Do they think the nervous system is "turned off" in kids and "turns on" later? Likewise with the formation of memories. A human consciousness that is dealt searing pain under paralysis for an eon of thought-time, might trigger a life long psychosis that impairs living and learning.
Or a thirst for revenge.
Do we already measure EEG for adults? Or not? If we do, why has it taken so long to do with kids? If not, is this a first step? Why start with kids rather than adults?
This article provides shockingly little context.
There are a lot of not backed by science beliefs in the medical field that won't die until the doctors that believe them do.
So with this kind of practice, you create any patient's worst nightmare: being cut open, feeling everything, knowing everything, but unable to stop it. And you are unknowing, uncaring or too cheap to prevent that e.g. via EEG monitoring.
Edit: Parent removed his comment. Roughly, from memory, there was some claim by him about being a professional anesthetist, having very rarely encountered EEG and only bi-spectral index monitoring (an EEG-derived computed measurement) in some IV cases, some claims about the unreliability of both and about the preference for MAC (minimum alveolar concentration) to monitor depth of anesthesia.
https://www.nejm.org/doi/full/10.1056/NEJMoa0707361
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>Awareness during anesthesia: how sure can we be that the patient is sleeping indeed? (2009)
https://pmc.ncbi.nlm.nih.gov/articles/PMC2683150/
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>Awake Under Anesthesia (2018)
https://www.newyorker.com/books/page-turner/are-we-all-awake...
........................................ >Single-trial classification of awareness state during anesthesia by measuring critical dynamics of global brain activity (2019)
https://www.nature.com/articles/s41598-019-41345-4
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>Intraoperative and Anesthesia Awareness (2023)
> The minimum alveolar concentration (MAC) is the minimum concentration of an inhaled anesthetic at 1 atm of pressure that prevents skeletal muscle movement in response to a surgical incision in 50% of patients.
So first, you do not measure the depth of anesthesia, you measure the concentration of the anesthetic. Second, you judge this concentration by the prevention of muscle movement. Called paralysis.
Please tell me you are not really a doctor.
[0] https://www.sciencedirect.com/topics/medicine-and-dentistry/...
Edit: In case you are wondering why this response doesn't really fit the parent comment, the parent saw fit to completely replace his comment without an indication that he did so. Originally there was a claim in the parent comment about "MAC being the primary indication of anesthetic depth being the textbook definition" or something to that effect. To which I responded. I guess I must have hit a nerve there ;)
How so?
> children sometimes wake up from anesthesia with a set of side effects including lack of eye contact, inconsolability, unawareness of surroundings, restlessness, and non-purposeful movements
In general, a very simple mental model for general anesthesia is that it's an unnatural state for your body and your body will do its best to get rid of it, similar to say alcohol or drugs. This means systemic inflammation, stress on your cardiovascular system, liver and kidneys, brain, and so forth. Most all of these issues scale with how much anesthetic you receive, similar to a hangover being worse the more you drink.
In other words, general anesthesia is rough on you just like getting black out drunk is, it's just more controlled and we do our best to try and limit the downsides because it's invaluable for surgery where applicable.
Can confirm having watched our kids recover from general anesthesia multiple times.
Full disclosure: have three kids, eldest child at lifetime total of 4x general anesthesia so far (1x for endoscopy, 3x for surgery), youngest child lifetime total of two (1x endoscopy, 1x dental work). Middle child seems to have escaped so far... he asked recently what it was like, siblings answered unanimously - "terrible".
I had a general anesthesia at 21 for dental surgery. The come back was a nightmare: nausea, shaking, cold and hot alternating, terrible headache, cramps, exhausted and mentally depressed during ~2 days. I couldn't eat, I couldn't drink (but brute force myself to do it), I couldn't think or concentrate on anything but the pain. The only close experience I can remember is the wake up after a blackout hangover but it really wasn't that bad compare to the anesthesia.
6 years later a car crash required artificial coma during 3 days. They drug me along the week following my come back. The dreams during the last day of coma and that week took me through fascinating and terrifying experiences half real (intubation, interactions with family and medics...) and imaginary (ever-repeting-same-day, interns having a fireplace in the ICU floor with guitars, mind-controlled bed to move around the room...). They finally gradually stop the drug and I was only a bit angry and physically suffering from my injuries but not that bad.
Big up to the amazing Royal Perth Hospital team for that amazing care. They saved my life and made the process a confortable trip.
I always wonder what was that drug that produce so weird half-wake dreams with not much side effects. And why they don't always use that for dental surgery and everything else. I heard hypnosis can work instead of a classical general anesthesia and am keen to try if the funny Australian drug isn't an option. Everything but not the general anesthesia.
edit: wonder if both experiences could have been the same sedative drug but the second had a hypnotic wake-up parachute drug during the comeback.
I’m sure everyone’s experience is different, but it made me feel groggy in a way that was difficult to bounce back from.
This was state of the art in medicine for quite some time. I fear the general trend of "medication bad" will get us back to those dark times.
Btw, those dark times ended only as recently as 1987! https://www.newsweek.com/when-doctors-start-using-anesthesia...
Modern technology and medicine in particular have made our lives better and longer in ways our near ancestors could not have dreamed of or hoped for.
It's not hard to find counterexamples of course: opioid addiction, climate change, etc. But on balance we're a hellava lot better off now than 50 or 500 years ago.
Nice to use a bit less anesthesia for faster/better recovery and money savings. But for goodness sake - let's not go TOO far down that path.
I think the rest of what you're saying is fairly accurate, though.
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.
> 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/
> 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-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...
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.
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 ;)
Let me preempt one possible line here: I do not love the circumstances under which I would have been circumcised as a neonate in Mississippi in the very early 1980s, and I do not resent the result. Living that far tied up in the past is for men who can't figure out how to do anything else. I am not one of those and despite an essential sympathy with the theoretical basis of their position that no putative benefit remotely justifies the the risk of the intervention, I have a short way with "intactivists."
But if it had been possible safely to administer more than EMLA (perhaps!) for pain relief, not even in that place and time would anyone be so barbaric as to refuse it. Of course. And that, making possible that precise measure of mercy in the case where the intervention is not merely cosmetic, is exactly that at which this research is directed. So, to anyone looking to make a cause of the ghosts of a billion foreskins or whatever, I would say please do not attempt even by implication to recruit my argument in support of your position.
They did major surgery. Like opening the cranium or abdomen. Like removing limbs. Like removing burnt skin by brushing it off and applying skin grafts. And no, they didn't even apply Lidocain, because children don't feel pain. At best, they gave muscle relaxants as chemical restraints and to make the tissue easier to cut.
What I meant is, it is "minor" as far as surgery goes, as opposed to "major". The distinction is about the risk to the life of the patient, the kind of anesthesia you need (local vs knockout), the setting you do it in (walk-in vs stay at the hospital) and the amount of aftercare required (change the bandage vs. medication+monitoring+hospital).
And those studies are BS, done to prove a preexisting point. Any properly done study by independent researchers without an agenda doesn't show any kind of effect from circumcision beyond the resulting sensory problems, deformation, nerve damage, erectile dysfunction, scarring and adhesion.
For example there is stuff like Ketamine, which in some cases can live up to its other use as a recreational drug and give the patient very colorful dreams. There are sedatives that just take away the capacity to form memories, but leave you awake and aware, just calmer. In cases like some knee surgeries, it is possible to leave the patient fully awake, just paralyze and numb the legs.
Apparently I had a small anesthetic overdose in the hospital as a kid and woke up a day or two later than expected, but from my perspective, nothing happened and I just went to sleep then woke up.