Parents are notified by the operating room on the day prior to operation as to the time to present for surgery and are given NPO orders at that time. In general, patients are NPO for solids and non-clear liquids for at least 6 hours (usually afyter MN), NPO for breast milk for 4 hours. Infants and young children may have clear liquids until 2 hours prior to surgery and then are completely NPO. Parents are instructed to call if their child has a fever or illness requiring antibiotic therapy. Elective cases are generally cancelled in this instance. Please verify this with the attending prior to cancelling any procedure.
Preoperative labs are at the attending surgeons discretion. A recent (72hours) CBC and electrolytes are fairly typical. Coagulation studies are not generally necessary, unless there is an underlying coagulopathy or concern for same. Blood product availability depends on the operation. For neonatal laparotomy, one unit of PRBCs split into pedi-packs is generally ordered. Since these patients typically have intravenous access, they are generally made NPO after midnight so as to allow for earlier operation should the schedule permit. (i.e. an outpatient does not show). Please ask if you need clarification.
Bowel Preparation for GI surgery:
Patients are generally placed on a clear liquid diet and receive GoLytely solution as a mechanical prep. Young children will often drink the necessary volumes without much of a problem. Alternatively, a small feeding tube can be placed to assure that volumes are administered over limited time frames for maximal effect.
The volume of GoLytely is based on the patients weight.
50cc/kg over two hours is a reasonable initial dose and can be followed by another 25-50 cc/kg depending on effectiveness.
Not all patients who receive bowel preps require enemas. When they are given, they are saline enemas in a volume of approximately 10cc/kg, administered every 2-4 hours. (See table below)
A note of caution: Children who have problems with incomplete evacuation (i.e. most of the congenital anomalies of the colon and rectum, Hirschsprungs, Imperforate anus, myelo-meningocoele patients) should not receive Fleet enemas because retention of this will result in potentially fatal hyperphosphatemia!
The operating surgeon indicates the use of neomycin and erythromycin base. Intravenous antibiotics are generally ordered in the operating room.
Age Volume Age Volume
NB 50 cc 8 year 450 cc
1 year 100 cc 10 year 500 cc
2 year 200 cc 12 year 600 cc
3 year 250 cc 14 year 700 cc
4 year 280 cc 16 year 800 cc
6 year 350 cc