October 2001

Spotlight on UAMS/ACH Researcher — Dr. ‘Sunny’ Anand

Babies feel pain — babies remember pain — and Kanwaljeet Singh “Sunny” Anand, M.B.B.S., D.Phil., section chief, Pediatric Critical Care Medicine, has made it his business to prove it. For years, the medical community upheld the belief that babies do not feel pain. Consequently, surgeons completed complex surgical procedures like open-heart surgery while babies were receiving little or no anesthesia.

During his residency training at Oxford University (1982-85), Dr. Anand had an intuitive feeling that something was not right about the way surgical procedures were being performed on preterm neonates. “When I found out that babies were not receiving any anesthesia during open chest or abdominal surgery, I instantly felt concerned about that,” he said. This intuitive feeling sparked the beginnings of Anand’s lifelong commitment to changing methods of critical care for neonates worldwide.

His first research efforts began with pain management for neonates undergoing thoracic surgery. “I stumbled into this area of research as a doctoral student at Oxford,” remembered Anand. When he went to an anesthesiologist and asked why neonates were not given an anesthetic. “He just told me, ‘hey, babies don’t feel pain. If we give them an anesthetic, it might make their blood pressure go down.’” Anand was not satisfied with this traditional and commonly accepted belief.

Later, he began to disprove that belief by testing stress hormone responses to surgery in preterm and full-term newborns. What he found was that stress hormones rose dramatically in response to the surgical procedure. Along with a team of researchers, Anand embarked to discover the effects of anesthesia on those stress response levels. “We did some clinical studies to see if the neonates’ stress hormone levels went down during operation if they were given potent anesthesia, and that’s exactly what happened,” he reported.

Soon Anand and his mentor, Paul Hickey, M.D., were conducting dose escalation studies to determine the proper amount of anesthesia required by neonates undergoing cardiac surgery. In 1999, Anand received a grant from the National Institutes of Health’s Child Health and Human Development Institute (NIH-NICHD), to conduct a study on the need for analgesia and sedation in premature neonates. Grants for $2.75 million supported this study, with the goal of enrolling 940 of the sickest and smallest premature babies. The grant allowed collaborating centers across the nation to participate, with Anand serving as principal investigator.

While Anand has been conducting research on pain management since the early 80s, within the last decade the scientific community has moved toward accepting the fact that babies do feel pain. Yet, Anand continues with research in the area of neonatal pain management and critical care. He currently seeks to determine the long-term effects of pain on premature babies, who frequently undergo repetitive painful invasive procedures. “Before now, no one had thought of the fact that premature babies may later develop cerebral palsy, mental retardation or other cognitive problems as a result of the repetitive pain they are exposed to early on,” said Anand.

Last February, the Archives of Pediatric and Adolescent Medicine published a consensus statement, spearheaded by Anand, on managing pain in neonates. “We used grant funds from a pharmaceutical company that was interested in helping with pain management in premature babies. So, we set up an International Evidence-Based Group for Neonatal Pain and after two years of work, we came up with a consensus statement that was published this year,” explained Anand.

The group, comprised of 14 different countries worldwide, formed a consensus statement providing an evidence-based framework that physicians can use at the bedside with clinical protocols for specific procedures. Having published the article just a few months ago, Anand has already received calls from the Joint Commission for Accreditation of Hospitals (JCAHO). JCAHO is going to use this article to identify the benchmark for neonatal pain management. “Things are moving in the right direction,” said Anand. “Once this becomes common practice, my mission is over, I’ll have to find something else. But, the last 20 years in this area of research have been remarkable — a very interesting journey.”

In the 2001 edition of “America’s Top Doctors” Anand was named as one of America’s top 1 percent of doctors. Over the years, he has had a number of research articles published in the area of neonatal anesthesia and pain management and has conducted more than 30 research projects in this field. Though he has been a “mover and shaker” in his area of research, he modestly asserted, “There’s a lot of activity in this area of research. A number of people have joined in the crusade. I’m not by any means the leader, I’m just one of the soldiers.”