Li Minxue, Liu Qin, Wang Can (Beijing Tuberculosis Hospital)
From Nov. 1966 to Sept. 1978, 640 intrathoracic operations (lobectomy and segmental resection in 527, pneumonectomy in 51 and operation for empyema etc. in 62) under acupuncture anesthesia were performed in Beijing Tuberculosis Hospital. Because of marked mediastinal flutter, paradoxical respiration and retention of carbon dioxide during thoracotomy 5 of them general anesthesia had to be resorted instead.
In order to prevent the above mentioned complications, intrathoracic operations under acupuncture with intratracheal intubation have been done selectively in 192 patients since 1975. Oscillation method was used to monitor the change of respiratory resistance after intratracheal intubation during thoracotomy under acupuncture in 41 cases. It was found that the respiratory resistance was more than twice as normal during cough, mediastinal flutter or when there was a lot of tracheal secretion. The advantages of intratracheal intubation are: timely aspiration of secretions to reduce the respiratory resistance, especially in patients with poor respiratory function and copious secretions, and easier to control respiration, to ensure patients' security.
Valium and droperidol may be given prior to intubation to minimize the irritation due to intubation, to calm the patient and to make him tolerate the tube better.
Although there are many advantages of acupuncture anesthesia with intubation, care must be taken in patients with hypertension in whom blood pressure will rise persistently after thoracotomy, in patients with copious secretions to whom repeated aspiration will influence the smoothness of respiration and operation procedures, and in patients with too low a respiratory reserve, severe dyspnea may develop after the chest opened. Therefore, adequate management of respiration should be practiced even with intratracheal intubation, and the indication of accupuncture anesthesia for those patients must be prudent.
From Nov. 1966 to Sept. 1978, 640 intrathoracic operations (lobectomy and segmental resection in 527, pneumonectomy in 51 and operation for empyema etc. in 62) under acupuncture anesthesia were performed in Beijing Tuberculosis Hospital. Because of marked mediastinal flutter, paradoxical respiration and retention of carbon dioxide during thoracotomy 5 of them general anesthesia had to be resorted instead.
In order to prevent the above mentioned complications, intrathoracic operations under acupuncture with intratracheal intubation have been done selectively in 192 patients since 1975. Oscillation method was used to monitor the change of respiratory resistance after intratracheal intubation during thoracotomy under acupuncture in 41 cases. It was found that the respiratory resistance was more than twice as normal during cough, mediastinal flutter or when there was a lot of tracheal secretion. The advantages of intratracheal intubation are: timely aspiration of secretions to reduce the respiratory resistance, especially in patients with poor respiratory function and copious secretions, and easier to control respiration, to ensure patients' security.
Valium and droperidol may be given prior to intubation to minimize the irritation due to intubation, to calm the patient and to make him tolerate the tube better.
Although there are many advantages of acupuncture anesthesia with intubation, care must be taken in patients with hypertension in whom blood pressure will rise persistently after thoracotomy, in patients with copious secretions to whom repeated aspiration will influence the smoothness of respiration and operation procedures, and in patients with too low a respiratory reserve, severe dyspnea may develop after the chest opened. Therefore, adequate management of respiration should be practiced even with intratracheal intubation, and the indication of accupuncture anesthesia for those patients must be prudent.
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