Surgery and eating restrictions? - Page 2

[vbactivist]

Originally Posted by MotherWhimsey

to each their own, I think my mother's nightmare is that my kid would aspirate and spend the last hours of his life struggling for life on a vent from an issue that I could have prevented. Would you like to see what the results of aspiration (and not during the surgery but afterwards from vomit due to the anesthesia) looks like? It's not terribly pretty. http://s49.photobucket.com/albums/f2...spdistress.flv

He had a supraglottoplasty and we were not aware of how severe his aspiration became once his airway was fixed. So he was puking due to anesthesia complecations and aspirating the vomit (all exclusively breast milk by the way). And so, two weeks in the hospital, 14 days on high dose dexamethasone, and he was over the hill. But really, if they had told me I could have prevented that mess by just not feeding him after the surgery, I so would have been all over it.

I am really sorry for your experience. I was not suggesting that all mother's intuition will or should tell us to do the same thing. I will say my daughter was going to be on a vent whether she aspirated breastmilk or not (just the way it goes with OHS).

[Momily]

I think it's important to note that if a child aspirates under anaesthesia, they are aspirating vomit. So, regardless of whether or not the child is purely breastfed, they aren't aspirating pure breastmilk, they are aspirating a mixture of breastmilk and stomach acid.

As far as "they are already on a vent", I'm not sure what is meant by that. Are you saying that they're already on a vent, so therefore you don't have to worry about aspiration so much? I'd look at it the other way, that if a child was going to need the support of a vent to stay alive, they were going to be in a pretty fragile situation, and avoiding life threatening lung issues would be that much more important.

OP, I get how hard this is. I really do. The NPO periods never turned out to be as hard as I imagined them, and I hope the same is for you.

[vbactivist]

[QUOTE=Momily;15439024]I think it's important to note that if a child aspirates under anaesthesia, they are aspirating vomit. So, regardless of whether or not the child is purely breastfed, they aren't aspirating pure breastmilk, they are aspirating a mixture of breastmilk and stomach acid.

As far as "they are already on a vent", I'm not sure what is meant by that. Are you saying that they're already on a vent, so therefore you don't have to worry about aspiration so much? I'd look at it the other way, that if a child was going to need the support of a vent to stay alive, they were going to be in a pretty fragile situation, and avoiding life threatening lung issues would be that much more important.

OP, I get how hard this is. I really do. The NPO periods never turned out to be as hard as I imagined them, and I hope the same is for you./QUOTE]

I agree with this.

I was responding to a pp who said that she wouldn't want to "cause" her child to need to be on the vent. My child was going to be on a vent anyway.

I am just saying each of us has to do what we're comfortable with. I'm not judging anyone.

[MotherWhimsey]

Originally Posted by vbactivist

I was responding to a pp who said that she wouldn't want to "cause" her child to need to be on the vent. My child was going to be on a vent anyway.

I am just saying each of us has to do what we're comfortable with. I'm not judging anyone.

I wasn't saying I didn't want to "cause" my kid to be on a vent, I was saying I didn't want my kid to die of aspiration pneumonia and spend his last few hours on the vent. You said you didn't want your kid to cry in case she didn't survive. I was saying I didn't want my kid to have to be on a vent and then die.

[QueenOfTheMeadow]

Having a child go in for surgery is such an emotional thing, so I want to remember everyone to be gentle with each other and to avoid taking personal issue with each other.

[2boyzmama]

Obviously no parent wants the worst, and we'd all take reasonable precautions to protect our kids. That goes without saying.

BUT...we don't all jump straight to highly medicalized pregnancies and births to protect against the extremely rare cases where disaster has struck, you know? Many of us don't vaccinate (or do so selectively).

There's nothing one-size-fits-all in medicine. The fasting after midnight rule is trying to lump the whole population into one box, and it isn't true.

ALL of the research published by the American Society of Anesthesiologists says that breastmilk is considered "safe" 2-4 hours before. If your child has complicating medical factors, obviously that has to be taken into account. But for the typical child having an ordinary surgery, it is perfectly safe to breastfeed. And that is according to research, not to my mama gut or my desire to not see my kid cry.

There are times when disaster strikes anyway, yes, a child may still aspirate and have complications. Just like the best planned low risk home birth with Ina May herself may end in fetal or maternal death. You have to take the research and weigh it for yourself.

The OP wanted to know if there was a change in the child or in the breastmilk after a year that made it more risky to nruse 4 hours before. No, there is not. If you were comfortable nursing 4 hours before the last surgery, then you should feel perfectly comfortable nursing 4 hours before this surgery. You willingly took on those risks before, so unless circumstances have changed (health status of this child) or you have conducted more research yourself that changes your beliefs, then you should feel comfortable doing the same thing for this surgery.

[MotherWhimsey]

She asked, I gave her my opinion on why the time limit changes. I gave her our experience. And at the time of that video, we thought that with the surgery he'd be totally normal. Obviously he isn't. So sometimes there are things you don't know to take into account until later. The reaction to the anesthesia he had that caused the vomiting could be prevented following his anesthesia protocols now, but at the time, we didn't know it was an issue. So sometimes they make rules because of the unknowns.

I just think it's extremely bad advice to lie to your dr in that circumstance (and also when your water broke etc.) because they need all the info to make good decisions. Plus it is legally just a hot mess waiting to happen. If you're going to disregard their advice, then do it openly and tell them ahead of time so at least your butt is somewhat covered in the event that something happens.

[vbactivist]

I disagree. SOmetimes dorcotrs have all the info and make bad decisions. Ultimately, our child's health (and our own) is our responsibility. So, I will do whatever I jhave to and share and withhold whatever info I deem neccessary based on what I believe to be the best course of action.

It actually should (and for me, does) work the other way. I expect my doctor to give me all the info so that I can make good decisions.

But I am confortable with that responsibilty. Others may not want to be responsible. That's ok. But I think most people here tend to accept and persue that responsibiltiy.

[MotherWhimsey]

yes, but if you think they are making bad decisions, you talk to them about it. They have malpractice insurance, you don't. There are just a lot of legal ramifications to lying to your doctor about something like that.

[anj_rn]

There are several different drugs for sedation (both general and moderate sedation), anesthesiologists choose medications based on a patients age, length of time they need to be sedated, and what will be done for the cjild. Some sedations cause worse nausea than others, so the times really do vary. In addition, some drugs halt gastric motility, so what would normally run through will not. There is no way the nurses giving instructions can carefully identify every risk for every child and give specific instructions to each, so most hospital departments follow age based guidelines.

If you are concerned about the guidelines, call the anesthesiology group and explain the situation (including info on the previous surgery). Let them know when your daughter usually eats, and ask if they can give you a better timeframe so they will not have a screaming child when you get there. If you choose to lie to an anesthesiologist (and your child vomits), they may indicate it in the chart and require your child to be admitted overnight prior to surgery in the future.

[moongazer]

**UPDATE**
Ds had the surgery yesterday (Broncioscope and Adeniodectomy). After reading all your replies and the links provided, I chose to nurse him 6 hours before the surgery. I did try to call the Anesthesia Dept. on Sunday to talk about it but was told I could only have them paged if it was an emergency. Anyway, I also chose to be honest with the Dr. Of course as luck would have it, we got the MOST conservative anesthesiologist. She pushed DS's surgery back 2 hours. It was that, or reschedule and hope we get another anesth. Ds really needed the surgery done now for insurance reasons.

He did really well. Much better than I would have thought. He kept signing "drink" but didn't cry or get upset. He did have some issues with throwing up after they extubated him, so I guess in the long run I am glad that she waited. His O2 sats were low (87ish) and he needed a racemic epi treatment and oxygen and I know that I would have worried that it was my fault if I had lied. You know how Mommy Guilt is!!

Thanks so much for all your input!
Becky

[MotherWhimsey]

I'm sorry you guys had some rough spots. s

how's he doing now? Is he drinking yet?

[Cinder]

I'm assuming it's cause they don't have any rules for kids over 1 who are breastfed. I fought it with Janelle, and got permission to breastfeed her up to 4 hours before her tonsillectomy at 3 1/2 years old, I argued it couldn't be any worse than if she was 10 months old to give her the same thing, they made the doctor call me, I explained him what I was fighting, he laughed and just told them she could have it. So, if nothing else, get your doctor who is doing the surgeries opinion on it.

[moongazer]

He is eating, drinking and nursing normally Thanks for asking! Plus no more apnea! YAY!!

[MotherWhimsey]

Originally Posted by moongazer

He is eating, drinking and nursing normally Thanks for asking! Plus no more apnea! YAY!!

Dude, that is TOTALLY worth it! I'm glad he's doing great now. Hopefully you guys will get more sleep now!

[Momily]

Originally Posted by Cinder

I'm assuming it's cause they don't have any rules for kids over 1 who are breastfed. I fought it with Janelle, and got permission to breastfeed her up to 4 hours before her tonsillectomy at 3 1/2 years old, I argued it couldn't be any worse than if she was 10 months old to give her the same thing, they made the doctor call me, I explained him what I was fighting, he laughed and just told them she could have it. So, if nothing else, get your doctor who is doing the surgeries opinion on it.

I agree that there shold be guidelines for kids over 1 who are breastfed, and that those guidelines will probably be shorter than for solid foods/other nonclear liquids.

However, given that the guidelines for both clear liquids and food go up at 1, I'm not sure why you'd assume that those for breastmilk wouldn't increase?

I know that my son at 3 1/2 went much longer between feedings than he did as an infant -- I assumed that was pretty normal, and a sign that he was eating more at a time, and what he was eating/drinking was taking longer to leave his stomach.