Zeng Bangxiong, Zeng Qiongfang, Sheng Bangtao, Zhang Hansheng, Liu Junjie (The 1st Hospital, Wuhan Medical College)
From 1973 to 1978, acupuncture anesthesia was applied to 48 cases of congenital cardiac disease, operated on under direct vision with the assistance of extracorporeal circulation, including 22 cases of interatrial septal defect, 20 cases of interventricular septal defect, 1 case of tetralogy of Fallot, and 5 cases of pulmonic stenosis, one case of the latter group being complicated with an additional ASD. Age varied from 7 to 33 years. Body weight ranged from 16 to 75 kg. A disc-type oxygenator and blood dilution technique were used, with a perfusion rate of 50 to 90 ml/kg. The body temperature was kept at 33 to 34ºC during the operation, using a heat exchanger interposed between the outlet of the pump-oxygenator and the inflow catheter at the ascending aorta. Shivering did not occur when the temperature was lowered at the beginning, and raised at the conclusion of the operation. Interruption of the intracardiac circulation lasted from 5 to 37 minutes.
Premedication: Sod. luminal 0.1 and scopolamine 0.15 mg were administered intramuscularly half an hour before operation.
The acupuncture sites adopted were bilateral Hegu, Neiguan, and Binao through to Janyu. A G6805 type acupuncture apparatus was used, releasing continuous pulsatile waves with a frequency of 3 to 5 Hertzs. The electric current was adjusted to such strength as can be tolerated by the patient. Induction of anesthesia lasted 30 minutes and then operation commenced.
Intratracheal intubation was not used in any of the patients. When the mediastinum was entered through a mid-sternal splitting incision, a mask was applied for the patient to breathe oxygen, and assisted ventilation was given whenever the patient complained of being smothered. In most cases, respiration stopped at occlusion of the ascending aorta, and was recovered 3 to 5 minutes after the heart resumed beating. Assisted ventilation was again applied to if the recovered respiration was unduly slow. A nasopharyngeal catheter was inserted for oxygen inhalation when the sternum was closed. In three of the 48 cases, intravenous composite anesthesia had to be added in the midst of operation for breathlessness. This was used in one case for heavy loss of blood, and in two others for the pleura been torn. Intratracheal intubation had to be performed for control of respiration. For the rest of the cases, acupuncture anesthesia proved satisfactory enough for operation to be carried through, but in most cases local anesthesia had to be supplemented at the site of skin incision for incomplete analgesia effect by acupuncture. Dolantin, used during operation, did not exceed 1 to 1.5 mg/kg in dosage. For incooperative children, we also used gamma hydroxybutyric acid for basal anesthesia in a dosage of 50 to 80 mg/kg.
All cases but one had a smooth postoperative recovery without pulmonary or other complications. The one case which did not recover so smoothly had an episode of pulmonary edema, the cause being probably undue dilution of the blood during perfusion (with a hematocrit of 15%).
Anesthetic and operative mortality were nil.
We have come to the conclusion that acupuncture anesthesia is an efficient technique for anesthetizing patients of congenital heart disease during intracardiac surgery under direct vision. It is simple, safe, and contributive to a smooth and speedy postoperative recovery with remarkably less pulmonary and other complications.
From 1973 to 1978, acupuncture anesthesia was applied to 48 cases of congenital cardiac disease, operated on under direct vision with the assistance of extracorporeal circulation, including 22 cases of interatrial septal defect, 20 cases of interventricular septal defect, 1 case of tetralogy of Fallot, and 5 cases of pulmonic stenosis, one case of the latter group being complicated with an additional ASD. Age varied from 7 to 33 years. Body weight ranged from 16 to 75 kg. A disc-type oxygenator and blood dilution technique were used, with a perfusion rate of 50 to 90 ml/kg. The body temperature was kept at 33 to 34ºC during the operation, using a heat exchanger interposed between the outlet of the pump-oxygenator and the inflow catheter at the ascending aorta. Shivering did not occur when the temperature was lowered at the beginning, and raised at the conclusion of the operation. Interruption of the intracardiac circulation lasted from 5 to 37 minutes.
Premedication: Sod. luminal 0.1 and scopolamine 0.15 mg were administered intramuscularly half an hour before operation.
The acupuncture sites adopted were bilateral Hegu, Neiguan, and Binao through to Janyu. A G6805 type acupuncture apparatus was used, releasing continuous pulsatile waves with a frequency of 3 to 5 Hertzs. The electric current was adjusted to such strength as can be tolerated by the patient. Induction of anesthesia lasted 30 minutes and then operation commenced.
Intratracheal intubation was not used in any of the patients. When the mediastinum was entered through a mid-sternal splitting incision, a mask was applied for the patient to breathe oxygen, and assisted ventilation was given whenever the patient complained of being smothered. In most cases, respiration stopped at occlusion of the ascending aorta, and was recovered 3 to 5 minutes after the heart resumed beating. Assisted ventilation was again applied to if the recovered respiration was unduly slow. A nasopharyngeal catheter was inserted for oxygen inhalation when the sternum was closed. In three of the 48 cases, intravenous composite anesthesia had to be added in the midst of operation for breathlessness. This was used in one case for heavy loss of blood, and in two others for the pleura been torn. Intratracheal intubation had to be performed for control of respiration. For the rest of the cases, acupuncture anesthesia proved satisfactory enough for operation to be carried through, but in most cases local anesthesia had to be supplemented at the site of skin incision for incomplete analgesia effect by acupuncture. Dolantin, used during operation, did not exceed 1 to 1.5 mg/kg in dosage. For incooperative children, we also used gamma hydroxybutyric acid for basal anesthesia in a dosage of 50 to 80 mg/kg.
All cases but one had a smooth postoperative recovery without pulmonary or other complications. The one case which did not recover so smoothly had an episode of pulmonary edema, the cause being probably undue dilution of the blood during perfusion (with a hematocrit of 15%).
Anesthetic and operative mortality were nil.
We have come to the conclusion that acupuncture anesthesia is an efficient technique for anesthetizing patients of congenital heart disease during intracardiac surgery under direct vision. It is simple, safe, and contributive to a smooth and speedy postoperative recovery with remarkably less pulmonary and other complications.
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