Thermal Changes in Peripheral Vascular Disease during Sympathetic Ganglionectomy under General Anesthesia.

A great deal of confusion has existed regarding the differential diagnosis of Raynaud's disease, thrombo-angiitis obliterans, and arteriosclerosis. Raynaud's disease affects, predominantly, young women, and because it is caused by vasospasm is completely relieved in the uncomplicated case, by sympathetic ganglionectomy. It need not be confused with thromboangiitis obliterans and arteriosclerosis with occlusion. Arteriosclerosis with occlusion is usually found among elderly people, and since vasospasm is rarely, if ever, an element in the condition, it is not affected by sympathetic ganglionectomy. Thrombo-angiitis obliterans practically always affects young men, has an element of vasospasm, and many of the patients can be satisfactorily treated by sympathetic ganglionectomy. Simple tests have been sought which would aid in differential diagnosis and which, by revealing the degree of vasodilation possible, would help to determine the suitability of these cases for operation, and, in some degree, indicate the probable prognosis. Observations made on patients undergoing sympathetic ganglionectomy under general anesthesia revealed certain thermal changes which may prove of value in this connection. With the use of general anesthesia, administered by inhalation, it was noted that extremities which were not denervated were temporarily relieved of vasomotor spasm, and that there was definite postoperative clinical improvement of these extremities. It was difficult to interpret this temporary improvement, but it was thought for a time that the entire sympathetic nervous system was reflexly or indirectly affected by operation on, or manipulation of, any part. Adson (1) ventured the suggestion that the general anesthetic probably influenced the entire sympathetic nervous system by affecting the vasoconstrictor center in the diencephalon. Morton and Scott (6) measured the changes in cutaneous