This section has the following topics:
- Leaving the hospital
- Coping with pain
- Eating and drinking
- Driving and working
- Caring for someone else
- Caring for children
Leaving the hospital
If you have undergone day surgery, you may be discharged from the hospital or clinic only when you are fully conscious and able to walk. Most facilities require that you be accompanied by a responsible adult, who either drives you home or accompanies you in a taxi. This person or another adult should stay with you for the first night.
It is common practice to advise all patients not to drive automobiles, operate equipment or make important personal or business decisions for at least 24 hours. This is because of any residual effects of drugs which might interfere with your ability to make decisions. Patients are also routinely advised about the additive effects of alcoholic beverages and sedative drugs.
Help at home
Ideally you should have someone (a relative or a friend) stay with you for a period of time after anaesthesia and surgery. One reason for this is because the effects of the operation may limit your physical activity. You may need assistance with everyday things, such as washing and dressing. Even when you are physically quite capable of attending to your own needs, you should arrange to have someone with you, in case you develop pain, vomiting, dizziness or a surgical problem like bleeding.
You should be given clear instructions as to what to do in the case of complications, such as pain, bleeding or persistent vomiting. You should also know when you are to return to see your surgeon.
Coping with pain
Your surgeon or your anaesthetist will give you a prescription for pain-relieving medication. This is normally in the form of tablets or capsules, and may include some anti-inflammatory drugs. (The combination of pain-relieving and anti-inflammatory drugs has been found to be helpful postoperatively.) You should continue to take these until you can resume your normal everyday activity. Failure to use pain-relieving medication when you have pain may restrict your activity and so prolong your recovery period. You should not hesitate to contact your anaesthetist, surgeon or family doctor if you have any problems.
Coping with cancer pain
Some patients are in constant, severe pain from cancer or another debilitating and chronic disease. These patients can receive considerable relief if their pain is adequately assessed and then managed. Techniques for pain management include:
•non-drug therapies, such as heat, distraction, relaxation
•prescription of adequate doses of appropriate drugs, including painkillers, sedatives and tranquilisers
•prescription of drugs and other therapies to deal with the side effects of the painkillers – for example, laxatives for the treatment of constipation from opiates or narcotics
•changing how painkillers are given (subcutaneous infusions, implantation of epidural catheters and pumps)
•nerve blocks, which can be either temporary or permanent.
All these techniques can be used at home. However, good follow-up from an anaesthetist or chronic pain doctor is needed.
Eating and drinking
You can eat and drink whatever appeals to you. However, it is sensible to begin by drinking water and then progress to other drinks, such as ginger ale or tea. It is better to avoid milk-based liquids, and to abstain from alcoholic beverages for at least 24 hours. Once you are able to tolerate drinking clear liquids, then it is probably safe to try eating something light, such as toast or soup.
Nausea and vomiting can normally be controlled by medication. It is unlikely that you will be discharged from hospital if vomiting is a major problem. However, if vomiting becomes troublesome at home, you should contact your anaesthetist, surgeon or family doctor as soon as possible. Persistent vomiting can be dangerous because you cannot take in the fluids that you need for normal body function. Severe vomiting may put excess strain on healing stitches or staples. There are a number of drugs which are likely to be quite effective.
There is no danger to your baby from any of the drugs that you may receive during anaesthetic. Most of them are destroyed or eliminated from the body quite quickly and the concentrations in breast milk are very small. Even morphine and similar drugs will be present in only very tiny amounts.
Driving and working
You should not drive any vehicle (including riding a bicycle) for at least 24 hours after a general anaesthetic. We do not tolerate people driving with alcohol in their blood. Similarly, you should be certain that all sedative drugs have been eliminated from your body before attempting to drive.
You can return to work when you feel able to do so, as guided by your surgeon and family doctor. From the anaesthetist’s point of view, within the first 24 hours you should remain at home. Also within that time you should not drive, operate any machinery, or make any important decisions. After 24 hours you can return to work, although you may feel more tired than normal at the end of the day.
The process of surgical care and hospitalisation no longer involves a stay of days to weeks. Nor does it involve supervised convalescence. Instead, many patients spend only a few hours in a hospital or clinic and then go home. In addition, because of the advances in anaesthetic drugs and techniques, many patients feel quite clear-headed the next day. As a result, there is a temptation to resume all normal activities.
While getting back to normal activity is important, you must also give your body adequate rest and time to recover. As stated elsewhere, patients do not simply undergo an anaesthetic. They also undergo some kind of operation or procedure. This in itself is stressful, with the body reacting by producing stress hormones. Patients, who complain that they were ‘exhausted for weeks’ after their last anaesthetic, are encouraged to think about what they did after their last operation. Most often, these patients then relate that they proceeded with their lives as though nothing much had happened, and they attempted to do everything they did the day before the operation. Both patients and their families should understand that getting better requires rest, nutritious food, and gentle but progressive exercise.
Caring for someone else
A relative or friend
If you are placed in the position of caring for a relative or friend who has had an anaesthetic, you need to know what to expect and how you can help.
In the hospital, nurses and other staff will care for the patient. Your presence will be important in hastening recovery from surgery and anaesthesia, by providing a reassuring link with normal life outside the hospital. You can help by talking, holding a hand, or assisting with everyday activities such as eating and washing. The patient is likely to be a little slower to think and react, especially after a long or complex operation and when pain-relieving medication is being used on a continuous or frequent basis. This requires patience and tolerance on your part.
The patient may vomit. This is never pleasant, either for the patient or for carers. It is best just to clean up and carry on, rather than making a fuss or reacting negatively – it is not the patient’s fault!
At all times, if you are uncertain as to how to manage the situation or if you need explanation, ask the nursing staff.
When you are caring for the patient at home, many of the same principles apply. Ensure that the bathroom and toilet facilities are easily accessible and that there is someone available to assist if necessary. You might consider giving the patient a bell to ring when needing help. Make sure that the patient has all prescribed medication and painkillers available. Encourage him or her to take the pain-relieving medication, rather than endure unnecessary discomfort.
The patient who has had major surgery and anaesthesia is likely to feel a little tired for anything up to several weeks. This is especially so in older patients. Carers need to be aware of this and to be prepared to seek help at any time. Contact should be made with the patient’s family doctor, as soon as possible after discharge from hospital.
Looking after an elderly relative after discharge from hospital can present major difficulties for families. Recovery from anaesthesia and surgery takes longer than with a young, fit patient. An elderly patient may suffer temporary forgetfulness. This becomes particularly important if there is a need to remember such things as the taking of regular doses of prescription medicine.
Most importantly, elderly patients need to return to their usual level of activity, although this may be a slow process. Lying in bed and sitting in a chair for prolonged periods after surgery puts anyone at risk of developing a blood clot or deep vein thrombosis (DVT), in a vein in the leg or pelvis. Such clots can be potentially lethal if they become dislodged and travel to the heart and lungs where they block the flow of blood.
Caring for children
On the way home
If your child is prone to car or motion sickness, he or she is more likely to vomit during the journey from hospital to home. The chance of vomiting is further increased if the child has already had something to drink or eat and if a dose of potent pain reliever has been given.
Drugs are available that are very effective in reducing the chance of nausea and vomiting. These drugs are called anti-emetics and may have been given by the anaesthetist while your child was still anaesthetised.
Continued vomiting, particularly by an infant or a small child, requires urgent attention. The excess loss of fluid with lack of intake can rapidly lead to dehydration and severe illness. If you are concerned, contact your anaesthetist or surgeon immediately.
Children feel pain just as adults do. Similarly, they deserve the same attention to control of pain. In general, children tell things as they are. If it hurts, they say so. They also show other signs in keeping with the severity of the pain – for example, whimpering or crying. Small infants may be difficult to assess as far as pain management is concerned. Crying may be an indication of either pain or hunger, or both. Infants can often be pacified by feeding and they will then sleep peacefully. If they remain unhappy despite having had their normal feed, it is likely that they are in pain. Grimacing and drawing up of the legs may be additional signs.
The most commonly used pain reliever in children is paracetamol (acetaminophen). This drug may be given as a tablet, a suppository, or a liquid (which comes in different flavours). Suppositories are easy to use in small infants and a plastic freezer bag may be used as a substitute for a glove when placing the suppository in the rectum.
Most children will have been given their first dose of paracetamol (acetaminophen) at the time of surgery and so they may not need any more for a few hours. Your child may have received a general anaesthetic plus a local anaesthetic without any other pain reliever. If so, then the first dose of paracetamol (acetaminophen) should be given before the local anaesthetic wears off. You will be told when to do this, as well as which drug and how much.
Stronger analgesics (pain relievers) may be required, especially in the first 24 hours after surgery. Codeine is commonly used and is usually given by mouth. Side effects include constipation and nausea, but these are uncommon with a small number of doses.
Anti-inflammatory analgesic drugs may be used, although not all are approved for use in children. Your anaesthetist will provide details about doses.
Mixtures of drugs may be beneficial, reducing the likelihood of side effects. Preparations that combine paracetamol (acetaminophen) with codeine are common and some also contain other additives, including mild sedatives.
Aspirin should not be used in children under the age of twelve years. This is because a rare, usually fatal inflammation of the brain, called Reye’s syndrome, can result when children take aspirin.
Eating and drinking
The simple answer to the question of ‘when can my child eat or drink’ is ‘when your child feels like it’. Your child should not be forced to drink something and may not want to drink until after arriving home after day-stay surgery.
Your child should start with sips of water, progressing to ginger ale and cordial, and then to milk. The same applies to eating – begin with easily digested food, such as jelly and bread and butter, although some children like to start with ice cream. It is not unusual, however, for children to want something more substantial; some have been known to enthusiastically consume a hamburger three hours after a tonsillectomy.
Sleep disturbance, including nightmares, is frequently described after hospitalisation, surgery and anaesthesia. The less stressful the hospitalisation, the less likely sleep will be disturbed. Things that may reduce the chance of a sleep disturbance include:
- good preparation beforehand (see Preparation for Your Anaesthetic)
- a harmonious family
- the child being accustomed to other carers, such as a babysitter, rather than being overprotected
- parents who are calm, as children can sense parental anxiety
- the presence of one or both parents as much as possible throughout the hospital stay
- sympathetic medical and hospital staff
- needles not being used
- good pain control
a short stay in the hospital.
Resuming full activity
The answer to the question ‘when can my child resume full activity’ is again simple: ‘When he or she feels like it’. If the operation requires a period of modified activity, your child’s surgeon will advise you of this. In general, there are no particular guidelines and you will be surprised at how quickly your child returns to a normal state of activity.
There may be a surgical reason to recommend against swimming – for example, grommets (tubes) in the ears or a large surgical wound. If not, then swimming should be considered as a part of full activity.
Back to school
Unless there is a surgical reason for delay, your child may return to school as soon as he or she regains full and normal activity. It is wise to inform the teaching staff of the operation. The teachers will then be aware if any untoward reactions do occur, but should otherwise treat your child normally.