During subtotal gastrectomy under acupuncture anesthesia, patients often complain of pain, nausea, palpitation, sweating, etc. These symptoms may be divided into three groups of functional disturbances namely, neurological, circulatory and gastrointestinal. According to the differentiating principles of Traditional Chinese Medicine, these symptoms may be grouped under "stasis of vital energy and stagnation of blood" characterized mainly by pain; "belching from the stomach" characterized by nausea and vomiting; and "deficiency of both vital energy and blood" characterized by palpitation, sweating and distraction. Following the theory of the channels and collaterals, and as verified by practice, Renzhong and Chengjiang are effective in combating pain, Zusanli and Pishu are conducive to overcome the traction sensation of visera and regulate the function of stomach; Neiguan and Xinshu conducive to eliminate distraction and to prevent sweating. These six points were used in subtotal gastrectomies. The strength of the electric stimulation was adjusted from time to time accoding to the clinical manifestations of the patients during operation. In a total of 141 cases of subtotal gastrectomies under acupuncture anesthesia, 122 (86.5%) had excellent anesthetic result (grade I), 17 (12%) classified as good result (grade II) and 2 (1.4%) was poor (grade III). In a comparable group of 143 cases in which different points were stimulated, 57 cases. (39.8%) belonged to grade 1, 68 (47.5%) grade II and 18 (12.5%) grade III. The antipain, antitraction and antitonicity effects as well as the physiological index during the course of operation were individually assessed, and only when all of these items showed excellent results, the effect of acupuncture anesthesia was considered as grade I.
Through the synchronous observation of the pulse quality ( maixing) and cardiovascular function, and through the inspection of microcirculation of the lingual papillae, it has been proved that, the pulse quality of the patient showing excellent result remained practically unchanged after induction of acupuncture anesthesia and during the course of operation; the blood pressure fluctuated occasionally within the range of 20mmHg; the heart rate varied not more than 20/min., and there was slight increase of cardiac output and peripheral vascular resistance; and the rheoencephalogram was practically normal or showed slight increase. As to the cases with poor results, the pulse became feeble and thready, the blood pressure was elevated for more than 40 mmHg for a rather long period, the heart rate increased more than 30/min., the cardiac output decreased and the peripheral vascular resistance increased in the later period of operation, and the rheoencephalogram fluctuated or decreased. The changes of all these items in patients with grade II anesthetic results were some where between those of grade I and grade III.
The sympathetic nerve, which is closely related to the cardiovascular function, was in a relatively steady state in cases with excellent anesthetic effect. In these cases there was a decreased release and increased storage of the transmitters in the nerve endings as manifested by the presence of large granular vesicles. On the contrary, there was an increased release and a decreased storage of the sympathetic transmitters in cases with poor acupuncture anesthesia, and in them, it was difficult to find granular vesicles in the nerve terminals under the electron microscope. Hematological and chemical investigations showed that DBH activity and the contents of plasma cAMP were found to be decreased, but the content of PGE which inhibits the release of noradrenaline was increased. These findings suggest that PGE may regulate the sympathetic nerve activity during the process of acupuncture anesthesia. Thus it helps to relieve pain and prevent disturbances of the circulatory functions produced by surgical trauma.
Another aspect of the auto-regulatory function initiated by acupuncture is its influence on the pain-producing substances. The blood from the traumatic areas of the patients with the poor acupuncture anesthetic effects caused pain when applied to the denuded skin, while the blood from the traumatic areas of excellent cases didn't. The characteristics of these painproducing substances were similar to those of BK and 5-HT, The investigation of the BK had indicated that its amount was smaller in grade I than in grades II and III in the blood from the traumatic areas as well as that taken from veins. It has been found that the ability of BK formation including kalikreinogen, kininogen, kininase, became weaker, while its destruction became greater in grade I patients, while in grade III patients the changes of above mentioned factors were just the oppsite.
5-HT, the other peripheral pain-producing substance showed decrease in grade I, and an increase in grade III cases. Because the content of 5-HT in blood is closely related to its absorption, storage and transportation by the platelets, further examination was made. It was shown that in the grade I, while the 5-HT level decreased in plasma, more granules of 5-HT in the platelets were found under electron microscope. In the grade III as 5-HT content increased the granules of 5-HT in platelets were replaced by vesicles. It seems that under acupuncture the platelets appear to be in a more stable state. Thus the reduction in BK formation and 5-HT release during acupuncture could be one of the mechanisms of relief of pain caused by surgical trauma. At the same time, the analgesic polypeptide in serum was increased markedly in excellent cases, but decreased in poor ones.
The reason that patients tolorate surgical trauma better under acupuncture anesthesia is due to the regulatory function of acupuncture. This, however has its limits. In subtotal gastrectomy, theree is usually a transient painful reaction when the gastric arteries are clamped. At these crucial points, it is often helpful to give a small amount of 0.5% procaine (not more than 5ml in total) by local infiltration. Besides, in order to enhance the analgesic effect and minimizing discomfort when the stomach is under traction, 50mg of dolatine and 10 mg anisodamine are injected just before operation. These supplementary medications will not interfere with the effect of acupuncture anesthesia, but on the other hand, they will make up it's deficiency. They should be given according to the conditions of the patients and the types of operation.
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