In front of the entire class: Surgical success rates

Dr. Harvey Cushing became the father of brain surgery, following his surgical residency at Yale in the late 1890s. He attributed his success to meticulous care, rather than innovations per se. One key to his success was meticulous record-keeping. It started when he was assisting with surgery as a student, using a sponge to administer ether, and the patient died in front of the entire class. Appalled and mortified, Dr. Cushing and a classmate soon developed "ether charts," to keep track of a patient’s heart and respiration rates, perhaps his first major contribution to medicine. Such charting revolutionized surgery by greatly curbing complications and deaths from anesthesia, according to the Journal of Neurosurgery.

Since Dr. Cushing's era, anesthesia is the field of medicine where doctors have most greatly reduced their error rates. The systematic collection of their data and the scrutiny of it by those empowered to change medical practice saved many lives. Doctors in other fields also now record information on their success rates. It's time for this information to become routinely available to consumers. In Massachusetts, a legislative bill to require surgeons to provide some basic information to consumers is under consideration.

Advice: Find out the success rates for your surgery and your surgeon before you go under the knife.

Read another story about such transparency of surgical data. Thanks to Richard Conniff for the source story in the January/February 2011 issue of the Yale Alumni Magazine.

I thought it was a regular dental procedure: An anesthesia error

When five-year old Diamond Brownridge broke her arm, doctors had no problem in sedating her. Then, when her mother brought her to the dentist last September to fill two cavities and cap her front teeth, her mother said, “They did tell me they were going to sedate her, but I thought it was a regular dental procedure.”

Improperly administered anesthesia led to her death.

The 35-pound girl had received two injections of diazepam or Valium within five minutes, followed by oral Valium, lidocaine, several other medications, and nitrous oxide. The Illinois Department of Professional Regulation said the dentist had failed to properly monitor her blood pressure, pulse and respiration during her treatment. The Cook County Medical Examiner’s office found that the anesthesia caused a lack of oxygen to her brain, causing her death.

Children often need drugs to reduce anxiety, relieve pain, or reduce movement during dental procedures and some medical tests, like MRIs. Children may unintentionally become too deeply sedated, and so must be monitored very carefully until they are fully awake. The American Academy of Pediatric Dentistry and the American Academy of Pediatrics have recently jointly issued guidelines (summarized here) for safe pediatric sedation. The guidelines make clear that the clinician must have advanced airway training, use a pulse oximeter to measure oxygen levels in the blood, and take other precautions, according to AAPD spokesperson Dr. Stephen Wilson.

Advice to parents whose children need sedation: Beforehand, ask your dentist or doctor if s/he follows the new guidelines. If not, consider whether it could happen to your jewel.

Read another anesthesia story, or read the sources: Judy Foreman in Monday’s Boston Globe, Christian Nordqvist in Medical News Today, and CBS2chicago.com.