Donald P. Todd

The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade

Twenty-nine consecutively treated patients over a 5-year period with upper extremity reflex sympathetic dystrophy were admitted to Massachusetts General Hospital for prolonged continuous stellate ganglion blockade. Diagnosis was based on the presence of pain, decreased joint motion, trophic changes, and vasomotor disturbances. Selection for blockade was made on the failure to improve with outpatient physical therapy, tranquilizers, and mild analgesics. Treatment consisted of indwelling-catheter injections of bupivacaine hydrochloride every eight hours to the stellate ganglion for an average of 7 days, supplemented with vigorous physical therapy. Improvement during treatment was documented in all but two patients with regard to pain and decreased joint motion and in two-thirds with regard to trophic and vasomotor changes. Longterm follow-up demonstrated a relapse rate of 25%, but marked improvement persisted in the rest and normal status was attained in four of 26 patients at an average of 3 years later.

A Study of Deaths Associated With Anesthesia and Surgery

Ten teams consisting of an anesthetist, a surgeon, and a secretary worked for a 5-year period in 10 University hospitals scattered widely over the United States. All the deaths occurring on all of the surgical and surgical specialty services were examined and appraised as to their causes by the team working in each participating hospital. Final decisions were made by the local team in each hospital, usually after a full staff discussion. These decisions were made as soon after each death as those who were on hand at the time of the death could assemble the relevant material. It is to be emphasized that in this study, there was nothing voluntary or selective about the reporting of the deaths, once an institution with its team had agreed to participate. A point is made of this fact, because studies of intermittently, casually, or partially reported deaths can never get to the center of a problem of this kind. All deaths were categorized and reported. The designation of the cause of death was made in the institution where it occurred; this classification was not altered in the central office. Reports to the central office were made at 4-month intervals by each of the participating hospitals; thus each institution sent in 15 reports over a 5-year period. In these reports, the causes of death were characterized as patient’s disease, error in diagnosis, error in surgical judgment, error in surgical technique, or during anesthesia. For 2 weeks during each 4-month period, the numbers of certain key operations were tallied, to check the uniformity of the surgical material in the 10 institutions. A sampling of the ages and races of the patient material was made on all patients present in the 10 hospitals on 2 dates that were considered representative. From the data collected on 599,548 anesthesia treatments, the following observations can be made for the period of this study.