Andrew's recovery is continuing well, and he's reacting in a really funny way. They gave him an extra dose of steroids just before the surgery this morning, in order to reduce inflammation, etc. The nurse said that was why he was awake so soon after his surgery, though she was expecting him to go to sleep after they started the extra medication, which is called Versed. Versed, medically known as Midazolam, has the following drug description:
"Midazolam is used to produce sleepiness or drowsiness and to relieve anxiety before surgery or certain procedures. It is also used to produce loss of consciousness before and during surgery. Midazolam is used sometimes in patients in intensive care units in hospitals to cause unconsciousness. This may allow the patients to withstand the stress of being in the intensive care unit and help the patients cooperate when a machine must be used to assist them with breathing."
The description mentions drowsiness, sleepiness, or unconsciousness four times in four sentences. He's also on regular doses of morphine and Ativan, and had major anesthesia this morning. One would think he would sleep for the next three days...but not our baby. When I called before shift change at 6:30pm, the nurse said, "Your baby is hilarious." Apparently he was wide awake the entire time, watching her every move, staring at his mobile, and even trying to turn his head to follow her movements. Just like his daddy, he doesn't want to go to sleep when anything interesting is going on. She finally had to put a blanket over his eyes to make him go to sleep.
The night nurse had the same report. He's been awake a lot, though entirely comfortable and not irritated. When he does get a little upset, he's been a lot more consolable than he was before the operation. His blood pressure is a little high from the steroid dosage, but he's still behaving very well and all his gases have been good. All his vent settings had gone up in the last few days when he was getting so upset, and they've been able to wean them back down today. His oxygen percentage is at 25%, which is the lowest ever. His vent is at 20 breaths per minute, down from 26 this morning. He's breathing above the ventilator while he's awake and sometimes when he's asleep, except for the few times the drugs have really kicked in and put him into a deep sleep. Suppressing respiration is one of the expected effects of the drugs, but he's been able to keep great blood gas levels even on low settings.
We're very proud of how he's handling his recovery so far. It appears that his discomfort in the last few days didn't involve a relapse with his lung issues, which have continued to improve. They'll continue with the same strategy, but probably won't try extubating him until he's on much lower doses of medication. He's on a few extra meds (the painkillers, antibiotics, etc) for now.
They've been getting some light green fluid from his NG (nose to stomach) tube, which is to be expected for a few days. In the morning they'll remove that tube and start doing everything through the G-tube (direct to stomach). In a few days, they'll be able to replace the huge plastic disk on his chest with a much more unobtrusive connector. As his stomach excretions become more clear, that will be a sign that his bowel has recovered from the surgery and is ready for feedings again. We'll be starting over with very small amounts of milk, but hopefully he'll respond better now that there aren't any obstructions.
It'll be several days before they remove the bandage over his incision, and probably ten days before the Steri-Strips and remaining tape are gone. We're not sure exactly what it looks like, but it's straight enough that it ruins our cover story. With his long, curving scar, we thought he could tell people it was a shark bite...the new scar will require a new explanation. Any ideas?
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