4 ms·

My wife is a doctor and looked into the history of this for a bit more context. Apparently, there were some cases in 1987 where premature neonates were paralyse

My wife is a doctor and looked into the history of this for a bit more context. Apparently, there were some cases in 1987 where premature neonates were paralysed but not given general anaesthesia due to risk of immediate death. This led to a position statement from the paediatric society at the time that nobody should be operated on without pain relief / general anaesthetic. Note that this does not mean that general anaesthesia was not given at all to kids before 1987, but that there was a belief in the USA (and elsewhere) that newborns did not need pain relief during anaesthesia. Your use of 'kids' versus 'newborns' is a bit misleading in that respect.

holowoodman 1y ago
https://www.sciencedirect.com/science/article/pii/S1526590013000254 https://www.sciencedirect.com/science/article/pii/S152659001... > textbooks at the time taught that [open heart] surgery [...] ‘‘could be safely accomplished with only oxygen and a paralytic’’ 69(p.580) when performed on infants. Textbooks isn't "some doctors errorneously believed", it is what most doctors believed, taught and practiced. > infant surgery routinely conducted with no or minimal anesthesia well into the 1980s "Routinely" isn't a few isolated cases, that's the word for "this is the usual thing to do". https://pubmed.ncbi.nlm.nih.gov/20608214/ https://pubmed.ncbi.nlm.nih.gov/20608214/ > The study by McGraw (1941), although badly designed, convinced the vast majority of clinicians that infants do not feel pain and do not require analgesia. This theory, reinforced by the fear of using opioids in young children, dominated medical thinking for more than 30 years. "Vast majority" and "dominated" also doesn't sound like just "some cases". https://www.nytimes.com/1987/12/17/opinion/l-why-infant-surgery-without-anesthesia-went-unchallenged-832387.html https://www.nytimes.com/1987/12/17/opinion/l-why-infant-surg... > surveys of medical professionals indicate that as recently as 1986 infants as old as 15 months were receiving no anesthesia during surgery at most American hospitals. We can discuss the definition of "kid" and "newborn", but I would no longer call them "newborn" when they start walking. Also "most American hospitals" means the practice was very widespread even in 1986. I think the whole situation is one of the medical community failing to recognize and admit their own mistakes. Instead, the obvious barbarism of the whole situation is played down, diminished and belittled. Thereby protecting their own feelings and standing at the cost of the victims' right to the truth. And thereby paving the way for a repetition of such gruesome mistakes. At which point I would argue, it might even be a little callousness or even intent...
- quantumwoke 1y ago
  I think there is a definitional problem with "kids" vs "infants" vs "newborns" which are all difficult to define, the type of anaesthesia that was administered and we are also talking about 40 years ago. Our understanding of anaesthetics and heart surgery in newborns was much different than today. America definitely has a checkered and sordid past here and in psychiatry. But we also have a duty to be definitionally exact here which is why I tried to get a bit more context when the GP used the term "kids". I had thought before investigating that meant all the way up to teenagers.
  - holowoodman 1y ago
    I admit that "kids" is a bit imprecise and can lead to misunderstandings. But that is just not important to this discussion. And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else. If you feel adventurous, have your family doctor give you a paralytic and then push a sterile needle under your fingernail. Then tell me the exact definition of sufficient anesthesia in that case ;)
    - rscho 1y ago
      > And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else. To my knowledge, this was only true for newborns. Infants and up usually got some sort of hypnotic.
- serial_dev 1y ago
  I don’t know where the truth lies, but even if everything you wrote is true (and it does sound reasonable to me), not giving anesthesia might still be a safer choice considering the side effects. Not saying it is, only saying that we need to take a look at the side effects and risks, and all other (at a time) available information before we call them barbarians.
  - holowoodman 1y ago
    At some point in adult medicine, it was recognized that using an analgesic during surgery, in addition to the then normal combination of paralytic and hypnotic, significantly increased survival rates. This fact was independent of the patients capacity to remember the pain and wasn't any kind of psychological response like PTSD. It was the basal reaction to injury and pain by stress that killed those patients. The exact same reaction kills non-adults. The proof took longer, but it is there now. That doctors even needed proof instead of, without further experimental knowledge, assuming the null hypothesis of children being small adults in this case already is proof of a kind of chauvinistic barbarism. Infants were some kind of lesser human to them, thus couldn't react in the same way as adults. Remember, the norm was _no_ analgesia, _no_ pain relief. For the majority of infants. Its not that they decided on a case by case basis on the right balance of analgesia vs. risk. They decided as a matter of course that analgesia was superfluous for infants.

holowoodman 1y ago

https://www.sciencedirect.com/science/article/pii/S1526590013000254 https://www.sciencedirect.com/science/article/pii/S152659001... > textbooks at the time taught that [open heart] surgery [...] ‘‘could be safely accomplished with only oxygen and a paralytic’’ 69(p.580) when performed on infants. Textbooks isn't "some doctors errorneously believed", it is what most doctors believed, taught and practiced. > infant surgery routinely conducted with no or minimal anesthesia well into the 1980s "Routinely" isn't a few isolated cases, that's the word for "this is the usual thing to do". https://pubmed.ncbi.nlm.nih.gov/20608214/ https://pubmed.ncbi.nlm.nih.gov/20608214/ > The study by McGraw (1941), although badly designed, convinced the vast majority of clinicians that infants do not feel pain and do not require analgesia. This theory, reinforced by the fear of using opioids in young children, dominated medical thinking for more than 30 years. "Vast majority" and "dominated" also doesn't sound like just "some cases". https://www.nytimes.com/1987/12/17/opinion/l-why-infant-surgery-without-anesthesia-went-unchallenged-832387.html https://www.nytimes.com/1987/12/17/opinion/l-why-infant-surg... > surveys of medical professionals indicate that as recently as 1986 infants as old as 15 months were receiving no anesthesia during surgery at most American hospitals. We can discuss the definition of "kid" and "newborn", but I would no longer call them "newborn" when they start walking. Also "most American hospitals" means the practice was very widespread even in 1986. I think the whole situation is one of the medical community failing to recognize and admit their own mistakes. Instead, the obvious barbarism of the whole situation is played down, diminished and belittled. Thereby protecting their own feelings and standing at the cost of the victims' right to the truth. And thereby paving the way for a repetition of such gruesome mistakes. At which point I would argue, it might even be a little callousness or even intent...

quantumwoke 1y ago
I think there is a definitional problem with "kids" vs "infants" vs "newborns" which are all difficult to define, the type of anaesthesia that was administered and we are also talking about 40 years ago. Our understanding of anaesthetics and heart surgery in newborns was much different than today. America definitely has a checkered and sordid past here and in psychiatry. But we also have a duty to be definitionally exact here which is why I tried to get a bit more context when the GP used the term "kids". I had thought before investigating that meant all the way up to teenagers.
- holowoodman 1y ago
  I admit that "kids" is a bit imprecise and can lead to misunderstandings. But that is just not important to this discussion. And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else. If you feel adventurous, have your family doctor give you a paralytic and then push a sterile needle under your fingernail. Then tell me the exact definition of sufficient anesthesia in that case ;)
  - rscho 1y ago
    > And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else. To my knowledge, this was only true for newborns. Infants and up usually got some sort of hypnotic.
serial_dev 1y ago
I don’t know where the truth lies, but even if everything you wrote is true (and it does sound reasonable to me), not giving anesthesia might still be a safer choice considering the side effects. Not saying it is, only saying that we need to take a look at the side effects and risks, and all other (at a time) available information before we call them barbarians.
- holowoodman 1y ago
  At some point in adult medicine, it was recognized that using an analgesic during surgery, in addition to the then normal combination of paralytic and hypnotic, significantly increased survival rates. This fact was independent of the patients capacity to remember the pain and wasn't any kind of psychological response like PTSD. It was the basal reaction to injury and pain by stress that killed those patients. The exact same reaction kills non-adults. The proof took longer, but it is there now. That doctors even needed proof instead of, without further experimental knowledge, assuming the null hypothesis of children being small adults in this case already is proof of a kind of chauvinistic barbarism. Infants were some kind of lesser human to them, thus couldn't react in the same way as adults. Remember, the norm was _no_ analgesia, _no_ pain relief. For the majority of infants. Its not that they decided on a case by case basis on the right balance of analgesia vs. risk. They decided as a matter of course that analgesia was superfluous for infants.