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CHILDREN?S SURGERY: WITH OR WITHOUT ANESTHESIA?
Dr. Fritz Berry specializes in pediatric anesthesiology at the Children’s Medical Center at the University of Virginia in Charlottesville.
“With new techniques,” says Dr. Berry, “we can anesthetize preemies as we do any patient with an unstable circulatory system. But there are doctors who do not feel secure about giving anesthesia to very sick preemies. Some fear that as soon as they do, these children will die.”
But the opposite may be true: Killing their pain may help these babies live. Dr. K. J. S. Anand, a researcher in the anesthesia department at Children’s Hospital in Boston, studied preemies who needed surgery to repair an artery near the heart.
Doctors gave one group of babies the muscle relaxant curare plus nitrous oxide (laughing gas), a mild anesthetic. The others received fentanyl, which puts the patient to sleep. Dr. Anand found that, following surgery, those given fentanyl had fewer problems with breathing and heart stability. His measurements of blood hormones showed clearly that, without full anesthesia, the babies experienced great stress and pain.
“I assume these babies feel pain,” says Dr. Swedlow, “and we try to give them an anesthetic – as much as we feel they can tolerate. We really have no way of knowing just how much is really safe and effective. It is better to survive and perhaps feel discomfort than die and not feel any discomfort.”
All of this leaves parents in a quandary. Debra Scharg of Oakland, California, an obstetric nurse, gave birth 3 months prematurely to Jacob Eli. He weighed 1 1/2 pounds and had a severe bowel infection. The Schargs say they gave permission to operate on the 18th day of Jacob’s life, on the condition that he be anesthetized. Jacob did not survive the surgery. The Schargs say they later found that medical records showed no evidence of Jacob having received painkillers.
“As it turned out,” Mrs. Scharg says, “our son was much too sick to go through the operation. We wished that the doctors had just let us hold Jacob to say good-bye to him. Instead, he died on the operating table in pain.”
Jill Lawson, determined to help other babies avoid Jeffrey’s fate, urges that parents discuss the issue with their pediatrician and the anesthesiologist, not the surgeon or assistant surgeon. It’s the anesthesiologist who makes the decision to give painkillers.
As of now, no laws compel a doctor to follow the wishes of an infant’s parents. If the doctor feels that anesthesia might impose too great a risk, he can order the drugs withheld. “Doctors need to spend more time talking to the parents,” says Dr. Berry. “We, too, are extremely concerned about the child.”
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