A Road Map to Surgery at CHOC Children’s

Having surgery at a hospital can be a scary thought for children and parents, alike.  Knowing what to expect can help alleviate fear and anxiety.  The photos below highlight some key aspects of the patient and family journey through the Tidwell Procedure Center at CHOC Children’s Hospital.

surgery at choc

Welcome to CHOC Children’s Hospital – a hospital for children and teens, only. When a child requires surgery, his needs are different than an adult. CHOC has specialized in pediatric surgery since we welcomed our first patient in 1964. Today, our nationally recognized surgeons perform the latest procedures using equipment customized to pediatric patients, from newborns to adolescents.

surgery at choc

After checking in at our first floor lobby, surgical patients and their families are directed to our Tidwell Procedure Center, which includes seven operating rooms, five procedure rooms and two cardiac catheterization labs. The Center boasts leading-edge technology and safety features, as well as a calm, healing environment. Here’s the Center’s bright, colorful lobby, featuring natural light, bubble columns and interesting artwork. There’s also a family room and playroom.

surgery at choc

We want our patients and their siblings to still have the opportunity to act like kids while facing the adult issues of surgery. In addition to a playroom in the lobby, we have an area for play, stocked with books and toys in pre-op. Dedicated child life specialists help normalize the experience by making the environment less strange. Providing distraction and developmentally appropriate education, child life specialists are important members of the surgical team.

surgery at choc

Child life specialists are at the bedside to provide developmentally appropriate education. Patients are able to see pictures of the operating rooms on iPads, which helps to limit stress and anxiety without the use of medication.

surgery at choc

Before heading into the operating room, patients stop at what is affectionately called the “kissing spot.” Here’s where they can say “see you later” to their loved ones before “taking a nap” for surgery.

surgery at choc

Child life specialists escort patients into the operating rooms and to provide distraction and emotional support while pediatric anesthesiologists and other staff members prepare patients for surgery.

surgery at choc

Following surgery, patients recover in our PACU (post anesthesia care unit). As soon as the patient is stabilized, parents/legal guardians are escorted into the area. During this time, patients need as much rest as possible to help their bodies heal and give pain medication time to take effect. The environment is kept calm and quiet. From here, the patient will either be taken to a hospital room, or discharged home.

Our physicians, nurses and staff are dedicated to getting kids better and back to their normal activities as quickly as possible. Patients and families are our partners in this effort; knowing what to expect before, during and after surgery can make a big difference on the experience and recovery. For more information, visit www.choc.org/surgery.

Take a virtual tour of the Tidwell Procedure Center

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7 Things You Didn’t Know about Pediatric Anesthesia

By Dr. Eric Ontiveros,  chair of pediatric anesthesiology at CHOC Children’s

Finding out that your child needs surgery can be scary for parents to hear. You want to know that your child is in the best hands possible, and the nationally ranked surgeons and pediatric anesthesiologists at CHOC Children’s specialize in the care of kids. Your child’s pediatric anesthesiologist is not only an important member of your child’s surgery team but also the entire perioperative experience (before, during, and after surgery).

7 things you may not know about pediatric anesthesia:

  1. Before surgery, the preoperative area is the location where you will meet your child’s full surgical team. During this time, questions about your child’s medical and surgical history will be asked and the perioperative plan is adjusted to fit your child’s medical needs.
  2. It is normal for children to feel anxious before surgery. Premedication for anxiety may be administered, either orally or intravenously prior to surgery. This may require the help of a parent. The goal of premedication is to reduce the anxiety and facilitate a smoother transition to general anesthesia. Evidence shows that easing a child’s anxiety prior to heading into surgery may limit the emotional disturbances felt during recovery after surgery. Child life specialists are also available, and may use distraction, video or music therapy to calm an anxious patient.
  3. Anesthesiologists will use a multimodal approach to pain management when appropriate. In addition to pain management during surgery and in the recovery room, a particular child and surgery may qualify for a regional anesthesia procedure or “pain block” that will help control postoperative pain during the days following surgery.
  4. For younger children who meet specified criteria, an inhalational technique may be used to initiate general anesthesia. This technique administers anesthesia through a mask (with a flavor of your child’s choosing) and avoids the placement of an IV until after your child is asleep. For older children, an IV may be placed in the preoperative area after receiving anti-anxiety medicine in oral form.  This allows general anesthesia to be administered in IV form.
  5. You know you’re not supposed to eat or drink anything before surgery. But do you know why? When general anesthesia is administered, your muscles relax, including the muscles in your stomach and esophagus. The body’s reflex to swallow is also briefly suspended during anesthesia. This combination makes the lungs vulnerable to aspiration of food, which can be very dangerous. Abstaining from food for 8 hours prior to surgery is very important for the safety of anesthesia for your children.
  6. Common side effects of general anesthesia include nausea, vomiting, itchiness and something called emergence delirium. Emergence delirium lasts 5-15 minutes and happens during the process of waking up. It usually goes away on its own but can be very concerning for parents because your child may not recognize or respond to you. If your child experiences any of these symptoms after a procedure, their care team will be available to provide appropriate medication to treat those side effects.
  7. Difficulty sleeping may occur for a few nights after a surgical procedure. Night terrors are a common occurrence in children ages 3-6 who have had ear, nose and throat procedures. This difficulty sleeping is often troubling for parents but will typically resolve after a few days and requires no additional treatment. Maintaining a consistent bedtime routine as well as eliminating sources that may interfere with sleep (caffeine, sugar, high energy activities and electronics before bedtime) may help in dealing with these disturbances.

The more information you have, the calmer you and your child will be prior to surgery. Parents are encouraged to ask as many questions as possible when you meet their child’s anesthesiologist, before or after surgery.

In the video below, a pediatric general and thoracic surgeon answers parents’ most common questions about surgery and anesthesia:

Video: Get answers about anesthesia

 

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Skin Lumps: When Parents Should Worry

Noticing a skin lump on a child can be scary for parents, and it’s easy to automatically assume the worst. Fortunately, most skin lumps are benign and not a major cause for concern, according to Dr. Saeed  Awan, a pediatric general and thoracic surgeon at CHOC Children’s.

skim lumps
Dr. Saweed Awan, pediatric general and thoracic surgeon at CHOC Children’s, offers advice on skin lumps

Some children are born with skin lumps, and some lumps appear later. The majority of patients with skin lumps will not have any other symptoms, but they can include pain, bleeding, redness, loss of appetite and night sweats. Surgery is often recommended in order to remove these skin lumps, to avoid the risk of infection.

Lymph nodes are the most common lumps that parent notice and worry about. Most parents find lymph nodes in the neck area but can also notice them around the ears and at the back of the skull.

“A pea-sized, rubbery node beneath the skin is nothing to worry about,” says Dr. Awan. “Healthy lymph nodes fluctuate in size- they grow and they shrink, but bad lymph nodes keep growing and are not subtle.”

A lymph node over one centimeter in diameter needs further investigation by a medical professional, especially when associated with loss of weight or appetite, fever or night sweats.

Dermoid cysts, another common lump, typically appear at the part of the eyebrow closest to the temple, but can occur in the middle (midline) of the neck or in the upper chest area. They are rubbery and the size of a pea. These cysts generally do not pose a hazard to your child’s health, but are typically removed to prevent infection. A midline dermoid cyst on the scalp needs more investigation from a pediatric surgeon.

Another common lump is pilomatrixoma, which usually appears on the face, neck or arms, and originates in the hair follicles. It usually manifests as a solitary, asymptomatic, firm nodule.

Hemangiomas develop in the skin when there is an abnormal buildup of blood vessels. This can occur at birth or shortly after. These lumps may increase in size during the first year and then go away on their own over the next three to four years. Most of these do not require surgery unless they are blocking the airway, vision or nostril. Lymphangiomas are rare, but are characterized by swelling on the side of neck.

Thyroglossal cysts are the most common cause of midline neck masses and are generally located just below the hyoid bone, yet these neck masses can occur anywhere along the path of the thyroid gland.

Branchial cysts and sinuses are swelling on the side of the neck. They are typically removed in order to prevent infection.  There are pre-auricular sinuses or skin tags. All of these need to be removed to prevent infection

If you see a skin lump on your child, consult your primary care doctor. If the lump changes size or color, or there is pain associated with the bump, or your child also experiences weight loss or appetite loss, night sweats or a fever, urgent evaluation and further investigation is needed.

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CHOC Expands Pediatric Surgery Team, Expertise

The addition of a new CHOC Children’s pediatric surgeon with a unique expertise lays the groundwork for an expansion of CHOC’s surgical services for the smallest of patients.

While specializing in the full spectrum of pediatric surgery, Dr. Peter Yu has special expertise in the surgical treatment of babies before birth, and is working with hospital leadership to develop a multi-disciplinary fetal surgery program at CHOC in the near future.

Dr. Peter Yu

“I’m extremely happy to be at CHOC,” Dr. Yu says. “There is so much talent and potential here, as well as a pioneering spirit and willingness to undertake big things.”

Fetal surgery was uncharted territory about 30 years ago, Dr. Yu says. The following years, however, have seen many advances, including new techniques that allow surgeons to treat babies while in utero for conditions that are life-threatening or potentially debilitating.

With special training from the Children’s Hospital of Philadelphia, a pioneering institution in fetal surgery, Dr. Yu is determined to bring that level of expert care to CHOC and augment his team’s scope of services.

Also specializing in neonatal, thoracic and hernia surgery, Dr. Yu is board certified in general surgery, pediatric surgery and surgical critical care. Among his other goals are enhancing CHOC’s trauma program, advancing its minimally invasive surgery program, and furthering CHOC’s national reputation through quality patient care and innovative research.

As a medical student at the University of Missouri School of Medicine, Dr. Yu fell in love with the culture and technical aspects of surgery, as well as the potential to make sick patients better quickly.

“I realized that the best surgeons were kind, dedicated, hard-working and team players – traits that I really value,” he says. “When I discovered pediatric surgery, I felt it was a perfect fit for me.”

Dr. Yu completed his general surgery residency at UC San Diego, followed by a surgical critical care fellowship at Boston Children’s Hospital and a pediatric surgery fellowship at the Children’s Hospital of Philadelphia. He is currently working on a master’s degree in public health from Johns Hopkins Bloomberg School of Public Health.

In his spare time, Dr. Yu enjoys spending time with his three children and his wife, an intensive care nurse. He also enjoys surfing, basketball and competitive swimming on a local U.S. Masters swim team.

Call 714-364-4050 to schedule a consultation with a CHOC pediatric surgeon.

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  • Preparing Your Child for Surgery
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Breast Masses in Teen Girls: Cancer or Benign Tumors?

Breast masses can be a cause of concern for adolescent girls and their parents.  Fortunately, the majority of these masses are benign tumors, and breast cancer remains very rare among this age group. The size of the mass, however, and associated pain may warrant surgery, says Dr. Maryam Gholizadeh, CHOC pediatric surgeon.  A young patient who detects a mass should be seen by a surgeon to evaluate her options before getting a needle biopsy.

Dr. Gholizadeh has experienced an increase in patients with breast masses, which may point to girls being diligent with breast self-examinations.   The patients are healthy and are experiencing hormonal changes fairly common in adolescence.  All of them are incredibly anxious.

“These young girls, who vary in ages from 13 to 17, are of course very scared, as are their parents.  I spend a lot of time educating them and, should surgery be necessary, reassuring them,” explains Dr. Gholizadeh. “As a woman, I have empathy for what these girls are feeling about their bodies and work really hard to make them feel comfortable with me.”

Surgery to remove the mass is performed under general anesthesia—administered by a pediatric anesthesiologist—an outpatient basis, with no hospitalization required.   Dr. Gholizadeh takes great care to preserve the shape of the breast and to minimize scarring by placing incisions either under the breast or around the nipple.   Her patients are home within a few hours of arriving at CHOC.  Patients can usually return to school within 48 hours and resume activities after two weeks.

“These young ladies are eager to get back to school, sports and other activities, and don’t want to be slowed down.  My goal is to provide the best surgical outcome for them, including a quick recovery,” says Dr. Gholizadeh.

A recognized expert in her field, Dr. Gholizadeh specializes in all areas of pediatric and neonatal surgery. Her clinical interests include pediatric oncology, thoracic surgery and minimally invasive surgery. Dr. Gholizadeh is board certified in general surgery and pediatric surgery.  She can be reached at 714-364-4050.

Will Your Newborn Need Surgery? Plan Now

The news comes as a shock, usually during the first prenatal ultrasound between the 16th and 20th week of pregnancy. Treatment planning, however, cannot begin too soon when a developing baby is diagnosed with a complex birth defect.

 

Some babies are born with complex conditions requiring surgery during the first few hours following birth. From the moment prenatal testing reveals an abnormality, CHOC Children’s is ready to help with the prenatal care and birth planning necessary to ensure the best-possible outcome.

CHOC has a trained and experienced team that includes perinatologists, neonatologists, pediatric surgeons and NICU nurses to guide families through the months before delivery. And families are essential to the planning process.

“The well-being of the child is surprisingly dependent on the well-being of the family, both psychologically and emotionally,” said Dr. David Gibbs, division chief, pediatric surgery, CHOC Children’s Specialists. “Preparation helps the family cope better, and the family that is coping better is able to provide better care for their child.”

According to Dr. Gibbs, recent advances in the care and outlook for babies born with abnormalities have come from closer prenatal coordination with perinatologists and families, combined with highly specialized neonatal intensive care. The CHOC NICU is rated by the American Academy of Pediatrics as a Level 4 NICU, the highest designation available and given only to facilities that also provide onsite surgical repair of serious congenital or acquired malformations.

That immediate access to the full NICU medical team, resources and support is critical for babies born with gastroschisis, a condition that requires surgery within the first hour following birth, and omphalocele, which must be corrected within the first few days. For the smallest and sickest, CHOC’s Small Baby Unit offers additional support to help babies grow and recover more quickly with fewer infections and setbacks.

For babies born with congenital diaphragmatic hernia, the CHOC Surgical NICU provides the optimal environment in which to stabilize and gain strength before surgery. One special room inside the CHOC NICU converts into a state-of-the-art operating room, allowing pediatric surgeons to perform delicate procedures within the unit.

And babies born with congenital cystic adenomatoid malformation (CCAM) may actually get to go home for continued evaluation months before surgery.

Deciding Where You’ll Deliver

Dr. Gibbs added that an important element of prenatal planning is deciding in advance where your baby will be born. Moms who know their baby will need surgery may choose to deliver at a hospital that is near a pediatric facility like CHOC. When the baby is born, the CHOC Transport Team is ready 24 hours a day to transport the baby to CHOC from hospitals throughout the region. Specially trained and equipped, this team uses ground and air transportation to travel to and from hospitals throughout Orange, Los Angeles, Riverside, San Bernardino and San Diego counties — and even beyond.

“We expect most children will do well and have normal lives,” Dr. Gibbs said. “But the first step is meeting with the perinatologist, pediatric surgeon and NICU team. Starting that relationship as soon as possible will make the process of coping with what may seem to be an overwhelming process a lot easier.”

CHOC’s surgeons provide cardiothoracic surgery, gastrointestinal (GI) surgery, general surgery, neurosurgery, urological surgery, otolaryngological (ENT) surgery, plastic surgery, ophthalmologic surgery and orthopaedic surgery.

Learn more about surgical services at CHOC.

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  • The Importance of a Pediatric Surgeon
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  • Preparing Your Child for Surgery
    Surgery is scary for kids and parents, alike, but not talking about an upcoming surgical procedure can create more fear and anxiety in children. In episode number 29, Child Life ...
  • Matthew’s Story: Healing in the Surgical NICU
    Grace Wu beams as she watches her son Matthew smiling and happy after enjoying his bottle. “It’s good to see him so happy and active,” she says. “That he could do ...

Matthew’s Story: Healing in the Surgical NICU

Grace Wu beams as she watches her son Matthew smiling and happy after enjoying his bottle.

“It’s good to sbabies surgeryee him so happy and active,” she says. “That he could do that makes me very, very happy.”

It’s a marked change from the days following Matthew’s birth almost four months ago.

As a newborn, he was diagnosed with volvulus, a condition wherein the intestine is twisted and can ultimately cut off blood circulation. Symptoms of volvulus include a distended stomach and intolerance to feeding, which Matthew exhibited.

The baby was quickly transferred to CHOC Children’s for emergency surgery at just three days old. CHOC surgeon Dr. Saeed-Ur-Rehman Awan repaired the malformation by performing an ileostomy, wherein the intestine is brought outside the body.

Next, Matthew needed time to heal his organs. He spent the next three months recovering in CHOC’s Surgical Neonatal Intensive Care Unit, a special part of the hospital’s main NICU dedicated to the care of babies who need surgery.

There, Matthew was under the care of a multidisciplinary team that included Dr. Irfan Ahmad, a CHOC neonatologist and co-director of the surgical NICU, and many other clinicians.

In the unit, the team cares for patients jointly, discussing the cases of children like Matthew as a group and forming a treatment plan that often calls for the expertise of other specialties at CHOC.

Another key component of the surgical NICU care team is parents and families. In Matthew’s case, his parents and grandfather, Jerry, partnered with clinicians on every stage of the baby’s care.

“Jerry was there every single day holding Matthew – even when he was crying,” Dr. Ahmad says. “He was a great member of the team, and he provided a lot of support.”

As Matthew began eating orally in small volumes as well as through intravenous methods, he geared up for a second surgery that would reattach his intestines. That procedure was performed just three months after the first.

After several more weeks of recovery, Matthew was able to eat fully from a bottle and was on his way home, much to the relief of his family.

“I was very worried because for the first time, I thought I might lose him,” Grace says. “I am very thankful for the care he’s received.”

More articles about CHOC’s Surgical NICU:

Surgical Services: Then and Now

Operating Room_lgIt’s been so much fun this past year to reflect on how CHOC has evolved since my first visit in 1964.

And I most certainly cannot forget the changes in surgical services, which CHOC has specialized in since its opening nearly 50 years ago.

CHOC has the latest surgical equipment, technology and techniques, including minimally invasive procedures and robotic surgery methods.

At CHOC’s Tidwell Procedure Center, fully-integrated operating rooms give surgeons full, wireless control of cameras and lights and the ability to view all of the room’s monitors and camera images, patient records and imaging reports on large, flat-screen displays as needed throughout the procedure.

Surgeons can also consult with other surgeons in other operating rooms and our hospital pathologists in real-time using video conferencing to discuss the surgery as it is happening.

Another big change since the hospital’s opening in 1964 has been the addition of child life specialists. These important CHOC staff members work with patients to help ease any fears and worries about a procedure, and to improve understanding of surgery through developmentally appropriate methods.

Surgery is scary for anyone of any age, but I know I would feel better knowing I was in CHOC’s care!

____________________________________________________________________________________________________________________________________________

Surgical Services at CHOC Children’s specializes in providing patients — from infants to young adults — with the most state-of-the-art services in a compassionate, family-centered environment. CHOC’s experience in exclusively treating children, teens and young adults makes it the expert in pediatric surgery.

 

12 Questions to Ask Before a Child’s Surgery

questions_before_kids_surgeryWhen a child faces surgery, the procedure can be just as scary – or even scarier – for a parent.

The good news is that CHOC Children’s practices patient- and family-centered care, and works to ensure parents and patients are informed.

Parents with a child facing surgery should ask plenty of questions to learn as much as possible about their child’s surgery and post-operative care – and CHOC’s surgical services team is ready with answers.

“You have to do whatever you need to do so you feel like you are being a good parent,” says Dr. David Gibbs, a pediatric surgeon and president of CHOC’s medical staff.

Dr. Gibbs recommends that parents ask the following questions before a child’s surgery:

  1. How will this operation help my child?
  2. Is the surgery an inpatient or outpatient procedure?
  3. How long will my child need to be in the hospital?
  4. What type of incision will be used?
  5. What medications will he need?
  6. What are the risks of the surgery and the anesthesia?
  7. What type of post-surgery care will the child need afterward?
  8. How will my child’s pain be managed?
  9. When will my child be fully recovered?
  10. What limitations will my child have after surgery, and for how long?
  11. When can my child eat and drink after surgery?
  12. Is there anything else you think we need to know about this surgery?

Learn more about the Tidwell Procedure Center and surgery at CHOC.

Related articles:

  • The Importance of a Pediatric Surgeon
    Children are not just “little adults” and when possible, should be treated by a physician who is specially trained in pediatrics. Their physiology is different, and since they’re still developing, ...
  • Preparing Your Child for Surgery
    Surgery is scary for kids and parents, alike, but not talking about an upcoming surgical procedure can create more fear and anxiety in children. In episode number 29, Child Life ...
  • Will Your Newborn Need Surgery? Plan Now
    The news comes as a shock, usually during the first prenatal ultrasound between the 16th and 20th week of pregnancy. Treatment planning, however, cannot begin too soon when a developing ...