Department of Anesthesiology, Lda First People's Hospital
Forty-seven cases of posterior fossa operations under acupuncture anesthesia were done between 1974-1978, which included trigeminal neuralgia, cerebellopontine angle tumor, infratentorial arachnoid adhesion, cerebellar abscess and tumor, third and fourth ventricular tumor, glossopharyngeal neuralgia, tumor in the region of the foramen magnum and basilar malformation.
Two combinations of acupuncture points were used, one was Futu penetrating to Fengchi and the other was the points for posterior fossa operation adopted by national conference. The rate of excellent and good results was 77.2% and 74.8% respectively. The difference was not statistically significant. In one case of 4th ventricular tumor the respiratory rate of the patient slowed down to 8/min. for a short duration. In another case of tumor in the region of the foramen magnum, apnea occured suddenly during the dissection of the tumor, resuscitation failed and the patient died 10 hours postoperatively. Blood pressure and pulse were stable during the operation in the remaining cases. In five cases acupuncture anesthesia was carried out after awake intubation of the patient and the results were satisfactory. Nausea and vomiting occurred in 10 cases.
1. Management of respiration: Since vital centers may be involved during the operation, sudden apnea might occur, therefore the anesthetists must always be on the alert. In patients who had already respiratory difficulties before operation, acupuncture anesthesia should be applied with caution. Awake intubation makes the operation safer in severe cases and cases that might involve the vital centers. The patient should lie in the lateral position to facilitate treatment in case of emergency.
2. The cause of nausea and vomiting: Nausea and vomiting occurred in 40% of patients undergoing the sectioning of the sensory root of trigeminal nerve. In addition to the dynamic disturbances of cerebro-spinal fluid it might also be the result of traction during exposure of the trigeminal nerve and pressing upon the vestibular nerve. Increase in the intra-cranial pressure and stimulation of dura may also be the cause. For prevention, nothing should be taken by mouth before operation and the surgical manipulations should be gentle, quick, sure and precise. When vomiting occurs, operation should be stopped temporarily and acupuncture and antiemetics should be used.
Forty-seven cases of posterior fossa operations under acupuncture anesthesia were done between 1974-1978, which included trigeminal neuralgia, cerebellopontine angle tumor, infratentorial arachnoid adhesion, cerebellar abscess and tumor, third and fourth ventricular tumor, glossopharyngeal neuralgia, tumor in the region of the foramen magnum and basilar malformation.
Two combinations of acupuncture points were used, one was Futu penetrating to Fengchi and the other was the points for posterior fossa operation adopted by national conference. The rate of excellent and good results was 77.2% and 74.8% respectively. The difference was not statistically significant. In one case of 4th ventricular tumor the respiratory rate of the patient slowed down to 8/min. for a short duration. In another case of tumor in the region of the foramen magnum, apnea occured suddenly during the dissection of the tumor, resuscitation failed and the patient died 10 hours postoperatively. Blood pressure and pulse were stable during the operation in the remaining cases. In five cases acupuncture anesthesia was carried out after awake intubation of the patient and the results were satisfactory. Nausea and vomiting occurred in 10 cases.
1. Management of respiration: Since vital centers may be involved during the operation, sudden apnea might occur, therefore the anesthetists must always be on the alert. In patients who had already respiratory difficulties before operation, acupuncture anesthesia should be applied with caution. Awake intubation makes the operation safer in severe cases and cases that might involve the vital centers. The patient should lie in the lateral position to facilitate treatment in case of emergency.
2. The cause of nausea and vomiting: Nausea and vomiting occurred in 40% of patients undergoing the sectioning of the sensory root of trigeminal nerve. In addition to the dynamic disturbances of cerebro-spinal fluid it might also be the result of traction during exposure of the trigeminal nerve and pressing upon the vestibular nerve. Increase in the intra-cranial pressure and stimulation of dura may also be the cause. For prevention, nothing should be taken by mouth before operation and the surgical manipulations should be gentle, quick, sure and precise. When vomiting occurs, operation should be stopped temporarily and acupuncture and antiemetics should be used.
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