Randall Henri Steinmeyer,

I'm a Board Certified anesthesiologist and have been in practice for 24 years. I just learned that the Children's Hospital of Philadelphia where I trained has launched a program to increase flu vaccine uptake among children by vaccinating them while under anesthesia. The program is called "Close your Eyes. We'll Immunize" This is stunningly irresponsible. Here's why: Anesthetists are extremely risk avoidant and endeavor to minimize patient exposure to anything which carries potential side effects. This is particularly true of pediatric patients who very often have never been exposed to anesthetic medications. We simply cannot know how an individual child will respond to these drugs for the first time. Every single medication we administer during an operation can potentially trigger untoward or allergic responses. When this occurs our primary responsibility is to stabilize the patient. Our secondary responsibility is to identify the offending agent. There is absolutely no justification of introducing another agent, in this case a flu vaccine, which carries a risk of harm and contributes nothing to the success of the operation. Some of the more common side effects of flu vaccines are fever (11-16%) and less commonly, a rash (1%). There is also an non-zero risk of severe allergic reactions and high-grade fevers which can develop over the course of minutes. What if a child under anesthesia receives a vaccine and develops a rash and/or fever? Is it from the antibiotic that the surgeon requested? Is it from the narcotic? The anxiolytic? The barbiturate? Anesthetic gases can also (rarely) trigger a life threatening response called Malignant Hyperthermia which commonly presents as a high fever. Without subsequent testing we cannot know which agent was responsible. Most commonly the testing is never done and the child’s record will forever reflect the possibility that some or all of the drugs which were used are responsible for their reaction. This makes future anesthetic care significantly more challenging and will require the use of alternatives which may not be necessary. Advocating for a flu vaccine while a child is anesthetized reflects the pervasive yet inaccurate attitude among the medical establishment that vaccines are perfectly safe. I simply cannot believe that my mentors would have ever supported this initiative when I was a resident there. Close your eyes indeed.