Babies, surgery and no aenthesia

March 14, 2010 9:48 PM

Babies were often operated on with no anesthesia 30 years ago or more. Is this true?

Excerpt from "The Pain Scale" ($, Harper's 2005) by Eula Biss:

But when my aunt became a nurse 25-years ago, it was not unusual for surgery to be done on infants without any pain medication. Babies, it was believed, did not have the fully developed nervous system necessary to feel pain. Medical evidence that infants experience pain in response to anything that would cause an adult pain only recently emerged.

posted by stbalbach to Health & Fitness (26 answers total)

I assisted with no-anesthesia circumcisions in 1985.

It was awful.
posted by SLC Mom at 9:59 PM on March 14, 2010 [1 favorite]

Yes it is true. Same belief about animals.
posted by fifilaru at 10:00 PM on March 14, 2010

Also:

I never saw anything else done without anesthesia, but I've only been in nursing since 1980, which is just about the beginning of your window. So I can't attest to 'over 30 years ago.'
posted by SLC Mom at 10:03 PM on March 14, 2010

Not infants, but: in Torey Hayden's Somebody Else's Kids, an account of teaching a special ed class in the seventies, she relates how a young autistic boy in her class is given stitches with no anesthesia after cutting his tongue open; when she objected the doctor told her that 'those types' of children could not feel or understand pain.
posted by frobozz at 10:15 PM on March 14, 2010

I was circumcised without anaesthetic. Also they had to break my arm to get me out of my mother and I wasn't drugged for that, either. This was thirty-some years ago.
posted by turgid dahlia at 10:36 PM on March 14, 2010 [2 favorites]

Response by poster: evidence that infants experience pain in response to anything that would cause an adult pain only recently emerged.

This would make sense in the 19th century - when blacks were non-human and women had organically inferior brains - but 30 years ago or less? It seems unbelievable arcane and "barbaric, Jim". Is it possible pediatric anesthesia was just too dangerous because they didn't know the proper dosages? Even that seems a stretch. Was it a case of group-think where an old wives tale sort of ruled as "common sense" by tradition, until a rebel came along and broke the paradigm, sort of like how long it took the British to figure out scurvy was a nutrient-based disease, not soft work and a weak upper lip.
posted by stbalbach at 10:50 PM on March 14, 2010

A friend of mine needed to have some dental work done as a child and the dentist believed that children did not feel pain. Her mother heard her screaming from the waiting room and came in and stopped it. The dentist seemed to think that it was the noise of the drill that scared his patients, and that's why they screamed.

This happened in the 1970's, so yeah.
posted by ambrosia at 10:54 PM on March 14, 2010 [1 favorite]

Time Magazine, Tuesday, Mar. 24, 2009:
Study: Anesthesia in Infancy Linked to Later Disabilities

- In the 1960s, based on similar concerns over possible injury to a baby's immature nervous system, doctors advocated only light anesthesia or none at all for infants undergoing surgery. Some experts believed babies did not have sufficiently developed neural connections to even feel any pain .
"There was a whole series of papers showing that [giving anesthesia] was a bad thing to do," says Dr. Robert Wilder, a co-author of the Mayo Clinic study. "One thing that is very clear is that kids who have surgery without the appropriate anesthetic have higher degrees of morbidity and, in some cases, even mortality associated with surgery compared to kids who have gotten the appropriate anesthetic." (...)

By far, the most common procedure performed on the infants involved the insertion of tubes in the ears to remove fluid to prevent hearing loss and potential delays in speech and language skills; 26% of the babies undergoing surgery fell into this category. One-quarter of the infants needed general surgery, while 13% required some type of orthopedic procedure. Only 1% of the infants who had surgery needed a neurological procedure.
posted by iviken at 11:07 PM on March 14, 2010 [1 favorite]

My brother had surgery for pyloric stenosis without anesthesia in the early '70s. Basically, when he was a couple of days old they cut through his stomach muscles to unblock a blockage. So yup: it definitely happened.
posted by craichead at 11:07 PM on March 14, 2010 [1 favorite]

This would make sense in the 19th century - when blacks were non-human and women had organically inferior brains - but 30 years ago or less? It seems unbelievable arcane and "barbaric, Jim".

Oh, people had barbaric beliefs like that much later than the 19th century. Even addressing solely the medical issue and not the racist/sexist/etc point - consider that lobotomies were still widely practiced in the 50s.

Actually, this relates to your question: the "icepick up the nose" lobotomy method was apparently invented as a more humane way of performing lobotomies on patients in state mental hospitals that didn't use/have the budget for anesthesia.
posted by Solon and Thanks at 11:14 PM on March 14, 2010

consider that lobotomies were still widely practiced in the 50s.

Forced sterilizations of the mentally ill or handicapped (or those believed to be so) took place in the US until the early 80s, as well.
posted by frobozz at 11:22 PM on March 14, 2010

Also, this article from 1935 (via this thread on Snopes):

- Many necessary operations, which formerly were not done at all or performed without anesthesia because of its presumed danger, are now undertaken confidently under general anesthesia. (...) Ninety-six cases of children under two months, anesthetized without a fatality for operations for the relief of pyloric stenosis, intestinal intussusception, herniae into umbilical cord and cleft lip and palate, bear out this statement. The youngest patient was five hours old and the operation, the surgical reduction of an umbilical hernia of practically all of the small intestines. The surgeon in the case, Alanson Weeks, who first substituted for gastro-enterostomy here the rapid Fredet method, and has performed it one hundred and eleven times, credits the anesthesia with some of its success. (...)
The chief point of difference in anesthetizing children and adults is the unstable and irregular respiration of the former. This is recognized as the greatest danger with chloroform, as one delayed and deep inspiration may be sufficient for an overdose.
posted by iviken at 11:23 PM on March 14, 2010

By far, the most common procedure performed on the infants involved the insertion of tubes in the ears to remove fluid to prevent hearing loss and potential delays in speech and language skills; 26% of the babies undergoing surgery fell into this category. One-quarter of the infants needed general surgery, while 13% required some type of orthopedic procedure. Only 1% of the infants who had surgery needed a neurological procedure.

Anecdotal. I had both my ear drums lanced to prevent uncontrolled ruptures at around the age of six in the late 1960's. I distinctly remember being "knocked out" with some form of smelling gel (chloroform?) I was told by my parents afterwards that I screamed and screamed in pain during the procedure.
posted by michswiss at 11:48 PM on March 14, 2010

but 30 years ago or less? It seems unbelievable arcane and "barbaric, Jim"

Anesthesia is risky. (In fact, we still don't understand its mechanism of action.) It's dose dependent, and thus more difficult in babies and infants, as the differences between ineffective dose, effective dose, and overdose are proportional to body weight and thus smaller than in adults. Fewer infants and young children are anesthetized than adults, and so anesthetists have less institutional or personal experience with infant and child patients.

Consider that anesthesiologists, if all goes well, do very little during surgery -- they administer the anesthetic at the start, and possibly counteract it at the end of surgery. And yet, they are among the highest paid doctors, in one of the most stressful specialties. This is because anesthesia is hard, and if all doesn't go well, the anesthesiologist has only a tiny window in which to recover the patient.

So if the patient is under age in which we think the pain will be a traumatic memory, in some cases it's just good medicine to prefer temporary pain to anesthesia.
posted by orthogonality at 12:53 AM on March 15, 2010 [4 favorites]

In my peds clinical in nursing school, I held a 30-day-old infant in position for a spinal tap and administered "kiddie crack": sugar water on a passifier. That was 3 years ago.
posted by klarck at 2:13 AM on March 15, 2010

The capability of the human mind to accept certain beliefs even in the presence of overwhelming evidence to the contrary is truly amazing. I have been in the vicinity when an infant circumcision was done. A quiet, unsuspecting baby one moment, then an unholy shriek followed by intense and persistent crying. Who the hell could persist in assuring the mother that "he didn't feel any pain"? And what mother would believe it?
posted by megatherium at 3:34 AM on March 15, 2010 [3 favorites]

I'll believe that it's tricky to properly anaesthesize children, but any "in the dark 1970s, we believed children do not feel pain" explanations sound slightly crazy to me. I mean, I don't have a baby around to try on, but it seems pretty straightforward to establish that they react to being cut or poked with needles in pretty much the same way as older children.

There's a huge difference between the unbelievable original paragraph and orthogonality's probably correct "pain is felt, but not remembered".
posted by themel at 3:36 AM on March 15, 2010

Today there is a similar debate going on about when fetuses feel pain, because of the novel surgeries that can be done on the fetus in utero. (This might be a fruitful area for research into acceptance of anesthesia among children generally.) To hit on the ability of humans to believe crazy things, it is not unusual to find the same pro-life group that insists very tiny embryos feel pain when it comes to abortion procedures also insisting that 30-week-old fetuses DON'T feel pain when it comes to life-saving surgical procedures that doctors are hesitant to perform with anesthesia because of safety concerns.

People's willingness to accept facts is heavily colored by their political and other beliefs, including how heavily invested they are in the status quo.
posted by Eyebrows McGee at 3:58 AM on March 15, 2010 [2 favorites]

Megatherium, were you actually watching or merely in the vicinity? Because I've been at a number of circumcisions and what I usually notice is that the baby starts screaming when his nappy is removed, not when the circumcision actually takes place. And as klarck observed, they stop screaming when they're given a few drops of (very sweet) wine.
posted by Joe in Australia at 4:18 AM on March 15, 2010

I'll believe that it's tricky to properly anaesthesize children, but any "in the dark 1970s, we believed children do not feel pain" explanations sound slightly crazy to me.

All I can tell you is that that's what the doctors told my parents when my brother was born. It may be that in the dark 1970s, doctors lied to parents "for their own good," but they definitely told my parents that it was ok to cut my brother open without anesthesia because newborns don't feel pain. My mom says that they had an explanation for why babies scream as if feeling pain when they really weren't feeling pain. It didn't make any sense to her, but they were doctors and who was she to question?
posted by craichead at 4:25 AM on March 15, 2010 [2 favorites]

I underwent a no-anesthesia circumcision at age 3 in 1963.
posted by telstar at 4:26 AM on March 15, 2010 [1 favorite]

Also see:

He was already a seven year old when he witnessed his own circumcision - without anesthesia.
posted by telstar at 4:29 AM on March 15, 2010 [1 favorite]

"My mom says that they had an explanation for why babies scream as if feeling pain when they really weren't feeling pain. It didn't make any sense to her, but they were doctors and who was she to question?"

Generally the explanation was along the lines of, "Those are instinctive reactions to the sensation (even bacteria will move away if you poke it), but the child's brain isn't developed enough for him to FEEL pain the way an adult feels pain. They scream when poked for the same reason a bird flies south in the winter: It's an instinctual response that doesn't reach into the conscious brain." (We cover some of the history of this in my medical ethics class tangential to a case we cover; I don't have cites handy but this is the general gist of the materials we look at in class. Incidentally, it's also what Descartes and his contemporaries thought was going on when they were vivisecting dogs: No pain, just instinctive response to stimuli by a canine automaton.)

I would also point out that many scientists still won't cop to companion animals having emotions; our ideas about human development and human uniqueness are just so fraught because they're entirely about who WE are, so looking at children, animals, pregnant women, etc., is a hyper-emotional undertaking where careful observation is often confounded by our preconceptions and emotional needs.
posted by Eyebrows McGee at 4:59 AM on March 15, 2010 [4 favorites]

In addition to some of the beliefs expressed above, another belief that was widely held was that young infants might feel pain but would not remember it and therefor it would cause no long-lasting harm; this was contradicted by studies showing that following minor procedures (such as circumcisions) without anesthesia infants would show signs of stress (increased irritability, elevated heart rate and blood pressure, that sort of thing) around medical personnel for months or even years afterward.

The other issue is that some critically ill babies (and adults, for that matter) can be too medically unstable to tolerate the effects of anesthesia, which generally depresses the cardiovascular and respiratory systems. In those (nowadays very rare) cases the hope is that the patient who is already unconscious from shock and low blood pressure will not remember anything. If they become stable enough, of course, they are given a more typical anesthetic.

Pediatric anesthesia has a long history, though. One of the earliest recorded anesthetics (1842) was given to an eight year old boy. At the children's hospital where I work we routinely do major surgery with general anesthesia on critically ill premies who may weigh only 500 grams; we also usually don't even start IVs in the OR until the patient is asleep. Throughout the hospital various stratagems are employed to minimize the discomfort of even minor procedures, so the attitudes and beliefs you ask about are a thing of the past, at least among those who regularly care for children.

It is also worth mentioning that until the widespread adoption of anesthesia in the mid-1800's, everyone was operated on while awake, albeit often with some alcohol, opium, or other sedative/painkiller.
posted by TedW at 7:48 AM on March 15, 2010

Response by poster: Thanks everyone for the responses.
posted by stbalbach at 3:06 PM on March 15, 2010

the "icepick up the nose" lobotomy method was apparently invented as a more humane way of performing lobotomies on patients in state mental hospitals that didn't use/have the budget for anesthesia.

Eyes. They went in through the eyes. But not so much "humane" as "assembly-line fast".
posted by mendel at 8:13 PM on March 15, 2010