Zhuang Xinliang, Qu Guilian, Zhou Juncheng, Wu Weilin, Wang Zhendi (Shanghai First People's Hospital)
The fluctuation of intracranial pressure is affected by several anaesthetics and method of anaesthesia. The effect of anaesthesia on intracranial pressure may be greater in patients with space-occupying lesions within the cranium than in normals. In order to sum up the clinical regularity of acupuncture anaesthesia, serial observations on the fluctuation of cerebrospinal fluid pressure by means of the ventricular drainage tube were carried out during induction of acupuncture anaesthesia or general anaesthesia respectively in 18 patients with intracranial space-occupying lesions; at the same time the fronto-mastoid process rheoencephalogram, the plethysmogram of the auricular lobule and the blood pressure at the upper arm by auscultation were taken, so as to explore the possible factors that might bring an effect on the fluctuation of CSF pressure.
Method of anaesthesia: Electro-acupuncture was applied at the Jinmen and Taichong points with the continuous pulses of 80-100 Hz produced by a G-6805 electro-acupuncture apparatus to induce anaesthesia for 20 minutes. 0.1g of phenobarbital and 0.3mg of scopolamine were administered intramuscularly half an hour before anaesthesia. General anaesthesia was induced with a hypnotising dose of sodium pentothal (average 300mg.) and succinyl choline (1mg/kg body wt.). Of the acupuncture anaesthesia group (6 cases), three experienced a drop in the CSF pressure, one showed no marked change while the other two had an elevated pressure of the CSF. The average of them was a decline of 17.0 mm H[2]O. The general anaesthesia group (12 cases) all witnessed a decrease in CSF pressure after the intravenous administration of sodium pentothal, with an average of 60.0 mm H[2]O; while CSF pressure rose to various degrees following intra-venous administration of succinylcholine, averaging 94 mm H[2]O. Besides, the acupuncture anaesthesia group showed an average increase of 3.6 mm Hg in their mean arterial pressure, 2.3 mm average elevation of the amplitude of plethysmographic wave, and an average decrease of 0.11 ohm in cerebral resistance. In the general anaesthesia group, the mean arterial pressure dropped on an average by 13.9 mm Hg, plethysmographic wave amplitude decreased by 2.5 mm (average), and cerebral resistance was lowered by an average of 0.02 ohm after sodium pentothal i.v. was given; but an average elevation of mean arterial pressure by 8.1 mm Hg, an average lowering of the plethysmographic wave amplitude by 1.5 mm and an average increase of cerebral resistance by 0.02 ohm followed the administration of succinylcholine i.v.. Analysis of these results showed that the way in which CSF pressure was affected was not consistent with that affected the amplitude of the plethysmographic wave of the auricular lobule and mean arterial pressure, but was in agreement with that brought about the fluctuation in cerebral resistance. Basing on the fluctuations in cerebral resistance, it is postulated that the change of cerebral blood flow and the dilatation and contraction of cerebral blood vessels are the primary causes that effectuate the rise or fall in CSF pressure.
The fluctuation of intracranial pressure is affected by several anaesthetics and method of anaesthesia. The effect of anaesthesia on intracranial pressure may be greater in patients with space-occupying lesions within the cranium than in normals. In order to sum up the clinical regularity of acupuncture anaesthesia, serial observations on the fluctuation of cerebrospinal fluid pressure by means of the ventricular drainage tube were carried out during induction of acupuncture anaesthesia or general anaesthesia respectively in 18 patients with intracranial space-occupying lesions; at the same time the fronto-mastoid process rheoencephalogram, the plethysmogram of the auricular lobule and the blood pressure at the upper arm by auscultation were taken, so as to explore the possible factors that might bring an effect on the fluctuation of CSF pressure.
Method of anaesthesia: Electro-acupuncture was applied at the Jinmen and Taichong points with the continuous pulses of 80-100 Hz produced by a G-6805 electro-acupuncture apparatus to induce anaesthesia for 20 minutes. 0.1g of phenobarbital and 0.3mg of scopolamine were administered intramuscularly half an hour before anaesthesia. General anaesthesia was induced with a hypnotising dose of sodium pentothal (average 300mg.) and succinyl choline (1mg/kg body wt.). Of the acupuncture anaesthesia group (6 cases), three experienced a drop in the CSF pressure, one showed no marked change while the other two had an elevated pressure of the CSF. The average of them was a decline of 17.0 mm H[2]O. The general anaesthesia group (12 cases) all witnessed a decrease in CSF pressure after the intravenous administration of sodium pentothal, with an average of 60.0 mm H[2]O; while CSF pressure rose to various degrees following intra-venous administration of succinylcholine, averaging 94 mm H[2]O. Besides, the acupuncture anaesthesia group showed an average increase of 3.6 mm Hg in their mean arterial pressure, 2.3 mm average elevation of the amplitude of plethysmographic wave, and an average decrease of 0.11 ohm in cerebral resistance. In the general anaesthesia group, the mean arterial pressure dropped on an average by 13.9 mm Hg, plethysmographic wave amplitude decreased by 2.5 mm (average), and cerebral resistance was lowered by an average of 0.02 ohm after sodium pentothal i.v. was given; but an average elevation of mean arterial pressure by 8.1 mm Hg, an average lowering of the plethysmographic wave amplitude by 1.5 mm and an average increase of cerebral resistance by 0.02 ohm followed the administration of succinylcholine i.v.. Analysis of these results showed that the way in which CSF pressure was affected was not consistent with that affected the amplitude of the plethysmographic wave of the auricular lobule and mean arterial pressure, but was in agreement with that brought about the fluctuation in cerebral resistance. Basing on the fluctuations in cerebral resistance, it is postulated that the change of cerebral blood flow and the dilatation and contraction of cerebral blood vessels are the primary causes that effectuate the rise or fall in CSF pressure.
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