Circumcision Under Sedation
Children (5-15 years)
Adult (>16 years)
At Circumcision Pro we are the only dedicated Circumcision Clinic in London able to offer circumcision under sedation for children, older boys and adults. This is a fantastic and exclusive service that makes the process of circumcision so much easier and less nerve racking for both the patients and their families.
1st Circumcision Clinic in the UK to offer sedation
As far as we know, Circumcision Pro is the first dedicated Circumcision Clinic in the UK offering IV sedation for children and adults. Our speciality is dealing with cases which would otherwise be referred for a general anaesthetic. General Anaesthetic is much more expensive, restricted to NHS hospitals or large private hospitals, and most importantly can be associated with increased risk. Sedation is often a much safer and cheaper alternative to a general anaesthetic when it comes to minor surgical procedures such as a circumcision and can safely be carried out in a CQC registered private clinic such as ours.
Our Sedation Service is being led by Dr Rudi Swart, who has many years of experience performing sedation in all ages. For children he has carried out more than 10,000 cases. He has performed more than 20,000 cases in total. The surgical side is being led by Dr Ruhul Amin – Clinical Lead & Medical Director for Circumcision Pro – who has performed nearly 9000 Circumcisions to date. Dr Amin has been performing circumcisions since 2009. His complication rates are extremely low. Dr Amin can carry out male circumcision in all age groups from newborns right through to adults.
Why consider sedation for circumcision?
In the UK there are only a handful of reputable Circumcision Clinics. In all these clinics procedures are carried out under local anaesthetic. This means you are fully awake during the procedure but comfortable. However, the process of administering the local anaesthetic is normally uncomfortable and many find this process difficult especially if they are already very anxious. This is especially the case for children and teenagers as well as adults. Although many are absolutely fine having their circumcision under local anaesthetic alone, the option of sedation makes the whole process so much easier.
Sedation is when medication is given to help someone feel more relaxed and comfortable during a surgical or dental procedure. The medications that can be given vary in terms of what they are and how they are given. Sedation medication can be given orally, as an intramuscular injection or through the vein also known as intravenous (IV) sedation.
Oral sedation can help to relax you. It takes at least 20 to 30 minutes to have an effect. Following oral sedation you will still be awake and relatively alert during the procedure but slightly less anxious. Sometimes oral sedation can make you slightly drowsy but still very aware of what is happening around you. The effects of oral sedation can last for a couple of hours but generally wears off quite quickly.
When sedation is carried out for minor dental and surgical procedures it is most often administered through the vein – IV. The effects of IV sedation are much faster than oral sedation and usually means you will be very drowsy and unaware of the procedure being carried out. Pain medication is also administered at the same time. With IV sedation you will be asleep but easily arousable during the procedure. There is a dedicated doctor – Sedationist – looking after you whilst the surgeon carries out your procedure and will ensure that your breathing and oxygen levels are monitored throughout.
Afterwards you will have little recollection of the procedure. At the end of the procedure you will be awake and able to walk out. However, the aftereffects of sedation can last for many hours depending upon the medication administered. The doctor performing the sedation will provide details regarding aftercare and the need for someone to escort you home and look after you for the first 12 to 24 hours after your procedure.
Different levels of IV sedation
There are different levels of IV sedation. The three levels of IV sedation are minimal sedation, moderate (conscious) sedation also sometimes known as ‘twilight sedation’ and deep sedation.
The table below is taken from the Royal College of Anaesthetists Guide to sedation and defines the differences between these three types of sedation:
|Minimal Sedation||Moderate Sedation
|Will I remember my procedure?||You are likely to remember having your treatment, but not all the detail||You may remember some parts of your treatment
|What dose of sedative will I receive?||You will have a small amount of a sedative drug||You will have a little more sedative
|Will I be awake? Will I be able to talk?||You will be awake and able to talk normally||You will be sleepy but can talk normally and follow simple instructions if asked
|Level of relaxation?||You will feel relaxed and less worried by what is happening around you||You will feel very relaxed and sleepy
|Will my breathing be affected?||Minimal sedation should not affect your breathing||Moderate sedation should not affect your breathing
General Anaesthesia can only be legally provided within a hospital setting – either NHS or large private hospitals. With a general anaesthetic you will be completely unaware and completely unconscious during your procedure. This requires a much higher level of monitoring and often involves the use of a ventilator (breathing machine). With sedation you will not be completely unconscious.
Sedation works quickly and the dose can be adjusted so you get just the right amount. It allows you to be relaxed during your treatment. You may not remember much about your treatment afterwards. It usually has fewer side effects than a general anaesthetic. Recovery is quicker than after a general anaesthetic, so you can usually go home within an hour of your treatment.
Our sedation service has been set up and tailored towards children, teenagers and adults. Dr Swart can offer sedation for children as young as 5 years old or at least 20kg. There is no upper age limit. Of course in all cases Dr Swart will carry out a consultation and make a decision on whether you are a suitable candidate for sedation.
Sedation makes circumcision possible for children with autism
At Circumcision Pro our surgeons have a wealth of experience. Dr Amin has performed over 9000 circumcisions and Dr Ghani has performed close to 3000. On a number of occasions we have come across families with autistic children. Often parents have wanted to have their children circumcised for deep seated religious and cultural reasons but due to autism we have had to decline them. Autistic children generally do not tolerate procedures under local anaesthetic and trying to perform a circumcision in this way can be quite dangerous. At Circumcision Pro we have performed a number of cases for autistic children under sedation and this has proved to be a resounding success. The feedback we have received has been fantastic.
Our sedation service at Circumcision Pro is usually in the form of IV sedation and normally between light and moderate sedation. This is the case for children, teenagers and adults. Dr Swart will decide at the time of the procedure what is most appropriate and discuss this with you.
What happens on the day of the procedure?
On the day of the procedure you will be asked to come 30 minutes prior to your appointment. Dr Amin will carry out a consultation prior to the circumcision. He will go through the procedure and all aftercare. Once the consent process has been completed Dr Swart will also conduct a consultation. You will have an opportunity at this point to ask further questions about the sedation process prior to the procedure getting started.
Once the circumcision has been completed Dr Swart will remain with you until you have woken up and are able to get up and go to the toilet. At this point Dr Amin will carry out a final check and then you will be discharged home. Please remember that you will be required to arrange for an escort to take you home and remain with you overnight.
For children, we make additional arrangements to help ensure the whole process is as smooth and reassuring as possible. Parents are asked to arrive at the clinic with their child 30 minutes prior to their appointment. You will first be seen by Joanne Delaney. Joanne is a Paediatric Recovery Nurse and has years of experience working with parents and children. She is fantastic at helping to put children and parents at ease. At this point Dr Swart will have a final consultation with you to explain exactly what is going to happen and how the sedation process will be carried out.
Joanne will assist Dr Swart to place a cannula (plastic tube) into a vein in the back of the hand so that IV sedation medication can be administered. Numbing cream is applied before inserting a cannula to make this as painless as possible. Dr Amin will then carry out a consultation and discuss the circumcision and aftercare. Following completion of the consent form by both parents your child will be taken through to the operating room. Joanne will accompany your child throughout the procedure. Thanks to the many years of experience the team has in providing sedation and surgery, our team is very calm throughout. Our team will help to alleviate any anxiety you may have about the sedation and circumcision surgery.
Moderate or ‘Conscious’ Sedation, as the name suggests, means that your child will be conscious throughout the procedure. He will be asleep but rousable. He will not remember what has happened and he will not be in pain. Dr Amin will administer a local anaesthetic penile block to the penis. This will mean he will not be in pain during or after the circumcision. While your child is asleep, his blood pressure, heart rate, and blood oxygen levels will be monitored continuously. To keep your child asleep during the surgery, he will be given anesthetic medication through the IV. When the circumcision is completed, the medications will be stopped and your child will begin to wake up.
After completion of the circumcision, your child will be taken to a recovery area until sedation has worn off. Joanne will remain with your son until he has fully woken up and is safe to go home. You will be able to stay with your son at this point.
When your child is moved to the recovery room, you will be called so that you can be there as he wakes up. The surgeon who did your child’s circumcision will meet with you to talk about the surgery and answer any questions you might have. The penile anaesthesia will allow your child to wake up comfortably, without any pain from the surgery, and keep him comfortable for several hours afterward.
Your child will need to stay in the recovery room to be monitored until he is alert and his vital signs are stable. The length of time your child will spend in the recovery room will vary between 30-60mins because some children take longer than others to wake up after sedation. Children coming out of sedation may react in different ways. Your child may be upset and cry, or confused, feel nausea or vomit. These reactions are normal and will go away as the sedation wears off.
You will then be able to go home with the person accompanying you.
After your child is discharged and goes home, he may still be groggy and should take it easy for the day. Dr Rudi will give specific instructions and a contact number to contact him in any emergency. Please observe your child for the rest of the day and do not leave him unattended. Please kindly follow all the instructions.
You will also be given an emergency contact number if there are any concerns about bleeding after the circumcision.