Infant surgery without anesthesia (3): choices have had consequences

The previous two posts have explained the three ways in which surgery has been done on babies during the past century.  In brief, babies were worked on using general or local anesthesia – and also using no pain control at all.

The effect of infant surgery without any anesthesia on those patients in later life can be severe, lifelong, and even life threatening: the evidence of this is all over this blogsite – by way of readers’ Comments and links to academic reports.

The work and report of Drs K J S Anand and P R Hickey (1987) were crucial in making this terrible practice and resultant damage abundantly clear.  These men’s findings started a major (and still continuing) change in public attitudes to infant surgery without anesthesia, ranging from circumcisions to cardio-thoracic procedures.

The medical professions concerned have also changed their policies and attitudes, sometimes (it seems) under duress.  The available literature suggests that the practice of pediatric surgery in the USA may have been at the forefront and most influential in promoting the convenient and wishful fantasy that “babies do not feel or remember pain”.

How much have practices around infant “procedures” and surgery actually changed?

As stated, here has been significant change at the formal, official level.  Online we can find many reports and postings reflecting hospitals and associations of anesthetic and pediatric specialists that have revised their protocols, policies and (one hopes) their procedures.

Old Doctor1However, also online are far too many mentions of the old attitudes and ways continuing.  It may be that it’s only the “dinosaurs” of the medical profession who are guilty of this: doctors well past retirement age, unwilling or unable to update their methods, but in blind love with their life’s work and/or buoyed up by naively grateful patients.  I have heard and read too many stories about such people.
(I write this as one who during my professional life strove to keep my work “state of the art”, and then “moved aside” on my 65th birthday because I believed my work responsibilities required this.)

It seems also that many of the surgeons persisting with outdated practices are being “sheltered” by small local hospitals – of which there are many.  There can be a clear co-dependency among those interested in their financial and professional well-being rather than referring their youngest patients to more expert and specialist centres.

This blog is dedicated to informing, networking and reassuring those patients and parents who have been troubled by infant surgery.  My own experience with the effects of a 1945 pyloric stenosis operation (which was a lifesaver, but…) has motivated me to compare notes with others who have experienced something quite or exactly similar to what I have.

Below are some of the quite recent and deeply troubling comments about the present practice of infant surgery which I have gleaned from the web.  Read them and judge for yourself.

Hospital small1Dr Rae Brown wrote 21 August 2009 –
The surgical treatment of patients with pyloric stenosis is straight forward; the anesthetic management is not.  Infants still die in the United States because of attempts to manage cases in medical centers that have little to no experience with newborns.  This is usually because a surgeon feels that they can take care of a child but doesn’t consider the other health care professionals involved in the babies management.  This case should only be done in centers that have substantial experience with babies and especially anesthesiologists that take care of infants as a regular part of their practice.

Dr Jeffrey T Jung wrote in December 2010 –
Many hospitals still do circumcisions without local anesthesia, instead tying down the baby’s limbs and cutting with a scissors — or worse, strangulating off the offending tissue with a piece of string (ouch!).  Babies needing surgery for pyloric stenosis are often intubated ‘awake’ – which anyone who understands intubation knows is not a pleasant experience.  Until a couple of decades ago, babies underwent surgery on the heart–including splitting the sternum or breaking ribs – with only a paralyzing agent, for fear that babies wouldn’t tolerate narcotics or anesthesia.

A 1988 report on infant PS operations in the UK stated –
One patient underwent operation under local anaesthesia for religious reasons, but the remainder had general anaesthesia with endotracheal intubation.
Infants were extubated when fully awake.  Opiate analgesics were not prescribed because infants of less than 46 weeks’ gestational age (full term plus six weeks) have an appreciable risk of postoperative apnoea…
A modification of Robertson’s gridiron incision was used in all but the infant having the operation under local anaesthesia.

Finally, a note to the parents of babies who need surgery.

baby trusting1Often the surgery that is advised is life-saving – but not always.  Most pyloric stenosis (“PS”) operations today are done competently – but they may also be unnecessary.  Check the “Categories” box to the right if you’d like to know more about the alternative medical treatment.

But whatever you decide, consider your baby’s future emotional wellbeing by informing yourself of the options – and the possibility of your own child being treated without general anesthesia.

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2 thoughts on “Infant surgery without anesthesia (3): choices have had consequences

  1. Wendy Williams

    Yikes! Amazing that this day and age, general anesthesia is not standard most everywhere, especially in a developed country like America, for infant surgeries! And the thought of babies dying because they were operated on in a hospital without staff trained in pediatric care– horrors. Babies intubated while awake! More horror. Thank you, Fred, for telling it like it is on your blog. It’s so important that people know the reality of what’s actually going on out there so they can have more control over their baby’s care.

    Reply
  2. Fred Vanderbom Post author

    Yes, Wendy, It is horrifying and unbelievable that in developed countries like the USA, some infant surgery is still done without regard to knowledge that for 25 years or more has been available and widely publicized, especially in medical circles.
    We can only blame what is commonly called “bloodymindedness”: the all-too-common attitude that cares little for the facts and for others’ welfare, and believes that all that matters is my ease, wealth, and benefit.
    As this blog has often explained, this attitude is all too common among medical doctors, and we all urge parents of little ones to beware and prepared to deal with it.

    Reply

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