The Acupuncture Anesthesia Group for Cesarean Section, Hospital for Obstetrics and Gynecology, Beijing
Acupuncture anesthesia has been widely used in cesarean section throughout our country. During the course of operation, the patient's condition is relatively stable with reduced blood loss and steady efficacy. Cesarean section under acupuncture anesthesia in our hospital was started in April 1966, and up to the end of 1978 there were 3,535 cases performed. One thousand cases under our observation were analysed in the following aspects: the acupuncture anesthesia effect and its influencing factors, the condition of patient during and affer operation, its application in toxemia of pregnancy and its comparison with epidural anesthesia etc.
1. Method of anesthesia
Seven prescriptions of acupuncture points were used for inducing acupuncture anesthesia during the past years:
(1) Sanyinjiao, Zusanli, Ligou and Diji.
(2) Ear acupuncture.
(3) Sanyinjiao, external anesthesia point and para-incision needles.
(4) Renzhong, Chengjiang and para-incision needles.
(5) Sanyinjiao penetrating towards Juegu and para-incision needles.
(6) Sanyinjiao, Taichong and Xiajuxu.
(7) Sanyinjiao, Neiguan and Zusanli.
Among these prescriptions the third one is the most frequently used and the 6th and 7th only selectively used, while the others are no longer used.
The stimulation is given by an electric acupuncture apparatus with pulsatile current. The time of induction is from 15 to 30 minutes.
For supplementary medication 50 mg of dolantin may be given through the intravenous drip when the baby is being delivered or 10 minutes before operation.
2. Effect of acupuncture anesthesia
The successful rate of acupuncture anesthesia was 98.4% and the combined rate of Grades 1 and 2 was 75.8%.
3. Factors influencing the effect of acupuncture anesthesia
(a) Obstetrical factors
Parity, number of operation, planned or emergency operation, mode of operation and duration of operation are factors that affect the effect. In cases of primipara, first cesarean section, planned operation, lower segment cesarean section and duration of operation around or less than 30 minutes gave the higher percentage of Grade 1 or 2 and the difference is significant. Among these factors, the duration of operation was the most important.
(b) Mental factors
Those mentally calm evidently resulted in higher percentage of Grade 1.
(c) Selection of acupuncture points or prescription
There was no marked difference in the combined rate of Grade 1 and 2 among the above-mentioned seven prescriptions, but the selection of the acupuncture points according to differentiation of symptoms gave higher percentage of Grade 1 than applying the fixed prescription to all cases.
4. Patient's condition during operation.
(a) Change in blood pressure and pulse
Cases with factors that might influence the blood pressure and pulse were excluded in this item (e.g. toxemia, anemia, antepartum hemorrhage, etc.) leaving 664 cases to be analysed. Among these the range of change in blood pressure during the whole course of operation and at the time the baby is being delivered was small. Change in systolic pressure within 20 mmHg was 67.6% and 82.9% respectively and for diastolic pressure, 85.8% and 90.5% respectively. The change in pulse rate and pulse pressure was also small.
(b) Amount of blood loss
The average amount of blood loss during operation was 278.8±5.19 ml, blood loss less than 300 ml, 66.1% and that over 500 ml, 10.8%.
(c) Complications
There were 13 cases of postural shock, 2 cases fainted on needling and 23 cases of newborn asphyxia mostly due to obstetrical factors. There was no anesthesia accident or serious complications.
5. Postoperative conditions
The recovery after operation was quick and with very few complications. Pain of the wound was very light and 40.4% of them didn't need any analgesics. For those cases with medication, 5.2% needed dolantin. Most of the cases passed gas in 12 to 48 hours after operation. There were 82.8% of cases that had no gas distention.
6. Comparison between acupuncture anesthesia and epidural anesthesia for cesarean section
Fourty-five cases of cesarean section under acupuncture anesthesia and twenty-seven cases under epidural anesthesia done in 1974 were taken at random for comparison.
(a) Amount of blood loss during operation was evidently more in epidural anesthesia (Table 1).
(c) There was no marked difference in the postoperative course between these two types of anesthesia.
From these data we can see that acupuncture anesthesia has definite analgesic effect, and, besides, it also has the characteristics of stable blood pressure and pulse rate, less blood loss, free from anesthesia accident and complications.
7. Application of acupuncture anesthesia in patients with toxemia of pregnancy.
Sixty-four cases of cesarean section in patients with toxemia in pregnancy in 1976-77 using prescription 3 and 4 were analysed, including 10 cases of hypertension during labor, 37 cases of mild toxemia, light type, 6 cases of mild toxemia, severe type, 4 cases of pre-eclampsia, 1 case of eclampsia and 6 cases of chronic hypertension superimposed toxemia. The advantages shown here were that during the delivery of the baby the blood pressure and pulse being stable, less blood loss during operation and free from complications. During delivery of the baby, those with the change of blood pressure within 20 mmHg in systolic pressure, diastolic pressure and pulse pressure were 67.2%, 84.4% and 73.4% respectively. The average value of changes in these pressures was all below 18.6 mmHg. The average amount of blood loss was 267.98±21.94 ml and the loss below 300 ml was 68.8%. The rate of postpartum hemorrhage was 14%, very close to that (10.8%) in patients without toxemia. This means that acupuncture anesthesia can well be used in patients with toxemia of pregnancy.
8. Improvement in Operative Procedures.
With a view to raise the effect of acupuncture anesthesia, improvements were made in operative procedure. They consist of the accurate choice of the site and length of incision, improvement of maneuver in delivering the fetal head, changed method of suturing up the myometrium, good cooperation between the assistant, the instrument nurse and the operator, early injection of oxytocics, reducing the traction maneuver, etc.
With these measures, the duration of operation was shortened and the effect of acupuncture anesthesia improved.
9. Conclusion.
(a) Acupuncture anesthesia is fairly good for cesarean section. During the course of operation the blood pressure and pulse are stable and the blood loss is reduced. It can be used in ordinary patients as well as in those with complications, such as toxemia of pregnancy, anemia etc. It is also very useful in the countryside.
(b) The factors influencing the effect of acupuncture anesthesia are many-sided. The selection of appropriate prescription is of vital importance. It has been suggested that to form a prescription according to the basic theory of Traditional Chinese Medicine--"determination of treatment according to different symptoms" and selecting the acupuncture points in accordance with the course of channels in combination with the relative specificity of the acupuncture points. The prescription should consist of main acupuncture point complex to be used in every case and some other points for selective use in different conditions.
(c) Obstetrical factors may affect the effect of acupuncture anesthesia. Improvements made in the operative procedure to shorten the operation time and to improve the effect of anesthesia are introduced in the paper.
Acupuncture anesthesia has been widely used in cesarean section throughout our country. During the course of operation, the patient's condition is relatively stable with reduced blood loss and steady efficacy. Cesarean section under acupuncture anesthesia in our hospital was started in April 1966, and up to the end of 1978 there were 3,535 cases performed. One thousand cases under our observation were analysed in the following aspects: the acupuncture anesthesia effect and its influencing factors, the condition of patient during and affer operation, its application in toxemia of pregnancy and its comparison with epidural anesthesia etc.
1. Method of anesthesia
Seven prescriptions of acupuncture points were used for inducing acupuncture anesthesia during the past years:
(1) Sanyinjiao, Zusanli, Ligou and Diji.
(2) Ear acupuncture.
(3) Sanyinjiao, external anesthesia point and para-incision needles.
(4) Renzhong, Chengjiang and para-incision needles.
(5) Sanyinjiao penetrating towards Juegu and para-incision needles.
(6) Sanyinjiao, Taichong and Xiajuxu.
(7) Sanyinjiao, Neiguan and Zusanli.
Among these prescriptions the third one is the most frequently used and the 6th and 7th only selectively used, while the others are no longer used.
The stimulation is given by an electric acupuncture apparatus with pulsatile current. The time of induction is from 15 to 30 minutes.
For supplementary medication 50 mg of dolantin may be given through the intravenous drip when the baby is being delivered or 10 minutes before operation.
2. Effect of acupuncture anesthesia
The successful rate of acupuncture anesthesia was 98.4% and the combined rate of Grades 1 and 2 was 75.8%.
3. Factors influencing the effect of acupuncture anesthesia
(a) Obstetrical factors
Parity, number of operation, planned or emergency operation, mode of operation and duration of operation are factors that affect the effect. In cases of primipara, first cesarean section, planned operation, lower segment cesarean section and duration of operation around or less than 30 minutes gave the higher percentage of Grade 1 or 2 and the difference is significant. Among these factors, the duration of operation was the most important.
(b) Mental factors
Those mentally calm evidently resulted in higher percentage of Grade 1.
(c) Selection of acupuncture points or prescription
There was no marked difference in the combined rate of Grade 1 and 2 among the above-mentioned seven prescriptions, but the selection of the acupuncture points according to differentiation of symptoms gave higher percentage of Grade 1 than applying the fixed prescription to all cases.
4. Patient's condition during operation.
(a) Change in blood pressure and pulse
Cases with factors that might influence the blood pressure and pulse were excluded in this item (e.g. toxemia, anemia, antepartum hemorrhage, etc.) leaving 664 cases to be analysed. Among these the range of change in blood pressure during the whole course of operation and at the time the baby is being delivered was small. Change in systolic pressure within 20 mmHg was 67.6% and 82.9% respectively and for diastolic pressure, 85.8% and 90.5% respectively. The change in pulse rate and pulse pressure was also small.
(b) Amount of blood loss
The average amount of blood loss during operation was 278.8±5.19 ml, blood loss less than 300 ml, 66.1% and that over 500 ml, 10.8%.
(c) Complications
There were 13 cases of postural shock, 2 cases fainted on needling and 23 cases of newborn asphyxia mostly due to obstetrical factors. There was no anesthesia accident or serious complications.
5. Postoperative conditions
The recovery after operation was quick and with very few complications. Pain of the wound was very light and 40.4% of them didn't need any analgesics. For those cases with medication, 5.2% needed dolantin. Most of the cases passed gas in 12 to 48 hours after operation. There were 82.8% of cases that had no gas distention.
6. Comparison between acupuncture anesthesia and epidural anesthesia for cesarean section
Fourty-five cases of cesarean section under acupuncture anesthesia and twenty-seven cases under epidural anesthesia done in 1974 were taken at random for comparison.
(a) Amount of blood loss during operation was evidently more in epidural anesthesia (Table 1).
(c) There was no marked difference in the postoperative course between these two types of anesthesia.
From these data we can see that acupuncture anesthesia has definite analgesic effect, and, besides, it also has the characteristics of stable blood pressure and pulse rate, less blood loss, free from anesthesia accident and complications.
7. Application of acupuncture anesthesia in patients with toxemia of pregnancy.
Sixty-four cases of cesarean section in patients with toxemia in pregnancy in 1976-77 using prescription 3 and 4 were analysed, including 10 cases of hypertension during labor, 37 cases of mild toxemia, light type, 6 cases of mild toxemia, severe type, 4 cases of pre-eclampsia, 1 case of eclampsia and 6 cases of chronic hypertension superimposed toxemia. The advantages shown here were that during the delivery of the baby the blood pressure and pulse being stable, less blood loss during operation and free from complications. During delivery of the baby, those with the change of blood pressure within 20 mmHg in systolic pressure, diastolic pressure and pulse pressure were 67.2%, 84.4% and 73.4% respectively. The average value of changes in these pressures was all below 18.6 mmHg. The average amount of blood loss was 267.98±21.94 ml and the loss below 300 ml was 68.8%. The rate of postpartum hemorrhage was 14%, very close to that (10.8%) in patients without toxemia. This means that acupuncture anesthesia can well be used in patients with toxemia of pregnancy.
8. Improvement in Operative Procedures.
With a view to raise the effect of acupuncture anesthesia, improvements were made in operative procedure. They consist of the accurate choice of the site and length of incision, improvement of maneuver in delivering the fetal head, changed method of suturing up the myometrium, good cooperation between the assistant, the instrument nurse and the operator, early injection of oxytocics, reducing the traction maneuver, etc.
With these measures, the duration of operation was shortened and the effect of acupuncture anesthesia improved.
9. Conclusion.
(a) Acupuncture anesthesia is fairly good for cesarean section. During the course of operation the blood pressure and pulse are stable and the blood loss is reduced. It can be used in ordinary patients as well as in those with complications, such as toxemia of pregnancy, anemia etc. It is also very useful in the countryside.
(b) The factors influencing the effect of acupuncture anesthesia are many-sided. The selection of appropriate prescription is of vital importance. It has been suggested that to form a prescription according to the basic theory of Traditional Chinese Medicine--"determination of treatment according to different symptoms" and selecting the acupuncture points in accordance with the course of channels in combination with the relative specificity of the acupuncture points. The prescription should consist of main acupuncture point complex to be used in every case and some other points for selective use in different conditions.
(c) Obstetrical factors may affect the effect of acupuncture anesthesia. Improvements made in the operative procedure to shorten the operation time and to improve the effect of anesthesia are introduced in the paper.
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