Local Anesthesia for Neonatal Circumcision: Effects on Distress and Cortisol Response

Stang, Howard J.; Gunnar, Megan R.; Snellman, Leonard W.; Condon, Lawrence D.; Kestenbaum, Roberta

doi:10.1097/00006254-198810000-00013

Cited by 10 publications

(21 citation statements)

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“…Anesthesia has been shown to decrease the cortisol response to surgical stress. 17,31 All of our infants in this report received some sedatives or analgesics. Dosages used were the usual recommended dosages (fentanyl, 1 to 2 g/kg per hour; lorazepam, 0.1 to 0.2 mg/kg per dose; diazepam, 0.1 to 0.2 mg/kg per dose; or phenobarbital, 5 mg/kg per day).…”

Section: Discussionmentioning

confidence: 77%

“…The mean serum cortisol level of 11 ill term newborns in one study was 13.4 g/dl. 5 Mean cortisol levels after circumcision were between 17.2 and 19.3 g/dl 17,18 and mean serum cortisol levels after cardiac surgery was 22.3 g/dl. 19 Infants in this study were exposed to multiple physical stress such as intubation, mechanical ventilation, respiratory distress, and multiple intravenous catheterization and in one case, surgery.…”

Section: Discussionmentioning

confidence: 99%

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Low Serum Cortisol in Term Newborns With Refractory Hypotension

et al. 1999

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OBJECTIVES:The aim of this study is to measure baseline serum cortisol levels and clinical response to glucocorticoid therapy in a group of term infants with refractory hypotension. STUDY DESIGN:Seven term newborns with refractory hypotension were included. Serum cortisol levels were drawn before initiation of glucocorticoid therapy and measured by either fluorescence polarization immunoassay or radioimmunoassay. Baseline blood pressures, heart rate, and inotropes doses were recorded at baseline, then 4,8,12,24, 48, 72, and 96 hours after glucocorticoid therapy. Urine output and volume expanders the infants received were recorded 24 hours before and after glucocorticoid therapy. Dexamethasone was used at a starting dose of 0.2 mg/kg per day divided every 12 hours. The statistical analysis was done using analysis of variance with repeated measures and paired t-test. RESULTS:Serum cortisol levels of the infants ranged from 2.0 to 15.4 g/dl. After initiation of glucocorticoid therapy, there was significant improvement of blood pressure. Vasopressors were rapidly weaned and discontinued within 72 hours. In three of seven infants, no volume expanders were required after initiation of steroids, and none needed volume expanders after 2 days. Urine output increased significantly within 24 hours. All infants survived. CONCLUSIONS:Glucocorticoids improved pressure and stabilized clinical conditions of a group of term newborns with refractory hypotension. Serum cortisol levels of these infants were relatively low. We speculate that a subset of critically ill term infants has relative adrenal insufficiency and glucocorticoid therapy may be essential.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Low Serum Cortisol in Term Newborns With Refractory Hypotension

et al. 1999

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“…The DPNB technique has been described since 1978 in multiple papers. 25,[33][34][35] The technique is very similar to a digital block used in finger trauma and is easily taught to established practitioners 5,36 as well as to residents. 23 When used in conjunction with DPNB, a more comfortable restraint chair and oral sucrose was found recently to decrease the distress of the circumcision.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] The American Academy of Pediatricians (AAP) has endorsed the use of anesthesia for neonatal procedures by stating that "local or systemic pharmacologic agents now available permit safe administration of anesthesia or analgesia to neonates undergoing surgical procedures . .…”

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confidence: 99%

Circumcision Practice Patterns in the United States

Stang

Snellman

1998

Pediatrics

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ABSTRACT. Objective. To determine 1) the performing of circumcision by medical specialty, gender, and years of practice; 2) the pattern of anesthetic use for this procedure; and 3) the reasons physicians cite for not using anesthesia.Design. A total of 3066 questionnaires were received from a mailing to a representative sampling of physicians stratified by specialty and geographic location.Results. Fifty-eight percent (1768) of the questionnaires were returned and interpretable from the following specialists: pediatricians (PEDs), 73% (n ‫؍‬ 691); family practitioners (FPs), 52% (n ‫؍‬ 464); and obstetricians (OBs), 51% (n ‫؍‬ 623).Of the respondents, 956 (54%) perform at least one circumcision per month (35% of PEDs; 60% of FPs; 70% of OBs). Of the physicians performing circumcisions, 45% use anesthesia (71% of PEDs; 56% of FPs; 25% of OBs). Of physicians using anesthesia, 85% use dorsal penile nerve block.A significantly higher percentage of male physicians (57%) are performing circumcisions than are females (45%), but there was no difference in the percent using anesthesia. Recently trained PEDs and FPs were more likely to use anesthetics than were their older colleagues, but OB use of pain relief was independent of their practice longevity. Physicians in the western states were significantly more likely to use anesthesia than were other physicians from the rest of the United States.Respondents who did not use anesthesia cited "concern over adverse drug effects" (54%) followed by "procedure does not warrant anesthesia" (44%) as the most common explanations.Conclusions. A substantial number of PEDs are performing circumcisions, and they are most likely to use anesthesia (71%), followed by FPs (56%), then OBs (25%). With recent recognition of the importance of pain reduction in neonatal procedures and the lack of substantiated contraindications to newborn anesthetic use, additional education of current practitioners, residents, and parents is required to increase the use of anesthesia for circumcision. Pediatrics 1998;101(6). URL: http://www. pediatrics.org/cgi/content/full/101/6/e5; circumcision, anesthesia for neonatal circumcision.ABBREVIATIONS. AAP, American Academy of Pediatrics; DPNB, dorsal penile nerve block; EMLA, eutectic mixture of local anesthetics; OB, obstetrician; FP, family practitioner; PED, pediatrician.

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“…Topical anesthesia cannot fully protect an infant from substantial pain when circumcised [19,20], while general anesthetics must be avoided due to high risks [21]. [23].…”

Section: Benefit Versus Risk Of Harm Is the Correct Standardmentioning

confidence: 99%

Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury

2017

AMA Journal of Ethics

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Local Anesthesia for Neonatal Circumcision: Effects on Distress and Cortisol Response

Cited by 10 publications

References 0 publications

Low Serum Cortisol in Term Newborns With Refractory Hypotension

Low Serum Cortisol in Term Newborns With Refractory Hypotension

Circumcision Practice Patterns in the United States

Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury

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