Shanghai Chest Hospital
From February 1972 to the end of 1975, we have performed one hundred cases of serious mitral stenosis (S.M.S.) commissurotomy under acupuncture anesthesia. The success rate was 89%, of which 70% were excellent or satisfactory, no one died of anesthesia.
Among these 100 cases, 58 cases were female, 42 cases male, half of them had the ailment lasting more than 10 years, the longest being up to 36 years. 47% of them had a history of heart failure, some of them had suffered from repeated heart attacks up to 8 times. The diameter of the smallest orifice was 0.4 cm, the largest cardio-thorax ratio was 90%, 31% of the patients was scored in 4th grade of cardiac function. In 62% of the cases, EKG revealed atrial fibrillation before surgical intervention. Compared to the 123 simultaneous cases of non-serious mitral stenosis (N.M.S.), they presented about the same excellent or satisfactory score, while the failure rate of S.M.S. was significantly higher then N.M.S. (P<0.01).
During the course of surgical intervention, a strict respiratory management was applied: oxygen supply by intubation in 88 cases, by pressurized mask in 12 cases. The arterial blood gas analysis and acid-base index were all ranged within normal limits.
5% of the patients suffered from pulmonary edema, and all their orifice were less than 0.5 cm. After treatment, they all recovered within 2 hours.
Discussion:
1. The estimate of the safety of S.M.S. under acupuncture anesthesia:
Due to small orifice and poor function, the tolerance to anesthesia was not good. Under general anesthesia, 0.4% of the cases would die in induction stage. Here acupuncture anesthesia had its outstanding advantage in having a stable induction stage. Facts proved that the severity of disease is not a contraindication to acupuncture anesthesia. So, it is one of the safe methods in anesthesia indeed, but attention should be directed to a full supply of oxygen, a good management of pulmonary edema, before and after the operation.
2. The estimate of the effect of intubation on the course of S.M.S. operation under acupuncture anesthesia:
With the intratracheal tube, the PaO[2] and SatO[2] markedly increased, the activity of the muscles decreased, the acid-base index stabilized in the normal range, and the mediastinal paradoxical movement was minimized. All these provided a favorable condition for a careful operation and hemostasis. In case, that the orifice was very narrow, the lung function was greatly impaired, the C-T ratio was above 70%, cardiac function belonged to 4th grade, and the bilateral thoracotomy had to be applied, it would be much safer for the patients to have a strict respiratory management by means of an intubation.
From February 1972 to the end of 1975, we have performed one hundred cases of serious mitral stenosis (S.M.S.) commissurotomy under acupuncture anesthesia. The success rate was 89%, of which 70% were excellent or satisfactory, no one died of anesthesia.
Among these 100 cases, 58 cases were female, 42 cases male, half of them had the ailment lasting more than 10 years, the longest being up to 36 years. 47% of them had a history of heart failure, some of them had suffered from repeated heart attacks up to 8 times. The diameter of the smallest orifice was 0.4 cm, the largest cardio-thorax ratio was 90%, 31% of the patients was scored in 4th grade of cardiac function. In 62% of the cases, EKG revealed atrial fibrillation before surgical intervention. Compared to the 123 simultaneous cases of non-serious mitral stenosis (N.M.S.), they presented about the same excellent or satisfactory score, while the failure rate of S.M.S. was significantly higher then N.M.S. (P<0.01).
During the course of surgical intervention, a strict respiratory management was applied: oxygen supply by intubation in 88 cases, by pressurized mask in 12 cases. The arterial blood gas analysis and acid-base index were all ranged within normal limits.
5% of the patients suffered from pulmonary edema, and all their orifice were less than 0.5 cm. After treatment, they all recovered within 2 hours.
Discussion:
1. The estimate of the safety of S.M.S. under acupuncture anesthesia:
Due to small orifice and poor function, the tolerance to anesthesia was not good. Under general anesthesia, 0.4% of the cases would die in induction stage. Here acupuncture anesthesia had its outstanding advantage in having a stable induction stage. Facts proved that the severity of disease is not a contraindication to acupuncture anesthesia. So, it is one of the safe methods in anesthesia indeed, but attention should be directed to a full supply of oxygen, a good management of pulmonary edema, before and after the operation.
2. The estimate of the effect of intubation on the course of S.M.S. operation under acupuncture anesthesia:
With the intratracheal tube, the PaO[2] and SatO[2] markedly increased, the activity of the muscles decreased, the acid-base index stabilized in the normal range, and the mediastinal paradoxical movement was minimized. All these provided a favorable condition for a careful operation and hemostasis. In case, that the orifice was very narrow, the lung function was greatly impaired, the C-T ratio was above 70%, cardiac function belonged to 4th grade, and the bilateral thoracotomy had to be applied, it would be much safer for the patients to have a strict respiratory management by means of an intubation.
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