Is circumcision performed on babies using anesthetics?

Scientific working group for pediatric anesthesia of the DGAI

Dear parents,

Your child is going to have an operation or diagnostic procedure under general anesthesia. Concern for your child's health and possible complications of the procedure can be a particular burden for the family. Everyone who looks after your child therefore endeavors to keep these burdens as low as possible.
In the following, we want to try to explain the meaning and the process of anesthesia for your child by answering frequently asked questions.

Why does my child need anesthesia?
The anesthesia ensures that your child sleeps peacefully and is not in pain during an examination or surgery. Depending on the age and state of health of your child as well as the planned procedure, various anesthetic procedures can be used (see below).

How does anesthesia work?
1. Anesthesia (general anesthesia)
With general anesthesia, your child will sleep very deeply. For this purpose, a combination of anesthetic gas and / or anesthetic medication is usually administered. The anesthesia can be initiated through a breathing mask with anesthetic gas, which smells quite pleasant and hardly disturbs your child when falling asleep. Anesthesia can also be initiated by injecting anesthetic medication via a drip (infusion) that is placed before the start of anesthesia. This does not usually hurt, as the puncture site is made insensitive to pain with an anesthetic plaster (EMLA plaster).

2. "Twilight sleep" (sedation)
For some non-painful examinations, such as magnetic resonance imaging (MRI), your child has to lie completely still for a long period of time. Depending on the age of the child, sedation (“twilight sleep”) is usually required for this. Your child will sleep during the examination and will usually wake up very quickly afterwards. Sedation (“twilight sleep”) usually takes place with medication via a drip (infusion).

3. "Local anesthesia" (local or regional anesthesia)
In these procedures, pain is eliminated using a local anesthetic (local anesthetic), which is injected into the vicinity of one or more nerves and thus blocks the transmission of pain. Since children do not keep still when applying these anesthetic methods and do not lie still during the operations, local anesthetic methods are almost always combined with anesthesia or sedation (see above). The local anesthetic procedure ensures that your child remains pain-free during the procedure and that the required amount of anesthetic medication can usually be significantly reduced. The local / regional anesthesia usually lasts for several hours, so that your child hardly has any pain after the operation (see below).

Outpatient anesthesia - when does it make sense?
Many interventions in children can be carried out on an outpatient basis, i.e. without an overnight stay in the clinic. Children can quickly return to their familiar surroundings and unnecessary hospital stays are avoided.
The decision on whether this is also possible for your child is made by the surgeon and anesthetist together. The safety of your child is our top priority. After surgery performed on an outpatient basis, your child remains in the hospital for a few hours for observation. In order for it to be discharged, it must be largely pain-free and comfortable. After discharge, your child must remain under supervision for the rest of the day and must not actively participate in road traffic during this time.
Upon discharge, you will receive a leaflet from your anesthetist with the most important recommendations for behavior and contact persons / telephone numbers. Should problems arise, you can reach us by phone at any time of the day or night.

Who will perform the anesthesia on my child?
Your anesthetist (anesthetist) will discuss all the details of the anesthesia with you in peace. He / she will introduce you to all possible anesthesia procedures and work with you to choose the best concept for your child. During this informative discussion, it is very important that you provide the anesthetist with all the important information about previous illnesses, previous treatments and the current state of your child's health. At the end of the consultation, you will be asked to confirm your consent to anesthesia for your child with your signature.

During the operation, the anesthetist and an anesthetist will take care of your child and ensure that they wake up safely and painlessly from the anesthesia.

Pain after an operation - does it have to be?
Your anesthetist will discuss the details of pain treatment with you during the pre-operation consultation. Unfortunately, pain after an operation cannot always be completely avoided. In order to keep the pain as low as possible, your child will be given pain relievers as a preventive measure. If more pain occurs after the operation, further medication (in the form of infusions, suppositories or juice) will be administered in the recovery room or on the children's intensive care unit until your child is almost pain-free. Whenever possible, local anesthetic procedures are also used during the anesthesia, which also have an analgesic effect for several hours after the operation.

How long before an operation can my child drink and eat? When can they drink and eat again after an operation?
For safety reasons, your child must fast before the operation. Your anesthetist will tell you the exact fasting times. In general, the following rule applies: all children can drink clear liquids (water, tea, clear juices / juice spritzer) up to 2 hours before induction of anesthesia. Newborns and infants may be breast-fed or bottle-fed up to 4 hours before induction. Children over 1 year of age can eat solid food up to 6 hours before the start of anesthesia. It is recommended to only have a light meal before an operation (e.g. white bread, yoghurt, no fatty foods).

Is anesthesia dangerous? Will the anesthesia harm my child? What if you have to do anesthesia repeatedly over a shorter period of time?
Nowadays anesthesia is very safe: modern anesthetics are well tolerated and are quickly metabolized by the body, so that your child can quickly get back on its feet. Nevertheless, depending on the size of the procedure and the condition of the child, there is a low probability of complications and health risks. For this reason, the anesthetist is always with your child during the procedure to monitor the anesthesia and, if necessary, to prevent complications. The modern monitoring techniques and the experience of your pediatric anesthetist make a decisive contribution to the fact that any problems can be recognized early and quickly eliminated. Your anesthetist will explain the specific risks of individual anesthesia procedures to you in detail.

Nausea and vomiting may occur more or less frequently in children after an operation, depending on the age and the type of procedure. Because of this, many children are already receiving preventive medication. Cough, hoarseness or difficulty swallowing after an operation usually subside after a few hours. Occasionally, small bruises may appear at the site of infusion cannulas or catheters. Severe allergic reactions to drugs are very rare.

Parents are often very concerned when their child needs more than one anesthetic in less time. However, there is currently no reliable evidence that children are harmed by repeated anesthesia. Competent, child-friendly treatment and an environment in order to prevent possible trauma appear important, especially in the case of repetitive hospital stays.