Pediatric Perioperative Care Unit

The IWK Health Pediatric Perioperative Care Unit (PPCU) provides surgical care for children, youth, and their families requiring elective and emergency surgery including cardiac care, neurosurgery, ENT (ears, nose & throat), general surgery, ophthalmology, orthopaedics, urology, plastics, oral surgery, dentistry, and gastrointestinal. 

What to expect

The PPCU cares for patients having day surgery and patients who are being admitted to an inpatient unit. Your surgeon’s office will let you know if your child will be staying in hospital or going home the same day. They will also let you know the date and time of the surgery, and when to come to the IWK. If you are going to be admitted after the surgery, you will receive a call from the IWK Health Pre-Op Clinic nurse and possibly be scheduled for a pre-op clinic visit.

Pre-op visit
During a pre-op visit, a nurse will take your child’s/youth’s medical history, coordinate any pre-surgery testing (such as blood work, x-rays, CT scan, etc.), explain what to expect before surgery, answer all your questions, and make sure you feel prepared for surgery. Depending on your needs and type of surgery, you may see someone from anesthesia, acute pain service, physiotherapy, or occupational therapy.

If your child is older than three and/or had challenging health care experiences in the past, you or your child may choose to meet with a child life specialist before surgery. Child life specialists are trained in child development and use age-appropriate explanations, pictures, and play to prepare children/youth for medical procedures. Children and youth tend to cope better with medical procedures when they know what to expect.

Instructions about eating and drinking before surgery

Before anesthesia, eating and drinking are not allowed for specific periods of time. It’s important that you follow these directions carefully for safety reasons. If your child eats or drinks after the indicated time, the surgery may get cancelled or delayed.

Please notify the surgeon if your child:

• becomes ill before the scheduled surgery
• has been in contact with any communicable disease (measles, mumps, chickenpox, pneumonia, etc.) within three weeks before the surgery is scheduled
• has a cold

Please be prepared to bring and/or do to the following for your appointment:

• Stay with your child until discharge (a parent or legal guardian must accompany the child)
• Child's Nova Scotia Health Care card (or appropriate provincial health card) and IWK card if you have one
• Appointment letter
• Name and telephone number of your referring physician and/or family physician
• Insurance information
• A list of questions you and/or your child may have for the physician. Also, remember to ask for any instructions from the doctor or letters of medical necessity that you may need for school or your child's family physicians/pediatrician.
• Arrange for a ride or make plans to take a taxi home after your child's surgery. Some people find it useful to have another adult with them to care for a sleeping child in the car, public transportation with a sleepy child is difficult
• A container in the event your child is sick on the way home
• Make arrangements for other children at home
• Child's favourite toy or item (blanket, stuffed toy, ball cap, etc.)
• Loose clothing to wear home (especially if your child is having hernia repair, circumcision, undescended testicle or arthroscopy)
• Snacks, diapers, change of baby clothes or other necessities. Please do not bring food if your child must fast prior their appointment.
• A list of all medications that your child has taken in the past week (including non-prescription drugs such as Tylenol® and cough medicine)
• Be prepared to give prescription medications that need to be taken on the day of surgery as scheduled (with a sip of water, no more than two tablespoons)
• Give aerosol masks, inhalers, and/or puffers as necessary. Bring them on the day of the operation
• Remove all jewelry, make up and nail polish
• Long hair should be braided or tied back with a small, plain, non-metallic hair elastic
• Be at the IWK one hour and forty-five minutes (1hour 45 mins) before your child's operation time

Getting ready for surgery
The PPCU team is made up of doctors, nurses, anesthesia assistants, a child life specialist, housekeeping, unit aides and ward clerks. They all work together to keep surgeries on time as scheduled. Please note that your surgery time is our best estimate—your child’s surgery could be earlier or later for many reasons outside of control. Please make sure that you arrive one hour and forty-five minutes (1hour 45 mins) before your booked surgery time so that your child will be ready when it’s their turn for surgery.

After you arrive to the PPCU, you and your child will be placed in a room. Your child will be registered by one of the clerks. A nurse will go over your child’s medical history and give them a checkup. They'll listen to your child’s heart and lungs, and check blood pressure, height and weight. You and your child will be given identification bracelets. Your child will also be given hospital pyjamas to wear.

In the time left before the surgery, you and your child will meet the anesthesiologist and the surgeon. They'll go over the surgery with you and your child. Feel free to ask questions or have your concerns addressed. You may also meet the child life specialist. Their role is to make sure that your child knows what to expect, feels prepared and can cope. They use pictures, real equipment, and play to explain what your child will experience heading into the operating room and after waking up.  Children and youth tolerate surgery and anesthesia better when they are well prepared. The child life specialist will also make sure that your child has activities to keep them busy while waiting.

Going to the Operating Room (OR)
When it is time for your child to go, they'll go to the OR with a nurse. Children and youth are always welcome to bring a favourite toy, blanket, or stuffed animal with them to feel more at ease. We ask parents and caregivers to remind their child that you'll be waiting nearby and will see them when they wake up after surgery. Sometimes parents can go into the OR with their child. It is called Parental Presence at Induction or PPI. If you think that would be helpful for your child, please discuss it with the team. PPI isn’t always possible due to safety concerns.

In the OR, the nurses will help your child get settled onto the bed. There is a TV above the bed and your child can choose a favourite show or movie to watch for a short time while the team is getting ready. Your child will then get their anesthesia or “sleep medicine” either by breathing through a mask or through an intravenous (IV) line. The mask is held close to the nose and mouth and the medication is mixed with air. The mask will smell rubbery and sometimes the medicine can also be smelled. Your child will drift off to sleep as they breathe in the medicine. 

An IV is a tiny straw-like tube that is usually placed in the hand. It can be described as a “poke” or a “pinch”. The nurse will have already put numbing/freezing cream on your child’s hands to take away the feeling on the skin when the IV is placed. The anesthesiologist will then put the medicine in the IV tubing and your child will drift off to sleep. If you or your child prefer a certain method of getting anesthesia, you can talk it over with the anesthesiologist. However, it is ultimately the anesthesiologist’s decision as to which method would be best and safest for your child. Please note, most children will receive an IV as part of their care. The IV is used to give fluids and medicine during surgery. Younger children usually receive the IV after they are asleep. The surgery will begin once your child is in a deep sleep and the anesthesiologist will be closely monitoring your child throughout the entire procedure.

PPCU Waiting Area
A large waiting area is available for parents to wait in. A team member will give you a tour so that you know where this is. You’re welcome to bring food or drinks into this area. We encourage parents to get food and/or drinks and go for a walk if they wish. We ask that you don’t leave the IWK during your child’s surgery and make sure that you're in the waiting room at least 30 minutes before your child’s surgery is expected to be done. 

After the surgery, your child will go to the recovery room. Nurses will closely monitor your child as they wake up. Once your child is awake, they'll be reunited with you in our discharge area. After your child’s surgery, the surgeon will meet with you either in the waiting room, inpatient unit or the PPCU. Again, we encourage you to ask questions or express any concerns at this time. Some questions you may want to ask are:

• What can I expect my child’s recovery to be like over the next few days?
• Are there any problems I should be concerned about or watch for?
• What should I do if they happen?
• Do I need to schedule a follow-up appointment?
• When can my child go back to school/activities such as sports, dance, or swimming?
• How much pain will my child have? What can I do to help?

After Surgery
Your child will need to stay in the discharge area of PPCU until they are fully awake and not dizzy. This amount of time is different for each child and it is important to allow your child to rest. While they're resting, a nurse will continue to monitor your child as they wake up. Your child will be offered a clear fluid drink, such as water or apple juice, or a popsicle. It’s important to start food and drink slowly as the medicine can make your child feel sick to their stomach. To avoid disappointment, it’s best not to promise your child a high-fat meal right after surgery (i.e., hamburger, fries, chicken nuggets, etc.) and avoid heavy, spicy, or fried foods. If required, medication will be given by the nurse for pain, nausea, or vomiting.  

If your child is staying overnight in hospital, a nurse from the inpatient unit will come to PPCU to bring you upstairs. If your child is going home, they will be helped to your car if needed.

Before you leave, your nurse will talk to you and give you instructions on how to care for you child at home. This information includes:

• Problems to watch out for
• When to contact your surgeon
• Medications
• Eating and drinking
• Activities for your child
• Wound care

If your child needs special equipment or nursing care at home, we'll help you arrange it. We ask that you take a few minutes to review the written instructions and ask questions if there is something that you are unsure about. We want you to feel confident about caring for your child at home.