Hi
I am doing an article on surgery and children, and my 7 year old has to
have her fifth surgery at the end of this month, so if you'd like, have
the mom contact me directly. [log in to unmask]
the old recomendations by the ASA can be found here...
http://anesthesia.stanford.edu/kentgarman/clinical/NPO.htm
this was from 1999, which was 4 hours for NPO for breastmilk. however,
in Sept 2002, they changed that to 2 hours for breastmilk and clear
liquids and 4 hours for everything else. here is the link...
http://www.asahq.org/clinical/toolkit/sedmodelfinal.htm
here is the paragraph
4. NPO GUIDELINES:
A. Verification of NPO status in adult patients shall occur before
the start of sedation and analgesia and the patient shall be NPO for
at least 4 hours prior to the procedure unless the physician has
weighed the benefits for a shorter NPO period and it is documented
in the medical record.
B. Verification of NPO status in pediatric patients shall occur
before the start of sedation and analgesia. For elective procedures,
the child shall receive no solids or non-human milk for 4 hours
before sedation unless the risk of nutritional deprivation outweighs
the benefit of NPO in the estimation of the physician.
Small amounts of clear liquids or human milk are acceptable up to 2
hours before sedation and analgesia. Children at risk for
regurgitation or aspiration (e.g., known gastro-esophageal reflux,
extreme obesity) may benefit from pharmacologic therapy to reduce
gastric volume and increase gastric pH before sedation or from a
longer NPO period of time prior to the procedure. If delayed gastric
emptying is present, an Anesthesiology or GI consult should be
considered before sedation and analgesia.
C. Certain radiologic procedures require the administration of oral
fluids in conjunction with sedation and analgesia. Risk of
aspiration during these procedures must be weighed against the
benefits of sedation and analgesia.
So, an 8 hour NPO is way too long. What I would suggest for the mom to
do is to start this discussion with the hospital now, not the day before
surgery. Take in the sept newsletter, and other research that says a
shorter NPO time is acceptable. She might need to negotiate and many
hospitals are not accepting this 2 hour NPO but would accept 3 hours for
breastmilk and no other food for 8 hours or something similar (that is
what they finall agreed to 5 years ago for Lexie,on her 2nd surgery.
With my first, we negotiated it to 4 hours. With her third, I got a
two hour agreement, but that was a lot of hard work on my part.
There are also other considerations. Many post op wards want the kids
to drink juice (we were offered OJ--give me a break) or formula before
breastfeeding. Also there are two levels of postop, and parents are
usually not permitted at the first one, which is where, in my opinion,
the child needs them the most. With Lexie's 2nd surgery she was about
18 months old. We had a NPO of 3 hours, I was there when she was
anesthesized, I was there in the 1st post op room, and she immediately
climbed in the nursing position. When it was time to go to the 2nd post
op room, they were going to make me put her in the rolling crib to move
her to the post op room but I insisted they leave her in my arms and so
they put me in a wheel chair and we went that way. She recovered very
easily, I laughed at the idea OJ or formula would be easier on her post
op tummy and smiled at the water suggestion and just nursed her when she
indicated she needed to nurse. There were babies who had surgery before
her who were still "recovering", many without parents in the room, when
we left. Amazing how holding your baby and human milk can help a child
recover quickly. Anyway... if the mom wants to discuss this with me
directly, just have her email me or email me p rivately and I"ll give
you my telephone number.
It's kinda funny, Lexie's last surgery was almost two years ago, whens
he was five. She was still nursing, and we followed the 3 hour NPO for
breastmilk. She also nursed in recovery and was very vocal about how
that settled her tummy and made her feel good. Now for the first time
she is not breastfeeding while she has a surgery (and my 4 year old is
weaned too. :-( ) It'll be an interesting experience, for me.
Joylyn
Johanna Berger wrote:
>Help oh Wise Ones!
>
>Have a mom. Breastfeeding 18 month old. Is having kidney surgery on
>Thurs (1/16). Surgery will last approx. 2-4 hrs. She has been given NPO
>instructions of 8 hrs. for breastmilk, 2 hrs. for glucose water, water,
>apple juice. this is a child who loves to nurse. I have given her some
>recent citations from the archives. Does anyone have any additional
>information or can refer me to any (preferably prominent)
>MD/breastfeeding guru who might help her in this situation. She figures
>that she can hold off breastfeeding for 3-4 hrs.
>
>please e-mail privately as I don't always have time to read lactnet
>postings
>
>Thanks!!
>
>Johanna Berger, LSW, IBCLC
>Bala Cynwyd, PA
>
>
>________________________________________________________________
>Sign Up for Juno Platinum Internet Access Today
>Only $9.95 per month!
>Visit www.juno.com
>
> ***********************************************
>
>To temporarily stop your subscription: set lactnet nomail
>To start it again: set lactnet mail (or digest)
>To unsubscribe: unsubscribe lactnet
>All commands go to [log in to unmask]
>
>The LACTNET mailing list is powered by L-Soft's renowned
>LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
>mailer for lightning fast mail delivery. For more information, go to:
>http://www.lsoft.com/LISTSERV-powered.html
>
>
>
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
