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[[File:PureShock.jpg|thumb|Baby in shock after circumcision]]
'''Shock''' is one of the possible consequences of [[circumcision]], especially in newborns and infants at an age when effective [[pain]] suppression with general anesthesia is not possible.<ref name="agoglu2022">{{REFjournal |last=Aydoğlu |first= |init=B |author-link= |last2=Aydoğlu |first2= |init2=M |author2-link= |last3=Okur |first3= |init3=MH |author3-link= |etal=no |title=Social and psychological effects of circumcision: A narrative review |trans-title= |language= |journal=Journal of Applied Nursing and Health |location= |date=2022-12 |volume=4 |issue=2 |pages=264-71 |url=https://janh.candle.or.id/index.php/janh/article/view/110/138 |archived= |quote= ||DOI=10.55018/janh.v4i2.110 |format=PDF |accessdate=2023-05-03}}</ref>
{{WikipediaQuote|URL=https://en.wikipedia.org/wiki/Shock_(circulatory)}}
Shock is divided into four main types based on the underlying cause: low volume, cardiogenic, obstructive, and distributive shock. Low volume shock, also known as hypovolemic shock, may be from [[bleeding]], diarrhea, or vomiting.[1] Cardiogenic shock may be due to a heart attack or cardiac contusion. Obstructive shock may be due to cardiac tamponade or a tension pneumothorax. Distributive shock may be due to sepsis, anaphylaxis, injury to the upper spinal cord, or certain overdoses.</blockquote>
The American Academy of Pediatrics advised:<blockquote>When pain is prolonged, striking changes occur in the infant's physiologic and behavioral indicators. During episodes of prolonged pain, neonates enter a state of passivity with few, if any, body movements; an expressionless face; decreased heart rate and respiratory variability; and decreased oxygen consumption, all suggestive of a marked conservation of energy.<ref name="aap2016">{{REFjournal |last= Committee on Fetus and Newborn and Section on Surgery; Section on Anesthesiology and Pain Medicine;Canadian Paediatric Society; Fetus and Newborn Committee |etal=no |title=Prevention and Management of Pain in the Neonate: An Update |trans-title= |language= |journal=Pediatrics |location= |date=2006-11 |volume=118 |issue=5 |article= |page= |pages=2231–41 |url=https://publications.aap.org/pediatrics/article/118/5/2231/69964/Prevention-and-Management-of-Pain-in-the-Neonate?autologincheck=redirected |archived= |quote= |pubmedID=17079598 |pubmedCID= |DOI=10.1542/peds.2006-2277 |accessdate=2023-04-29}}</ref> <ref name="agoglu2022" /></blockquote>
=== Neurogenic shock ===
[[File:AmericanBabyInShockAfterCircumcision.jpg|thumb|American baby in shock after circumcision]]
|accessdate=2020-12-20
}}</ref>
== Hypovolemic shock ==
Every operation, including [[circumcision]], can lead to severe blood loss, which can lead to a “traumatic-hemorrhagic shock” (bleeding as a result of traumatic effects).
=== Traumatic hemorrhagic shock ===
The early complications of circumcision are [[bleeding]], [[pain]], inadequate [[skin]] removal, and surgical site [[infection]], but they usually tend to be minor. Of these, bleeding is the most common complication of circumcision. Bleeding may occur along the [[skin]] edges between sutures or from a discrete blood vessel, most commonly at the [[frenulum]].<ref>{{REFjournal
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005087/
|title=Hypovolemic Shock after Circumcision
* [https://alphamom.com/wp-content/uploads/2010/05/wonderland_circumcision-e1273195287922.jpg alphamom.com: Circumcision: the kindest cut, or the cruelest?]
Infants regularly go into shock during [[circumcision]] due to the extreme [[pain]] they cannot escape and from which they cannot defend themselves (because of being restrained by a [[Circumstraint]] or because of being held by adults). <ref name="agoglu2022" /> This is their only way to turn off pain perception. Visible symptoms are usually very swollen eyelids and puffy faces after the intense screaming before. With some, the apathetic eyes do not close by themselves in shock.
=== "Felt nothing" ===
Parents are very often misled by the statement by doctors and nurses that the child did not feel anything and is now sleeping peacefully. Often the parents are not present at the circumcision either. Newborns do not yet have any or only very few blockers of the nociceptors that transmit [[pain]] sensations to the brain.
When circumcision techniques last several minutes, children often go into a freeze, which was previously misinterpreted as falling asleep peacefully and which led to the belief that babies felt no [[pain]]. Measurements in such cases resulted in an usually 3 to 4 times increased cortisol value, which corresponds to a severe [[shock]] state.<ref>{{REFjournal
|last=Gunnar
|init=MR
}}</ref>
We owe the perception of [[pain]] to so-called nociceptors, free nerve endings that are excited when the body is injured or damaged. These specialized nerve cells are distributed all over the body; they send their signals via the spinal cord to the brain, where the excitation is then processed and interpreted as [[pain]]. The number of nociceptors exceeds that of all other receptors and their reporting system is largely independent of other sensory channels such as the sensation of warmth or touch. This shows how central the perception of pain is for the organism.<ref>{{REFweb
|url=https://www.dasgehirn.info/wahrnehmen/fuehlen/schmerzlich-aber-unabdingbar
|title=Schmerzlich, aber unabdingbar
{{SEEALSO}}
* [[Breastfeeding]]
* [[Circumstraint]]
* [[Pain]]
* [[Trauma]]
[[Category:Breastfeeding]]
[[Category:Pain]]
[[Category:Parental information]]
[[Category:Trauma]]
[[de:Schock]]