[Circumcision in children: an organizational or an ethical challenge?]

To review society, ethical and anaesthesiological issues related to circumcision in children.

Review.

Pubmed search and expert opinion

Circumcision concerns 30 of male world population. Reasons are ritual, medical and hygienic. In Muslims, circumcision is usual performed before the age of six. Surgery is performed at best under sevoflurane general anaesthesia and a penile bloc. Level 1 and level 2 antalgics are used for 72 hours, once the bloc has elapsed. In Jews, circumcision is performed soon after birth, in the community. Emla is the most convenient antalgics in this case. Except in case of emergency, circumcision under general anaesthesia should be delayed after 3 months as general anaesthesia is suspect to exert cerebral toxicity. Before the age of one year, there is a risk of increased respiratory problems following general anesthesia. Therefore, circumcision under general anaesthesia should be performed after one year of age. Circumcision may represent an adjunct to limit AIDS transmission in endemic countries.

The ethical point associated with circumcision is to allow best analgesia, in a way matching child's age. Analgesia, is achievable by both the surgeon and the anesthesiologist.