The story behind the use of anesthesia in premature babies

Recently, a heated debate started on Twitter about the use of anesthesia in babies. A user of this social network assured that until recently newborns were not anesthetized, as it is considered that they neither feel nor suffer. Numerous health professionals They came out to answer him denying that this is the case and, as often happens in the bird network, the controversy did not take long to ignite.

In fact, they were all partly right. If necessary, babies today they are operated under anesthesia general, even without son premature. However, until a little over 30 years ago, these last ones could only receive a mixture of what is known as laughing gas and muscle relaxants. The reason was not that it was thought that they did not feel, although it is true that years ago that theory existed. The truth is that it was done for their good, since the anesthetics used in the past could have been lethal for such fragile patients like them.

But, to better understand this, it is necessary to take a quick trip to the past and walk along a timeline in which the conception of the use of different types of anesthesia in infants lurched back and forth from one stream of thought to another for years.

Anesthesia in babies: a journey through the past

In 1656, the Swiss pediatric surgeon Felix wurtz threw out the idea that babies, especially premature babies, should be much more sensitive to pain. He did so in his work The Children’s Book, in which these ramblings can be read:

If new skin in older people is tender, what do you think of a newborn baby? If something as small as a finger hurts so much, how painful the torment in his whole body must be for a child.

Felix Wurtz, Pediatric Surgeon

This theory led to special care being taken with babies, from then until mid 19th century. At this time, those statements were supported by those of the English Michael Underwood, known for being the discoverer of a multitude of pediatric diseases. This doctor claimed that the babies’ nervous system was “very irritable” and that, therefore, they would be more sensitive to pain.

However, shortly after this trend of thought took a 180ยบ turn when the German neuroanatomist Paul Flechsig exposed that the nerves of premature babies were less myelinated. Myelin is a covering that not only protects nerves, it also helps signals to pass through them. Therefore, if this layer was incomplete, painful stimuli could not be transmitted correctly. But it was not only considered that babies would be less sensitive to pain. It was also held that they were unable to recall painful experiences. I mean, it could be that it did hurt, but they would never remember it.

This, together with the use of anesthesia in premature babies had a very high risk of complications, led to other options being considered.

Alternatives to anesthesia and types of sedation

The most common alternatives to anesthesia in babies were chloroform, cyclopropane and ether.

Its use in premature infants became the most widespread, until, already in the twentieth century, the Canadian Charles Robson became the first pediatric anesthetist, describing techniques to use this measure with all possible guarantees.

Liverpool’s technique is aimed at calming pain and causing a state of amnesia

Many surgeons of the time opposed his proposals until the middle solution arrived. It was described in the 1950s by the surgeon Gordon Jackson-Rees. His procedure, baptized as liverpool technique, consisted of using as a substitute for general anesthesia in babies a combination of curare and nitrous oxide. The first is a muscle relaxant and the second, better known as laughing gas, is used as a pain reliever. In addition, it causes a state of amnesia that could help forget traumatic situations. It is precisely for this reason that it has been used for years in dental practices, especially to treat patients with fear of this type of intervention.

Despite everything, many doctors opposed the use of this technique, alleging mistreatment of newborns. For this reason, until the 1980s it became a personal decision of the specialist.

A change in procedure

The last premature babies to undergo the Liverpool technique were Edward Harrison and Jeffrey Lawson. The first was intervened in 1986 to drain the fluid that was causing hydrocephalus from his skull. The second was operated on in 1987, due to cardiac complications after his birth. In both cases, their parents were told that anesthesia in premature babies could be fatal, especially if their heart was damaged, as in Jeffrey’s case. Therefore, curare was administered. They both died, possibly more due to his pathologies than the lack of anesthesia, although especially with the second it was proposed that he could have suffered a shock due to the pain.

In any case, at that time the theory that children could feel pain from the moment of birth was much more widely accepted. The use of the Liverpool technique was considered unethical and, fortunately, less dangerous types of anesthesia were already available. In addition, there was the option of monitor procedures to detect any cardiorespiratory complications early.

As a result, the American Academy of Pediatrics issued a statement stating that “anesthesia in infants is indicated according to the usual guidelines for the administration of anesthesia to high-risk and potentially unstable patients.”

Untreated pain can be very damaging to a developing nervous system, like that of premature babies

These last cases occurred in United Kingdom and United States. Other countries, such as Spain, had abandoned the Liverpool technique long before.

To this day, it is considered that the use of anesthesia in babies is necessary to comply with the principle of beneficence of bioethics, which requires avoiding harm to patients. In this case, your physical pain. It is known that untreated pain can be very harmful to a developing nervous system, like that of premature babies. For this reason, in recent decades no one has been operated on without anesthesia.

Anyway, without a day it was done, it was not because of a trivialization of the lack of memories. Actually, the intentions were good, because with that they tried to save their lives. The history of medicine is like this. Many mistakes have been made; but, with exceptions, they have generally always been with the best of intentions.