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August 25, 1945

CONTINUOUS CAUDAL ANESTHESIA AS A TEST IN THE SELECTION OF HYPERTENSIVE PATIENTS FOR SYMPATHEDTOMY

JAMA. 1945;128(17):1225. doi:10.1001/jama.1945.92860340001007
Abstract

The various methods now employed in the selection of patients for thoracolumbar sympathectomy appear to be unsatisfactory. Certainly no single test has been used which is capable of yielding reliadle data as to whether or not sympathectomy will favorably influence hypertension. As the hypertensive state in man "appears to be the result of a number of different factors joining together in an infinite variety of combinations," careful evaluation of the neurogenic component seems essential for a decisive answer to the problem of selection. The sodium amytal, sodium nitrite and cold pressor tests have been found of limited prognostic value in relation to surgery, since they provide an inaccurate index of "sympathetic tone." Thus, poor results have been reported in many cases in which these tests had forecast a favorable outcome.

The observations of Hindson and Edwards,1 as well as our own,2 have convinced us that continuous caudal anesthesia may be

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