Before Childrens' Strabismus Surgery
Administrative and insurance approvals
Most strabismus is covered by health insurance. Some policies have restrictions on so-called “pre-existing” conditions, who may perform your surgery, where it may be performed, what will be “covered”, copayments and deductibles, what will be paid and to whom, and other limitations. The insurance company or health plan, as part of the contract between and among employers, beneficiaries and others, generally imposes these restrictions. Similar restrictions are placed on providers, including surgeons under contract to the insurance company or health plan. Those contracts require all parties to “play by the rules”. There are often significant frustrations created by these rules and rulings of the managed care or insurance carriers. While your surgeon’s staff will assist you in knowing how your policy(ies) will affect reimbursement for your care, the ultimate responsibility for understanding your policy, and what it will provide, is yours. Your surgeon’s office responsibility is to provide you, and where contractually required, your insurance or managed care company with information about your diagnosis and proposed treatment. A fact of life is that these matters are often complicated and take time and resources to sort out. You may rest assured that any frustration you may experience is at least matched by your surgeon and his or her staff.
Once it has been determined what options are available, scheduling is a matter of matching your (or your child’s) medical needs with an appropriate facility at which your surgeon has obtained privileges and the combined schedules of the necessary parties. Apart from acute trauma, timing of most strabismus surgery is generally not medically critical. Nonetheless, once the decision has been made, it is generally advantageous—gaining the benefits of correction and avoiding long term fretting about surgery—to you or your child to proceed at an early convenient time.
It is reasonable and prudent to gain prior advice from doctors that provide ongoing care—such as pediatricians, internists and family practitioners—prior to proceeding with surgery. This will maximize the safety to you or your child through communication. There are also general guidelines about what preoperative testing, such a blood and urine tests, chest X-rays, and EKG that may be important to your anesthesiologist and health facility in determining the advisability and safest method of administering an anesthetic and performing surgery. Please be certain share any ongoing medical problems and issues with your surgeon and anesthesiologist prior to surgery. In particular, inform them about any allergies you may have to medicines, any bleeding tendencies you may have, and any past or family history of problems with anesthesia.
Since strabismus surgery is almost always elective in the sense of timing, every effort is taken to avoid taking unnecessary risk. Therefore, if a person is experiencing a temporary illness—for example, upper respiratory congestion, significant cough/sore throat, vomiting and/or diarrhea, and especially fever—it is often wise to postpone surgery. Please inform your surgeon if you are concerned about your or your child’s health before surgery, so that arrangements may be changed if necessary before coming to surgery.
It is unsafe to perform surgery soon after eating solid food. Therefore, a very important aspect of the hours preceding surgery is the restriction of the intake of solid foods and liquid drinks. The very important concern is that as anesthesia is being administered, food—indeed, any stomach contents—may be vomited and aspirated into the lungs, causing inability to breathe or pneumonia; in the worst case, this may be life threatening. The risk of aspiration of stomach contents in to the lungs increases with both volume of material in the stomach and its pH (acidity), and both increase with any food and drink. Your surgeon and anesthesiologist will provide you with detailed instructions about when to stop all intakes of liquids and food. In general, if surgery is to be performed in the morning, nothing should be taken by mouth after midnight the preceding evening. The following is a table of advice for children, based upon age and time of surgery. Please be certain to follow these instructions or those of your anesthesiologist. BEWARE: hungry children and adoring parents will often assume “just one bite” or “sip” will be acceptable; it will not be and will likely require delay or rescheduling of the surgery. Children will need constant supervision to assure they are in compliance with these requirements. One last note: clear liquids, such as water or apple juice, means you can see through them; orange or grapefruit juice and especially milk, for example, are not clear liquids.
Table for Fasting Instructions:
For Infants and Children Under Thirteen Years of Age:
- 8 HOURS: Solid high fat food is allowed until 8 hours prior to the scheduled procedure (Meat, cheese, fried food)
- 6 HOURS: Solid low-fat food is allowed until 6 hours prior to the scheduled procedure (Formula, milk, cereals, breads, fruit juice with pulp)
- 4 HOURS: Breast mild is allowed until 4 hours prior to the scheduled procedure
- 2 HOURS: Clear liquids are allowed until 2 hours prior to the scheduled prodedure (Water, Pedialyte, apple juice, Popsicles, clear Jell-O, Kool-Aid or Gatorade)
For Adolescents and Adults:
- Nothing to eat or drink after midnight prior to surgery; or at least eight hours prior to surgery.
- Should be taken as usual with a sip of water up to 2 hours prior to the procedure
- For asthma may be given at any time
Next Chapter, During Surgery