emergence delirium

This is a continuation of earlier posts on Ahna's eye surgery. It will be short. We are home and she is awake and needy and quite uncomfortable.


Her surgery went well, we spoke with her opthamologist, then were taken pretty quickly back to the recovery room.  She woke earlier than expected, and to put it mildly, was absolutely beside herself.  The nurse deemed her as a case of emergence delirium:  


"Emergence delirium is defined as a dissociated state of consciousness in which the child is inconsolable, irritable, uncompromising or uncooperative, typically thrashing, crying, moaning, or incoherent. Additionally, paranoid ideation has been observed in combination with these emergence behaviors. Characteristically, these children do not recognize or identify familiar and known objects or people. Parents who witness this state claim the behavior is unusual and uncustomary for the child. Although generally self limiting (5-15 min) ED can be severe and may result in physical harm to the child and particularly the site of surgery." (from a pediatric anesthesiology website)


They thought we might help calm her.  They were wrong.  When we got to her, there were FOUR grown women trying to manage her, keep her safe, keep her IV in and her eyes protected.  Her screams were louder than loud, and as forceful as her kicking legs and flailing arms.  Poor baby.  Poor baby.  Her nurse had given her "two pretty big doses of Fentanyl," without effect so far.  After a few more minutes and me handing her off to Daddy, who was bigger and stronger, AND after one more dose of Fentanyl, she did drift off to sleep.  Body jerking from the crying, she slowly relaxed and gave in to the sedative effects of the drug.  And Daddy didn't let go.  He held her until she woke again, probably an hour later, this time in a much different way. 


Juice in and IV out, we left the hospital less than 5 hours after arriving there.  


She has drifted off to sleep now.  Her eyes are a little swollen and extremely teary and glassy-looking, and her entire face looks generally puffy from the IV fluid.  She is uncomfortable and mostly cries when she is awake so far.  :-(  I don't expect her to be awake for long periods at all today, since they had to give her so much Fentanyl earlier. 


I took pictures throughout the day and plan to post those, but maybe tomorrow.  


We are glad to be on the "other side" of the surgery, for sure.

a late posting of earlier events

11:30 a.m. and she’s in surgery.
Was such a trooper this morning. Woke her just a few minutes before we needed to be on our way. Reminded her that it was Hospital Day and that God was going to help the doctor fix her eyes.
After gathering her full medical kit, a couple of lovies, her favorite blanket, and 2 stuffed animals (which she wanted nothing to do with once we arrived here) – we were on our way.


Buckled in her carseat, she asked, “May I please have a snack now, Mommy?”
“Well, we have to get to the hospital first. And then you’ll have a snack a little later, OK?”
“MAAMMAAA…. Hospitals don’t have snacks.”  (rolling her eyes at me like I didn't have a clue)


A few days ago, we were at the pediatrician’s office for her pre-op check, and it was the FIRST TIME EVER that she didn’t frantically scream throughout the entire process. She has been absolutely terrified of the doctor’s office and all things medical-related, since the day we took her from the orphanage worker.  Completely uncooperative, she wails her way through every event, every time we set foot in the door to the doctor’s office. It was such a relief, this past visit, to see that she was finally beginning to understand and cope and know that she was safe.


That being said, we were apprehensive about how she might tolerate all the events of today. Sensory overload happens quickly for Ahna. BUT – she has done beautifully, perfectly, performed like a champ. And we are so proud of her!


The final step of the morning, before surgery, was the "induction room."  Here, Ahna was to inhale her grape flavored "sleepy gas" through a mask, which of course would put her to sleep.  A kind man came to wheel her away, parents by her side.  It was a fun ride through the hallways of the hospital, back through a long corridor, and into the entrance to the operating room.  At this point, she had finally had enough, and decided that she did NOT want that mask near her, nor the 3 or 4 new faces around her.  Thankfully, her cries and yells and wide eyed fear lasted only about 60 seconds, and she was sound asleep.


Bill and I were led here, to the surgery waiting area, to WAIT.


More, a little later.

her eyes

Not long after we brought Ahna home at 13 months of age, we noticed that her left eye wandered outward on occasion.  We usually noticed it in the morning, or when she had just woken from a nap, or when she was tired.  In the beginning months, she would simply close her eyes and the left eye would refocus.  


Her opthamologist diagnosed the exotropia, which is simply an outward deviation of one or both eyes, due to weakened muscles in the eye (the lateral rectus muscles).  We learned that this condition would eventually get worse, and were told that Ahna would need corrective eye surgery between the age of 3 and 4.  


We were told to monitor for these warning signals:
1.  The frequency of the eye wandering was increasing
2.  The duration of each instance was increasing
3.  The angle at which the eye wandered? increasing
4.  It would become more difficult for her to correct the 'wandering eye' by batting her eyes - it would remain unfocused despite her effort.
5.  The eye would begin to annoy her - she would notice the problem, rub her eyes, etc.


Initially, with exotropia, vision is unaffected.  However, if corrective surgery isn't done, the brain eventually "tells" the wandering eye that it doesn't have to "see" along with the "good eye."  So surgery is necessary to help assure binocular vision, whereas  the brain uses both eyes together as a single unit.   


It's hard to believe that our girl will be 3 years old next month, and it turns out her eye surgery is taking place tomorrow.  


Over the past two or three months, her eyes have gotten significantly worse.  Both eyes - the right decided to join in on the wandering, too.  Guess it felt left out.  :-)  It has become a regular, many-times-a-day occurrence, for a brother or a parent to be calling to Ahna, "Your eyes, your eyes...." as a signal to her that she's out of focus.  She'll close those eyes, rub them, open, close.  It'll take a few tries and a few seconds to correct them.  The exotropia is still most evident when she is tired or sick, or when she is looking at something  in the distance.  Also, when we're out and about and she's in her carseat looking out the window, most usually when I glance back at her through the rearview mirror, her eyes are out of focus.


So it is time.  We feel extremely blessed to have an excellent pediatric opthamologist performing her surgery.  He, in fact, has done over 12,000 such procedures.  


I've decided to blog my way through Ahna's surgery and recovery for a few reasons:  because I'm obviously not blogging about anything else; because maybe it can help inform another family who may be going through the same thing, someday; and because our family in other states might want to follow along.


We leave for the hospital around 8:30 a.m. Hopefully, our baby girl will sleep in a bit, since she can have nothing to eat or drink when she wakes.


Her surgery is at 10:30.  More tomorrow.