WWYD - Gas or IV for GA for grommits?

[StartingAfresh]

It looks like we have a choice for ds, age 4 (but with social communiction problems)

Also, has anyone's dc had a pre-med and would they recommend it?

I'm inclined to refuse it if allowed.

Many TIA

[hobbgoblin]

Are you asking about the method for going 'under'?

DS had nasal opiate before his GA and then gas before IV.

[hobbgoblin]

Not for grommits - broken arm btw.

[NoodlesMam]

My DD was just over 2 when she had her first GA. They tried to get the IV in first by distracting her but opted for the gas after the second attempt. We had to use gas the second time also. I think they ususally try the IV way first and the gas as a last resort? TBH tho, I know she wont keep still and it's impossible to get a vein without digging about for ages so i wish they would just get on with the gas straight away. If you think your son would keep still long enough though I would go for the IV, the gas mask is horrible and smelly and I suppose at that age pretty frightening??? poor little things

[StartingAfresh]

Blimey, that seems like a lot. yes I mean going 'under'.

The nurse on the phone says that they might suggest gas if they can't get a canula in, but that they might go with gas anyway.

It seemed to be an either/or thingy.

If it is going to be IV anyway, then tbh I'd rather just go with the IV I think. I suppose the nasal opiate and then GA was to knock him out so they could get the IV in without a struggle was it?

[kreecherlivesupstairs]

DD had grommets a year ago, she did have the premed but it didn't do anything. She had emla cream put on before she went to theatre so the cannulation wasn't traumatic. They gassed her down then used the IVs and intubated her.

[StartingAfresh]

x post noodles.

I think I can get him to cooperate with IV, although distracting him won't work. He'll cooperate best if he watches the whole thing in close detail

I had grommits many times as a kid and I remember that I preferred the IV as the gas was horrid and made me feel awful and sick afterwards. (I had had so many grommits operations by the age of 6, that from them on I used to hide a glass of water behind my bedside cabinet before the operation because I knew that they restricted fluids afterwards and I couldn't stand the thirst . I would literally glug it the instant I woke up and then promtly throw up, but feel much better anyway.

[StartingAfresh]

kreech were you with her for the gas, and the IV?

They won't be able to do the IV without me there. The gas, I guess you just pin the fightened child down?

[hobbgoblin]

They asked DS if he wanted 'strawberry' gas or 'mint' gas. He was waaay to stressed to have the canula without a little help. He was given the nasal morphine for pain relief (his arm was severely broken in two places) which had the additional affect of chilling him right out. However, the going to surgery was frightening for him and he still squirmed at what they were trying to do so gas was needed.

I think it would be awful to have to fight to get the needle in, for all concerned so gas seems a good idea to me.

My personal experience is that while I am a person who aims not to put anything into DC that is unnecessary on the meds and drugs front, one is so desperate to avoid unneccesary stress and pain for them that that philosophy goes out the window.

Be prepared for a strange feeling when you see your child go under. If you have been worried in the lead up, the combination of it being taken out of your hands at this point, plus seeing them in such an altered state is very unsettling. I think this is very common as the nurse that accompanied me became very supportive at this point, and put her arm around me and I remember thinking "this is a bit OTT, gerroff you big softie" and then immediately sobbing my eyes out in a great release.

Hope this account of my experience of surgery is helpful even though the surgery situation is difefrent.

Best wishes.

[kitakat]

When my daughter was 5 she had the cream on the hand to numb the area and both times she had GA they put the cannula in while she was awake and used this to put the medicine in to knock her out.

she had really good play team though who she saw several times before her operation so she knew about everything that would happen. They were also really good in theatre with her and did loads to distract her.

My other daughter who is 9 and recently had an operation refused to have the cannula in (they finally did this when she was asleep) and although she chose the gas, fought them every step of the way. She had a brief run through of what would happen on morning of operation and she wasnt well enough prepared.

Not sure this helps you in any way but it does take longer for them to be knocked out with the gas and medicine in the cannula does work very quickly which can be a bit of a shock to see.

[kreecherlivesupstairs]

I was allowed in because I am a nurse, so therefore can be trusted not to become hysterical . I really wouldn't recommend the gas, she vomited 14 times after the surgery and the anaesthetist told me it was because she'd had so much. I ended up having a row with him about that. Stroppy mare.
I should point out, DD had her surgery in Switzerland where we were living at the time.

[CaptainNancy]

My 4yo recently had grommets- we let her choose the method, and I'm glad she went for IV as I think she would have been seriously freaked out by the gas mask (she has serious issues with going to sleep!)

She had 'magic cream' put on the back of each hand to numb them before insertion. We were offered a pre-med but as a back-up IYSWIM, and she didn't need it.

Putting the canula in was still painful for her, but she was very calm, and allowed them to do it, and they hid her hand from her by standing begween the bed and her hand - and distracted her with toys and questions (though she wasn't all that distracted, but fine because we were there)

The 'magic milk' (anaesthetic) worked so quickly when they injected it, that she didn't realise she'd been to sleep afterwards bless her!

Ours is a children's hospital, and they speak to the patient and involve them in their treatment and decisions all along- it really helps, and DH and I being calm and supportive helped too (though I was terrified inside!)

I am not sure how your DS's communication issues manifest, and how he is in temperament, so obviously can only share our experience. I hope all goes well- the difference having grommets has made to our DD's life is tremendous... I am so glad we did this.

[NoodlesMam]

Oh Hobbgoblin I know what you mean. I thought i would be fine, I knew it was necessary and told myself to get on with it. It didn't prepare me at all! They don't seem to breathe properly once out with the gas and that is pretty scarey and no one warned me about that but I definately think it's the control thing. You watch the docs doc knock them out and then you have to leave them. Sorry StartingAfresh, I don't want to worry you. My DD was perfectly fine, came round with a bit of screaming then got on with her day like nothing had happened! I wish I had known what to expect before my DD's first GA that's all

[CaptainNancy]

We were with her until she was unconscious btw.

[StartingAfresh]

I agree. I had the gas and I hated the stuff enough to at age 6-9 scream the place down when they came near me with it until they gave me the injection instead, and I'd had a premed. I was surprisingly lucid and strong-willed

No idea how I will convince them to let me stay with ds until the injection is done though. If he had a different language or was deaf, would he be allowed an interpreter in theatre? If so, can't his social communication disorder be enough of a reason, i.e. he needs an interpreter, i.e. me!?

[hobbgoblin]

I stayed with DS until he was asleep. I thought they automatically let you with DC???

[StartingAfresh]

I'm really not worried about the operation because I am one of four and we all had copious grommits operation, it was a way of life almost. At one time there were two of us in two different hospitals having the operation at the same time

Anyway, my concerns are really my ds' anxiety. Once he is a sleep I'll not be so worried, I'm sure. Getting him there without trauma is my concern because it is easy-peasy if you know how, but if you don't do it right not only will it cause anxiety for him then and there, the anxiety will stay with him for months and possibly wrt hospital and doctors, for years. That's the way he is.

[Shiftworker17]

Having a gas induced anaesthesia without IV access is a bit more risky than when there is an IV up and running - some anaesthetists will not do them on children without one, presumably yours is confident to do it though.

When you say you're inclined to refuse it, do you mean the pre-med? Why don't you want him to have it? I think you need to be pretty confident that your ds will tolerate either the mask if you go for a gas induction, or the cannula if you go for IV, because they will not necessarily pin him down if he is seriously screaming. I have seen operations cancelled at the last minute because of a child kicking off big time, and they then had to come back another time.

[StartingAfresh]

If my ds is lucid and can concentrate, he'll do anything I ask if asked in the right way.

If he is doped up, he'll fight the drug and everyone around him, rather than relax. He'll also be more frightened and confused.

That's why I don't like the idea of the premed.

[StartingAfresh]

Thanks shift it sounds like trying for an IV with no premed and me being there until he falls asleep is the safest and least stressful.

Now to convince the GA person!

[StartingAfresh]

Thanks Captain

Do they put the GA juice in as soon as the canula is in, or do they have to wander around fiddling with it and asking questions about it for a while?

[NoodlesMam]

I've always been ushered out the door as soon as my DD was out with the gas TBH. The Paediatric Anaesthetist will come and see you on the ward before they take your DS to theatre and in my experience they've always been brilliant and asked my opinion on how was best to handle my child. Also from what I could see everything is set up ready, including the correct dose of IV GA so things move pretty quick. You should be able to call the ward and discuss any concerns beforehand though and perhaps call in for a little tour around the ward and theatres? I was shown around in one hospital but not another although I think I could've requested it?

[Shiftworker17]

Can I ask why you don't want the pre-med?

[Shiftworker17]

There shouldn't be much of a delay before they put the magic milk in - they'll connect it to the bag of fluids, probably inject a sedative and anti-sickness drug and if your ds is happy with the mask, give him some oxygen. So maybe a minute or two. Usually the sedative works pretty quickly though.

[StartingAfresh]

Because anything he has ever had that is supposed to make him dopey makes him violent and anxious as he tries even harder to understand what is going on around him.

I don't think the premed will suit him. It didn't suit me or my brothers. My mum frequently asked for it not to be administered but it was policy then.

We were all perfectly compliant and well-behave until the premed when we turned into monsters. The problem is my ds has asd, so life is already extra-confusing for him.

[Shiftworker17]

Fair enough. Worth discussing with the anaesthetist though, because as I said, they will probably give the same, or similar sedative as part of the GA process.