WHAT TO EXPECT IN THE OPERATING RECOVERY AREA
When your child is awake enough in Post Anaesthesia Care Unit (PACU) you will be asked to join them. It is common for your child to be agitated, upset and disoriented for a short while in recovery. This is due to a combination of factors such as the anaesthetic wearing off, new environment, dizziness and pressure changes when the ears are operated upon, early start, no breakfast, young age, and rarely pain. It lasts about 30-45mins at the most and then they generally settle well. During your stay in the recovery room there will be nursing staff closely assessing and attending your child. It can be distressing to see but the child will not recall this time. During the operation strong weight and age appropriate pain and anti nausea medication will have been given, so pain is rarely the only cause.
Once your child is sufficiently awake and the recovery staff are happy with their progress you will be taken back to the ward area. In most cases your child will be able to eat and drink when ready. An intravenous drip will remain in place until review. It is common to be quite sleepy.
While you are on the ward the nursing staff will make sure that your child is assessed regularly. If you have any concerns at this stage you should alert the nursing staff so that they can help you.
WHAT TO EXPECT DURING THE HOSPITAL STAY
Older children that have their operation early in the morning may be discharged several hours later that day if they are doing well.
Minimum stay after surgery regardless of age will be 6 hours so keep free the entire day.
Not all children will meet the criteria for day surgery discharge so pack a bag with toiletries and change of clothes, and budget for an overnight stay when discussing hospital costs.
Children that will stay overnight will include:
- aged under 3 yrs
- children who have moderate or severe obstructive sleep apnoea
- children with other chronic medical issues
- children who are overweight
- children who are not managing to eat or drink, or who are feeling sick or excessively sleepy
For most children their stay in hospital is comfortable, due to the pain medications given by the anaesthetist during the operation and long acting local anaesthetic used by the surgeon. Most children will feel up to eating and drinking later that day and will either sleep or feel like watching TV or reading. In small number of cases there may be some degree of discomfort or nausea.
If your child has either of these you should alert your nurse as they can give medication to counteract it. The common times to feel nauseated or to vomit are immediately after the operation, when they first eat or when driving home (it is probably the motion in the car) so make sure you are given a “sick” bag to take with you for the ride home. If you have one you probably won’t need it!
MEDICATIONS TO TAKE HOME
1. ANTIBIOTICS
Some children will go home with a prescription for amoxycillin or augmentin, or another antibiotic depending on allergies. This is not a routine post op medication and will only be prescribed if infection is present or if the surgeon requests it.
2. PAIN MEDICATION
- At home use paracetamol (Childrens Panadol ® , Dymadon ® ) 3-4 times a day regularly for three days. Give the dose on the side of the bottle for your child’s age and do not exceed 4 doses per 24 hrs. Older children prefer chewable or soluble Panadol ®.
- Ibuprofen (Nurofen ®) may be given in between doses of paracetamol as directed on the label after the second day, unless your surgeon asks you not to use it.
- A prescription for oxycodone (OxyNorm ® ) syrup will be given, this can be given as well as the paracetamol and ibuprofen if needed. Use a syringe to measure the dose out exactly as directed on the bottle, it is most important with oxycodone that exactly the prescribed dose is given and, like all medications, under no circumstances should your child be allowed to dose themselves. Oxycodone is for the pain not covered by paracetamol and ibuprofen, not for regular dosage. If your child is comfortable on paracetamol you do not need to give it.
- PainStop ® is no longer recommended due to serious safety concerns in children
Your child will need pain relief for about a week and possibly longer.
It is not unusual for young children to refuse to take medications as they do not like the taste, but you must take the upper hand early in this situation rather than letting your child take control. If pain relief is not maintained at an adequate level you will run into trouble getting them to drink and eat enough a few days down the track. Use a small syringe to squirt the medicine into the back of the throat past the molar teeth rather than giving it to them to sip from a medicine cup. Employ whatever discipline, bribery or distraction techniques are required. Try to give the oxycodone syrup with a little food or milk to prevent tummy aches. Children may commonly complain of either throat or ear pain. The ear pain is what we call referred pain from the throat and may be worse than the throat pain.
3.GARGLES
Older children over about 8 years can use hydrogen peroxide gargles to improve healing, and local anaesthetic gargles can be purchased over the counter at the pharmacy to help with throat pain such as Cepacain or difflam.
EATING AND DRINKING AT HOME
There are no absolute restrictions on food and drink intake after a tonsillectomy. It is not uncommon to be “off your food” for a few days, and not uncommonly you may see a small amount of weight loss as a result. It is very important that your child maintains their fluid intake during their recovery. A normal diet is recommended and has been shown to promote healing and reduce infection.
SUGGESTED FOODS
- Normal family food. This may be rice, pasta, mince, fish etc
- All of the soft “comfort foods” such as jelly, ice cream, yoghurt, smoothies.
- Paddle pops or ice-blocks are cold, sloppy, taste good and have calories and fluid in them.
- It is important to maintain a good fluid intake of at least 80ml per kg body weight per day.
- The best fluid for maintenance hydration and thirst is filtered tap water
- If giving sugary drinks (such as fruit juice or soft drink) dilute these at least one part juice and 4 parts water to allow better water absorption. Full strength sugary drinks will make dehydration worse.
- If it gets to the stage that they are just not eating and drinking enough they may need to return to hospital for intravenous fluids. You should contact either your anaesthetist or surgeon if you have concerns that your child is dehydrated or vomiting.
Please read the information sheets provided by your surgeon for further information on post operative care and what to expect after your surgery. Contact the anaesthetist if there are any pain management problems, questions about dosing, vomiting, excessive sleepiness, or any other concerns.
Contact the surgeon urgently if there is any bleeding or breathing problems.
