Male1: Well, here that Maimonides where you practice has a short surgical stay concept, what is that?
Male2: Well, these operations are done as ambulatory operations. In other words, the baby is not allowed to eat for a number of hours before the operation because before an anesthetic, you want to make sure that the stomach is empty. You come to the hospital and prepare to meet the nurses, sign in and do all of those things and then the baby goes to the operating room, goes to sleep, and has the operation. But probably even though the operation may only take half an hour, the elapsed time is probably on average an hour or an hour and a half between going to sleep, being prepared, having the operation, waking up and then going to the recovery room. And then the child spends an hour in the recovery room just to make sure that they are recovering well from the surgery and recovering well from the anesthetic and then you go home the same day. The only time that that is not what we do with inguinal hernia is if there is some complicating factor. The most common factor that we have to consider is a premature baby, so if it is a premature baby who is having a general anesthetic, until they reach a certain age, in our hospital we use 60-weeks of gestational age, so a baby who is born at 30 weeks of gestational age, if they are ten-weeks old, their total gestational age is 40 weeks. So a baby who is premature who then has general surgery and has a general surgery and has a general anesthetic has to be monitored in the hospital overnight, so those babies stay for one night afterwards. The reason for that is there are some concerns that premature babies will not breathe well after they have general anesthesia. It is not clear which babies are at greatest risk for that and so, as a safety measure, we keep all of those children in the hospital where they can be monitored and obviously, we make provision for their parents to stay with the baby if necessary.
Male1: A good pediatric anesthesiologist tries to make the kid comfortable here, with the mother sedated with the mother and usually goes down to the operating area. Seeing the mother as the last person they see, when they go to the recovery room, they wake up to the mother is the first thing they see and do not even realize they had something in between.
Male2: Absolutely. Obviously, with tiny infants, it may not be the case, but in any child from toddler through adolescence, we have the parents come into the operating room until the child goes to sleep because it is scary, never mind for a child, for an adult, I myself have had procedures done and it is terrifying to be lying on a stretcher or on a bed and to have doctors and nurses around you with all sorts of equipment, so we find that it is very good to have the parents come with the child into the operating room, they go to sleep and then, they are taken from the operating room to the recovery room, so when they wake up, the mother or father is there at the bedside. So it is not exactly part of the surgery, but it is part of the overall care of the child. I just want to say also that one of the things about inguinal hernia repair is there is a root, there is an inverse relationship between your age and how quickly you get over it. People always say, “Is my baby going to be sick for a week or is my toddler going to be out of commission or when can he go back to school?” And the answer is that, when adults have even minor surgery like an inguinal hernia repair, usually we sit around and complain and groan and moan for a week or so, but it has been my experience that toddlers usually are back to running around and jumping and climbing the next day, and so I always tell parents just to use common sense to try to get your 18-month old to take it easy is a battle that is not worth fighting. If they want to jump, that means, it does not hurt them, let them jump and if you find that your five-year-old needs a day or so resting and not going to school, I think that that is reasonable also. So we try to just use a sort of gentle common sense approach to how long the patient rests after having their inguinal herniorrhaphy.
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