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Nizoral (Ketoconazole)

Nizoral (Ketoconazole)


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Nizoral (Ketoconazole)
INFANTS AND SURGERY WITHOUT ANESTHESIA
He looks so helpless, strapped to the tiny operating table. Premature, newborn, weighing less than 2 pounds, the infant has a severe heart malformation. Surrounding him, hunched over, masked doctors and nurses strive desperately to repair what nature forgot to do.
The surgeon’s scalpel cuts through skin and muscle and nerve. The infant emits a muffled cry. He has been given a muscle relaxant but no painkilling drug, no anesthetic. Why?
First, doctors have long argued that premature infants could not feel pain because their nervous systems had not fully formed. Second, confronted with a tiny, sick baby barely clinging to life, surgeons and anesthetists often fear that a pain-killing drug might endanger an already weak breathing system or stop a heart hardly able to beat.
Dr. David Swedlow, assistant professor of anesthesia at Children’s Hospital of Philadelphia, says, “The judgment call is whether you think this child can survive the anesthetic, balanced against whether the child will survive the pain.”
Concerned doctors and nurses estimate that physicians withhold anesthesia in half of all major surgery for prematurely born infants. Every year in this country, 200,000 preemies spend the first weeks, sometimes months, of their lives hospitalized in intensive care units.
But protests were mounting as parents like Jill Lawson of Silver Spring, Maryland, discovered that doctors have kept painkillers from their babies. Mrs. Lawson’s son, Jeffrey, was born in February 1985, 14 weeks premature and weighing less than 2 pounds, suffering from heart and lung problems. He underwent surgery.
“Jeffrey had holes cut on both sides of his neck,” Mrs. Lawson says. “Another hole was cut in his right chest, an incision was made from his breastbone around to his backbone, his ribs were pried apart, and an artery near his heart was tied off. He was totally conscious throughout IV2 hours of surgery.” Jeffrey died 5 weeks later.
When Mrs. Lawson learned that no anesthesia had numbed her child to the pain, she first felt agony, then fury, and, in the end, vowed to change this practice. She wrote letters to medical organizations and government agencies and finally “went public” in a newspaper story.
Doctors have struggled with the problem for years. It was discussed at a 1970 conference of anesthesiologists held in Palm Springs, California. There a doctor stated that preemies did not need anesthesia, just some adhesive tape to hold them down.
Dr. Richard J. Ward, then of the University of Washington School of Medicine in Seattle, was in the audience. He countered that comment angrily, saying, “May I just mention that in no animal laboratory in the world could you get away with anesthetizing a puppy with adhesive tape. Some of us feel that perhaps an infant is worth at least the same amount of care as a puppy.”
Parade has learned that Mrs. Law-son’s efforts and Dr. Ward’s biting comments have not gone unheeded. Through interviews, we found that many, but not all, anesthesiologists now make every effort to ease an infant’s agony.
*12/266/5*

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