Neonatal surgery without anaesthesia

In 1986, the world was shocked when reports of infants undergoing major surgery with out anesthesia arose in both the USA and UK. In the USA, mothers of two premature infants wrote letters to the medical journal, BIRTH, protesting the “barbarism of surgery without anesthesia.”..

Why did infants not receive anesthesia that was comparable to that received by an adult? In the following years, numerous books and articles were written on the subject . A survey of such literature reveals that the two repeatedly cited reasons were: 1. Infants do not have the capacity to perceive pain. 2. It is too risky to use potent anesthetics on infants, given the risk for cardiorespiratory compromise and death...

The 19th century surgeon was rough, having inherited an attitude of indifference to pain from the days predating anesthesia. It was said that the role of a surgeon was to preserve life and not to prevent the temporary pain of the experience. As such, the use of anesthesia was originally restricted to those considered sensitive, primarily the rich, white and educated women and children...

...one of the two consistently cited reasons for the withholding of anesthesia from neonates was the belief that infants are insensitive to pain. When the American Academy of Pediatrics released its statement on neonatal anesthesia in 1987, it cited the commonly taught rationale that “nerve pathways [in neonates] are not sufficiently myelinated to transmit painful stimuli or that neonates do not have sufficiently integrated cortical function to recall painful experiences... 

Continue reading at this submission to the Osler Student Essay Contest.