Zhang Xingya et al. (Department of Anesthesia, First Hcapital of Zhongguo Medical College)
95 cases of mitral commissurotomy under acupuncture anesthesia during a ten-year period (1966-1976) were surveyed. There were 54.7% patients with poor cardiac function (grade III or IV). 87 cases were valvotomied through right interatrial groove, the remainder through left ventricle. Premedication consisted of sodium luminal (0.1g) and scopolamine (0.3 mg) intramuscularly. The acupuncture points were Hegu, Neiguan and Zhigou on the operated side, Xinshu, Geshu or points along spinal roots of T4 and T5 on the back. All patients were stimulated by electrical pulse stimulator except 9 cases by hand manoeuvre. Adjuvant drugs such as morphine 0.1 mg/kg or pethidine 1.0 mg/kg might be required before incision, and sometimes half dose of them was administered again before valvotomy by intravenous route. Most of the patients underwent acupuncture anesthesia successfully without further drugs during the entire operation. Only few of them might develop reaction for poor control of pain and local anesthetics such as procaine was given as local infiltration or nerve blocking. Large doses of narcotic agents should be avoided, because amnesia and respiratory depression might occur and cause more troubles during operation. 4 cases failed in this series, two of them due to large doses of narcotic agents. Respiratory control was most important under acupuncture anesthesia in this kind of operation. Any respiratory embarrassment during opening of chest might aggravate the poor cardiac function and give rise to arrhythmia. In 43 patients of better cardiac reserve (grade I and II), they might tolerate chest opening with "respiratory exercise". That was to respirate rhythmically, deeply and slowly with diaphragmic movement. Sometimes manually assisted respiration with face mask was given in 19 cases. In 52 patients with poor cardiac function (including grade III and IV), the cuffed endotracheal tubes were intubated under topical analgesia before operation, and conn
ected with closed anesthetic machine. This helped to control the respiration and prevent mediastinal flutter. In those patients with servere pulmonary congestion, extensive hemosiderosis, chronic bronchitis, pulmonary emphysema, low pulmonary compliance, cardiac hypertrophy and the presence of atrial fibrillation or cyanosis, they might be supported by assisted respiration, and gradually induced controlled respiration with intermittent positive pressure, to satisfy the patients' needs of ventilation and oxygen demand. Surgical manipulation should be carried out steadily, precisely, lightly and nimbly.
In our experiences, it is safer and more reliable to correct respiratory embarrassment by assisted respiration with face mask or intubation. Acupuncture anesthesia served as an effective analgesic with no myocardial depression and side-effects, and there were little changes of blood pressure, cardiac rate and rhythm. Severe complications including pulmonary edema were not encountered during operation. Since acupuncture anesthesia was equally effective in patients of good and poor cardiac function, it was a suitable method for poor-risk patients and resulted in quicker recovery with early food intake. Patients have better myocardial function in the postoperative period than preoperative, and there was not a single death in this series.
95 cases of mitral commissurotomy under acupuncture anesthesia during a ten-year period (1966-1976) were surveyed. There were 54.7% patients with poor cardiac function (grade III or IV). 87 cases were valvotomied through right interatrial groove, the remainder through left ventricle. Premedication consisted of sodium luminal (0.1g) and scopolamine (0.3 mg) intramuscularly. The acupuncture points were Hegu, Neiguan and Zhigou on the operated side, Xinshu, Geshu or points along spinal roots of T4 and T5 on the back. All patients were stimulated by electrical pulse stimulator except 9 cases by hand manoeuvre. Adjuvant drugs such as morphine 0.1 mg/kg or pethidine 1.0 mg/kg might be required before incision, and sometimes half dose of them was administered again before valvotomy by intravenous route. Most of the patients underwent acupuncture anesthesia successfully without further drugs during the entire operation. Only few of them might develop reaction for poor control of pain and local anesthetics such as procaine was given as local infiltration or nerve blocking. Large doses of narcotic agents should be avoided, because amnesia and respiratory depression might occur and cause more troubles during operation. 4 cases failed in this series, two of them due to large doses of narcotic agents. Respiratory control was most important under acupuncture anesthesia in this kind of operation. Any respiratory embarrassment during opening of chest might aggravate the poor cardiac function and give rise to arrhythmia. In 43 patients of better cardiac reserve (grade I and II), they might tolerate chest opening with "respiratory exercise". That was to respirate rhythmically, deeply and slowly with diaphragmic movement. Sometimes manually assisted respiration with face mask was given in 19 cases. In 52 patients with poor cardiac function (including grade III and IV), the cuffed endotracheal tubes were intubated under topical analgesia before operation, and conn
ected with closed anesthetic machine. This helped to control the respiration and prevent mediastinal flutter. In those patients with servere pulmonary congestion, extensive hemosiderosis, chronic bronchitis, pulmonary emphysema, low pulmonary compliance, cardiac hypertrophy and the presence of atrial fibrillation or cyanosis, they might be supported by assisted respiration, and gradually induced controlled respiration with intermittent positive pressure, to satisfy the patients' needs of ventilation and oxygen demand. Surgical manipulation should be carried out steadily, precisely, lightly and nimbly.In our experiences, it is safer and more reliable to correct respiratory embarrassment by assisted respiration with face mask or intubation. Acupuncture anesthesia served as an effective analgesic with no myocardial depression and side-effects, and there were little changes of blood pressure, cardiac rate and rhythm. Severe complications including pulmonary edema were not encountered during operation. Since acupuncture anesthesia was equally effective in patients of good and poor cardiac function, it was a suitable method for poor-risk patients and resulted in quicker recovery with early food intake. Patients have better myocardial function in the postoperative period than preoperative, and there was not a single death in this series.
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