to surgery. We admit the child and the family directly to a private,
quiet, dimly lit room away from non-sedated children. A dedicated
child life specialist attends to the child and family to help with distrac-
tions and interactions with hospital staff. We have the same-day sur-
gery nurse, surgeon and anesthesia provider visit the child and family
in the room. If we're confident that weight and vital signs have
remained unchanged, we may choose to skip these tests. As a pediatric
hospital, we ask all our patients to bring comfort items, including
stuffed animals, and we also encourage support animals if they use
them at home.
We do not ask these patients to remove any articles of clothing,
including earrings or elastic hair bands. If we need to remove cloth-
ing, we do it after the patient is anesthetized. Hospital gowns can be
scratchy. To a child with sensory processing difficulties, this can be
completely intolerable. We do not require patients to wear a name
bracelet as long as a parent is present, as applying these can be a trig-
ger for some children.
If our pre-op plan includes sedation, we typically use a combination
of midazolam (0.25 mg/kg or 0.5 mg/kg) and/or ketamine (1 mg/kg to 6
mg/kg). Using ketamine, a dissociative agent, allows us to use less
midazolam. Medication can be administered by cup or syringe, and is
made more palatable using flavored syrups of the patient's choosing.
Midazolam especially is very acidic. If the patient has an aversion to
taking liquids by mouth, we can use an intranasal or intramuscular
route if it's deemed to be overall less traumatic than an IV start or
mask induction. Dexmedetomidine can also be used for pre-sedation
(PO, IM or intranasal). It has the advantage of being tasteless, so it
can be helpful if patients have sensory aversions. It has poor oral
bioavailability however, and takes longer to onset.
4. Prepare the OR
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