using medication. This could be the case if your child has diabetes or for other reasons. Be sure to comply with these arrangements.

3. Inoculations and illness (children)

If your child has recently been inoculated of vaccinated, there is a minimum interval before the procedure can take place. The following rules apply:

• Diphtheria, (Whooping Cough), Tetanus, Polio, Hib: 2 days (for children between 2 months and 4 years old).
• Mumps, Measles, German Measles: 2 weeks (for children between 14 months and 9 years old).
• Meningitis, aK, Hepatitis A and B and Pneumococcus: 2 days.

If your child has had an infection during the last 3 weeks, or is in contact with someone with an infectious condition, please notify us immediately.

If your child has a temperature higher than 38°C, the procedure will not be carried out. It will be postponed until your child’s temperature has returned to normal. Please call 020-5664458 early in the morning to warn the nurse about this.

If your child is younger than 1 year old and is suffering from a cold, the procedure may be postponed. If your child is older than one year and has a cold, and there are signs of general malaise and/or a productive cough, please call the Ambulatory Surgery department as soon as possible.

Preparing for admission

• It is important to prepare your child for the day at the department by giving some information about what’s to come. It has been shown to calm and comfort children, when they know what to expect beforehand. A small description could be enough and will indicate remaining worries or questions. You can find some educative material for children om www.emmakids.nl. Also, on YouTube you may find videos that show the use of an anaesthetic face mask or intravenous drip.
• Bring something to the hospital that will comfort your child: a favorite book, teddy bear, toy, beaker, bottle or pacifier.
• You may bring pyjamas, but this is not obligatory as your child will be given an operation gown. Do not forget to bring slippers.
• Comfortable clothing is advised for you and your child. If you accompany your child to the operating theatre, you will be provided with an overall.
• Your child may not wear jewellery or have nail varnish on.
• It may be useful to purchase some Paracetamol/Ibuprofen ahead. This way you are prepared, if painkillers will be needed at home.

On arrival at the Day Care Centre

You should arrive at Amsterdam UMC, location AMC, with your child at the arranged time. Your child should not have had anything to eat or drink, in accordance with the rules explained earlier. The nurse will first take your personal details , show you around the department and measure some things (temperature, weigh). You might be visited by the doctor performing the procedure or the anesthetist.

In preparation for the anesthetic, the nurse will give your child medicine if necessary.

If the anesthetic is to be given via an infusion, the injection site (usually the back of both hands) will now be prepared in advance by using EMLA cream. (This is the case if you have not already applied the cream at home in advance, according to previous instruction.) The cream acts as a mild local anesthetic.

You can help your child put on the operation gown and you will need to put on your own overall (if you are accompanying your child to the operating theatre). Only one parent may escort the child into the operating theatre.

The operating theatre

The nurse will take you and your child to the operating theatre, where your child will be anaesthetized either by means of a mask or injection. This occurs according to the agreement made with the anesthetist present. This can be an emotional moment for both of you. As the anesthetic starts to take effect, some children become agitated and their eyes may roll backwards. This is nothing to worry about; it is considered to be perfectly normal. Once your child is under the anesthetic, the nurse will escort you back to the ward.

Your child may be given a local anesthetic while under general anesthesia, if undergoing an operation in the groin area, for example. When your child wakes up, he/she may feel tingling or weakness in his/her legs. Bedrest is strongly advised until feeling and strength is back to normal.

Immediately after the operation

You may re-join your child as soon as he/she has been brought to the (Ambulatory Surgery department) recovery room. Your presence at the start and end of anesthesia is comforting for your child. A nurse will monitor your child as he/she awakens from the anesthetic. The doctor who performed the procedure and the anesthetist will come and tell you how the operation went while in the recovery room or later, on the ward.

Your child may be in pain or feel sick after the operation. Medication (usually a suppository) is administered before or during the procedure to prevent this. Extra medication can be given after the operation, as required.

Going home

If everything goes well, your child will be able to return home on the same day. You will be given instructions about the medication and after-care, along with an appointment for the outpatient department.

You may travel by taxi or use your own transport. If using your own car, a second adult will be needed to ensure your child’s safety. Due to the fact that your child has been under anesthesia, you are not allowed to use public transport to go home.

On arriving home you are advised to feed your child easily digestible food for the rest of the day. He/she should not eat fatty or spicy food. Make sure your child drinks regularly, and if he/she appears tired, put him/her to bed or lie him/her down to rest on the sofa. Your child will be back to normal within a few days. If you are concerned, always contact the hospital.

The days after the operation

The nurse from the department might telephone you the day after the procedure to check that everything is all right. You may ask questions or discuss any problems with this nurse.

Accompanying the immediate effects of the operation and anesthetic (fatigue, pain), your child may display other symptoms such as insomnia or anxiety. These disappear in time. You can contact the staff at the Ambulatory Surgery department the next day within 24 hours post- surgery : at the nursing station. Telephone: 020-566 4458. After the 24 hours period you will be referred to the outpatient department (polikliniek), your general practitioner (huisarts) or Emergency Room.

Summary

• Prepare your child for a day in hospital by telling him/her what is going to happen.
• No food or drink before the anesthetic (refer to the relevant section).
• Take the child’s medications to the hospital and show it to the nurse.
• Your child may not wear jewellery or nail varnish.
• Take your child’s teddy bear, toy, favourite beaker or bottle to the hospital.
• Leave all valuables at home. Take your phone
• You should realize that you will be in the hospital for the whole day, possibly until late in the afternoon or early evening.

It is important to prepare your child for a day in hospital by telling him/her exactly what is going to happen. Repeating the information will help your child to accept what is going to happen.

Finally

If you have any questions about the information above or if you are unsure whether the information applies to your own situation, please get in touch with the Ambulatory Surgery department on the following phone number: 020-5664458.