Operation
Preoperative dose
Neonatal (<72 h old) surgery
50 mg/kg ampicillin and 2.5–3 mg/kg gentamicin
Class I
Cefazolin 25 mg/kg
Vancomycin (if MRSA or MRSE likely) 10 mg/kg
Class II
Cefazolin 25 mg/kg
Ampicillin 50 mg/kg
Gentamicin 2.5–3 mg/kg
Class III
Cefoxitin 40 mg/kg
Cefotetan 40 mg/kg
Class IV
Cefoxitin 40 mg/kg
Cefotetan 40 mg/kg ± 2 mg/kg gentamicin
Gentamicin 2 mg/kg + 10 mg/kg clindamycin
Preoperative Bowel Preparation
The use of mechanical bowel preparation is standard practice before urological procedures such as cystoplasty was based on observational data. This preparation was popularized beginning in 1966 and became routine practice by the early 1970s. Antibiotics were subsequently added to decrease the bacterial load [23]. The aim of mechanical bowel preparation with or without antibiotics is to decrease the intestinal content and the intraluminal bacterial content, which it has been postulated will reduce complications. Recent studies in adult colorectal surgery have shown an increased risk of abdominal septic complications, including anastomotic leakage, with bowel preparation [24]. The incidence of postoperative complications did not differ between children with or without preoperative bowel preparation. Those who did not receive bowel preparation had a significantly shorter hospital stay and avoided the unpleasant procedures [23]. Known side effects of bowel preparation are due to dehydration and electrolyte disturbances such as hypokalemia and hyperphosphatemia. Caution in patients with renal and/or cardiac impairment. The use of preoperative bowel preparation usually is by surgeon’s preference.
What Parents and Children Remember
The urologist should assume that parents and older children will remember everything good and bad. The statement that “Technical excellence will provide patient satisfaction” is false. Memories whether positive or negative will be imprinted from the time in the clinic or emergency room up until surgery and the postoperative period.
It is well known that significant preoperative anxiety is associated with a difficult and often prolonged anesthetic induction [25, 26]. If the child is not treated in an age-appropriate manner, the entire perioperative experience will likely be compromised. Conversely, if the psychological and emotional aspects of a child’s condition distract caregivers from the primary medical and surgical concerns, a successful outcome may be compromised [27]. There is consensus among anesthesiologists regarding the need for the treatment of a child’s anxiety before surgery [28] because for a lot of children, the immediate postoperative course reflects their experience during induction.
Table 32.2 [27] shows how the age of the child will affect his/her responses to anesthesia and surgery and some ways to ameliorate their anxiety.
Table 32.2
Responses to anesthesia and surgery by age and some ways to ameliorate their anxiety
Age | Response | Solution |
|---|---|---|
Infant | Fear of separation from parents and exhibit stranger anxiety | Parental involvement in the perioperative experience |
Toddler | Fear of loss of control | Enable the child to make choices, such as asking if the child has a color preference for his or her hospital gown |
Preschool | Fear injury and they tend to think in concrete terms and therefore may take statements literally | Caution when choosing the language used with this age group |
School | Fears that he or she may not meet the expectations of adults | Clearly explained the expectations from them |
Adolescent
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