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A: The Pre-Op Clinic is where you and your child come so necessary preparations before surgery can be completed.
A: The Pre-Op Clinic is located on the 1st floor of the Main Building at Boston Children's Hospital main campus. Click here for directions to the Pre-Op Clinic.
A: If your child will be staying overnight prior to surgery and is having general anesthesia your child must come to the Pre-Op Clinic before having surgery unless he is being admitted to the hospital the night before surgery.
Pre-Op Clinic visit is not necessary for Day Surgery Patients.
A: We recommend that you come within 28 days before surgery. If this is inconvenient, another time can be arranged by your physician's office.
A: Yes, to avoid delays, it is best to schedule appointments in the Pre-Op Clinic through your physician's office prior to surgery.
A: You and your child will see an admitting officer, a nurse, an anesthesiologist and a person who draws blood, if necessary. Your child's surgeon will decide if you need to see other members of the medical team.
A: Clinic space is very limited. Please do not bring brothers, sisters or friends along for this appointment.
A: Children under 18 years of age need to be accompanied to the Pre-Op Clinic by a parent or legal guardian. Generally, surgery cannot take place without consent forms that are signed by a parent or legal guardian.
Patients 18 years of age or older who can consent to their own medical care do not need to be accompanied by anyone.
Patients 18 years of age or older who are not able to consent to their own medical or dental treatment (for example, due to mental retardation and developmental delays) must be accompanied by a legal guardian.
It is important to note that once a child turns 18, his or her parents are no longer automatically his legal guardians and lack the ability to make consent decisions for the child. Therefore, in order to become a legal guardian for a child 18 years of age and older, parents (or others) must be appointed by a court. This process generally requires the assistance of an attorney and takes three to six weeks to complete.
Please note, if your child is 18 years of age or older and cannot consent to his or her own treatment, and you or another consenting adult has not been appointed as your child's legal guardian, the hospital may not be able to treat your child.
If you have been appointed your child's legal guardian by a court, please be sure to bring your papers with you to the Pre-Op Clinic.
For additional information about consenting to treatment, please see our section on consent for medical care.
A: If your child is a foster child, a child whose adoption is pending, or a child living with you temporarily on request of the child's natural parents, it will be necessary to bring all papers documenting your legal guardianship or authority to consent to the child's medical care. If you have no such papers, you should contact the Admitting Office at 617-355-3767 to work out any difficulties in advance. If the Department of Social Services (DSS) is involved, contact the assigned caseworker to clarify the department's role in any decision making. This is the only way can we ensure your child's admission will not be delayed.
A: Yes. If your child develops a cough, fever, pneumonia, chest cold or has an asthma attack within three days of scheduled surgery, you should call the department and let us know. If your child has been exposed to measles, mumps or chicken pox in the 21 days before surgery, please notify us as soon as you become aware of the exposure. Your child's surgery may need to be rescheduled so that other children are not at risk of catching these diseases.
If your child is taking (or has recently taken) any herbal therapy or natural remedy (such as St. John's Wort) or weight-reduction medications, please let your pre-op nurse practitioner or physician know. Some of these types of substances can interact with drugs during anesthesia.
If your child has any body piercing that cannot be seen, please let the nurse practitioners and physicians in the Pre-Op Clinic know. All metallic objects must be removed prior to surgery and anesthesia.
A: Having an empty stomach reduces the risk of certain complications of anesthesia, such as nausea and vomiting. In addition, if a child has eaten, stomach acid can enter the lungs and potentially lead to pneumonia. When a child is awake, he or she has protective reflexes that normally prevent food or liquid regurgitation into the lungs. Most anesthetics interfere with these reflexes. This is why fasting (not taking in either liquid or solid foods) is so important before surgery.
A: This depends on your child's age, the surgery and your child's underlying medical condition. Please see our dietary guidelines for more information.
A: In general, an anesthesiologist will review all medicines that should be taken on the morning of surgery. We will further discuss this with you during your child's Pre-Op appointment.
A: Patients should arrive at the Pre-Op Clinic on the 1st floor of the Main Building if they will be staying in the hospital after the procedure. If the patient is having day surgery and will not be admitted to the hospital for an overnight stay, please see our Day Surgery page for directions and instructions.
A: Preparations for surgery must be thorough. It takes at least 90 minutes for registration, blood tests (when necessary) and examinations by the doctors and nurses who care for your child.
A: Any support objects or special toys are allowed. This includes a special stuffed toy, pillow, blanket, favorite photo or drawing, etc.
A: You will meet your child's anesthesiologist in the Preoperative Area on the day of surgery. This physician will monitor your child's breathing, blood pressure and heart rate, and make sure your child is comfortable and safe during his or her procedure.
Your child's anesthesiologist is normally assigned to your child on the day before surgery. He or she will make the final decisions about your child's anesthesia care.
A: Please see our All about anesthesia page for general information about anesthesia.
A: Under certain circumstances, parents may be present while their child is falling asleep. Additional information about Parents in the Operating Room on our general Pre-Op Clinic and our Parent Present Induction program is available.
A: Your child will go to the Post-Anesthesia Care Unit (PACU), which is adjacent to the Operating Room on the 3rd floor. Your child will only go to the ICU if necessary.
A: After arrival to the PACU, the nurses will check your child's heart, blood pressure and breathing. Oxygen will be given by mask. When the nurses determine that your child is in stable condition, they will call you in to stay with your child while he or she is waking up.
A: Only parents or guardians are allowed in the recovery room.
A: Siblings are not allowed in the PACU. They may visit on the inpatient floors, however.
A: Yes. You may make arrangements with a nurse on the inpatient floor after your child is admitted. There is a bed space available for one parent to sleep.
A: Discharge time is prior to 11 a.m. Please make plans to pick up your child by that time. The discharge time is early in the morning to allow the staff to prepare the room for other patients.
A: You will be given the telephone numbers of the surgeon and the anesthesiologist on call. You may call these numbers if you have any questions. The morning after surgery, a nurse will call to find out how you and your child are doing.
At Boston Children's Hospital, we allow a parent to be present at the start of anesthesia when the anesthesiologist considers it to be beneficial for the child. This is called a Parent Present Induction (PPI). A formal program in existence since 1989, PPI helps prepare a parent who accompanies his or her child during the start of anesthesia.
There are a variety of medications that may be given in the preoperative (Pre-Op) holding area while the child's parent(s) is present. These medications help eliminate the distress of separation at the beginning of anesthesia. When these preoperative medications are inadequate or are not recommended, a parent may go with a child into the operating room for the start of anesthesia.
The decision to offer a PPI is individualized, and is made by evaluating factors like the child's age, developmental stage, emotional status, degree of anxiety and willingness to cooperate. Children less than 1 year of age do not usually require parental presence.
At the time of the preoperative evaluation, the anesthesiologist makes an assessment of the child and parents to determine their ability to participate in a PPI in the operating room. This decision process is very important as its goal is to prevent an undesirable situation. For example, a parent who is very anxious or frightened may have difficulty providing the psychological support needed during the start of anesthesia.
If a PPI is chosen, the anesthesiologist will discuss the plan for induction with you and your child. Since no one form of induction is suitable for every child, a backup plan will be made. Parental teaching will also be provided by nurses who explain the role of the parent to his or her child in the operating room, and how the child may react and look during the induction process.
Although both parents provide support for their child, we have learned that it is easier for a child to focus on one parent at the start of anesthesia. During the induction process, we encourage the parent to talk to and comfort the child as he or she would at home. It can become confusing for the child to have more than one parent talking to him or her at the same time. In addition, we can safely focus our teaching and support on one parent.
The most appropriate person to accompany the child is the one who will be able to provide the necessary support to the child. This selection is individualized and does not have to be the legal parent.
The parent should be healthy, have a calming influence on the child and must feel comfortable with his or her role in the operating room.
No. There is no form of induction that is suitable for every child, and there are medications that can be given in the patient preparation area decrease the child's anxiety. Many children who are informed and prepared for surgery may not experience fear and anxiety.
We are unable to protect pregnant women from anesthetic medications during an inhalation (mask) induction, and we prefer to avoid unnecessary exposure.
You will be asked to put on a one piece coverall (a jumpsuit that fits over your street clothes), a hat and a mask. Because the attire is strange, it can be frightening for a child. We encourage parents to put the jumpsuit on in front of the child and then reassure the child that you will only be dressed like this for a short period of time.
Children cry for many reasons: when they are sleepy, hungry, in pain or upset, for example. It also depends upon the child's stage of development. Some children, especially preschoolers, will cry when the mask is first introduced or when they notice a change in the environment. The operating room staff members consider this normal and sometimes even expect it.
A backup plan is always made during the preoperative evaluation. Your child's anesthesiologist will discuss this plan with you before starting a Parent Present Induction.
The anesthesiologist determines when the parent should leave the operating room. The anesthesia induction process is quick, and parents are escorted from the operating room to the Family Waiting Room by a member of the operating room staff at that time.
For more information, please call the Pre-Op Clinic at 617-355-3765.
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