title: At what age range should children be circumcised?
abstract: BACKGROUND
  Although male circumcision is a surgical intervention that is frequently performed in children, there is no consensus about the age at which it should be performed.
  
  
  OBJECTIVE
  The purpose of this study was to determine the best age range for routine male circumcision with respect to a child's health and the cost.
  
  
  METHODS
  This clinical trial was conducted in the affiliated hospital of the Erzincan University of Medical Sciences, Turkey, in 2014. The circumcised children were evaluated in 3 groups: < 1 year old (Group 1), 1-7 years old (Group 2), and > 7 years old (Group 3). To obtain a satisfactory Wilton sedation score, midazolam 0.1 mg/kg IV was administered first. If adequate sedation was not achieved, ketamine 2 mg/kg IV was also administered. If adequate sedation was still not achieved, general anesthesia was administered via a laryngeal mask. At the end of the surgery, the groups were compared in terms of post-anesthesia recovery duration, complications, discharging duration, and cost.
  
  
  RESULTS
  A total of 603 children were circumcised, 374 in Group 1, 94 in Group 2, and 135 in Group 3. Midazolam was sufficient for sedation in 364 Group 1 patients (97.3%), 6 Group 2 patients (6.3%), and 38 Group 3 patients (28.1%). The shortest post-anesthesia recovery duration after surgical intervention and time until discharge, the lowest cost, and the fewest anesthesia complications were observed in Group 1 (P < 0.05 for all).
  
  
  CONCLUSIONS
  Although almost all of the < 1 year-old children could be sedated with midazolam alone, most of the > 1 year-old children required ketamine or general anesthesia. Performing circumcision when children are less than 1 year old decreases the risk of complications due to anesthesia and lowers the costs compared with performing the procedure on older children.
authors.affiliation: Department of Pediatric Surgery, Erzincan University of Medical Sciences, Erzincan, Turkey.
authors.forename: Senol
authors.initials: S
authors.lastname: Bicer
authors.affiliation: Department of Anesthesiology, Erzincan University of Medical Sciences, Erzincan, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Kuyrukluyildiz
authors.affiliation: Department of Anesthesiology, Erzincan University of Medical Sciences, Erzincan, Turkey.
authors.forename: Fethi
authors.initials: F
authors.lastname: Akyol
authors.affiliation: Department of Anesthesiology, Erzincan University of Medical Sciences, Erzincan, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sahin
authors.affiliation: Department of Anesthesiology, Erzincan University of Medical Sciences, Erzincan, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Binici
authors.affiliation: Department of Anesthesiology, Erzincan University of Medical Sciences, Erzincan, Turkey.
authors.forename: Didem
authors.initials: D
authors.lastname: Onk
keywords: Age Groups; Anesthesia; Circumcision