Chen Qinglian (Department of Anesthesia, First Hospital, Zhejiang Medical College)
From March 1975 to December 1978, 27 cases with various cardiac diseases, aged 12-36 years and weighed 27-58 kg., were subjected to intracardiac surgery under acupuncture anesthesia with extracorporeal circulation. Operative time lasted 3-6 hours and time for cardiopulmonary bypass from 9-105 minutes. The series comprised ventricular septal defects (16 cases), pulmonary stenosis (1), mitral valve prosthetic replacement (2), atrial septal defects (5), ruptured aneurysm of sinus Valsalvae (1) and tetralogy of Fallot (2). Anesthesia went on smoothly in all cases except one, to whom general anesthesia had to be resorted instead.
1. Method of anesthesia.
Patients were given instructions with drills in proper breathing for 3-5 days before operation. Premedication included intramuscular sodium luminal 2-3 mg/kg, and in apprehensive cases pethidine 1-2 mg/kg as necessary.
Points selected for acupuncture were "Hegu", "Neiguan" and "Qiemen" through "Sanyangluo" on both sides. Needles inserted were connected to an electric pulse stimulator and oxygen was given via a nasal catheter throughout the operation.
2. With the advantages such as no adverse effect to heart from anesthetics, and median sternotomy making it easy to handle patients' respiration, acupuncture anesthesia seems to be one of the most preferrable choices for open-heart surgery under extracorporeal circulation.
3. The need of adjuvant in adequate dosage. Since acupuncture anesthesia could not afford a completely anesthetic operative field, suitable adjuvant drug was usually mandatory. Recently compound anesthesia which has been emphasized and recommended, combining two or more narcotics exerting supplementary action upon one another, would provide an ideal balanced anesthesia easily to be managed. It is rational to adopt such measures. During acupuncture one should endeavour to strengthen the needling effect to its utmost extent. In the mean while, timely administered adjuvant in proper dosage would be considered in accordance with the surgical trauma induced at the operation site.
Basing on the data documented including subjective feeling of the patients we routinely administered 0.25% xylocaine 20-105 ml for local infiltration of the skin and periosteum. Prior to the skin incision or spliting up the sternum, Fentanyl 0.0015-0.0025 mg/kg or 0.15-0.2mg intravenously or instead, Innovar 0.04-0.06 ml/kg or 5-10 ml may be given. After the establishment of extracorporeal circuits repeated doses would be administered as necessary.
4. Prophylaxis of rigor. Patients who remained awakened during operation couldn't stand hypothermia well. Even though the priming solution was preheated to around 36ºC and rectal temperature was maintained between 33.5 and 36.5ºC, mainly above 35ºC during cardiopulmonary bypassing. Nevertheless, rigor did occur in 16 cases thereafter, about 20 minutes afterwards. Rigor may prevent patient's cooperation and increase the oxygen consumption in the course of operation. However, rigor usually subsided after intravenous pethidine 25-30 mg and rewarming with hot water bags at 45ºC or so. Prerequisits would be, therefore, to keep warm the priming solution and to keep dry the operating table. As the intracardiac operations was carried out in the room temperature, brain tissue would get beyond the protection from hypothermia. Once the machine failed to function well, it would be disastrous to the patient and hence prophylactic measures must be made ready for prompt security.
From March 1975 to December 1978, 27 cases with various cardiac diseases, aged 12-36 years and weighed 27-58 kg., were subjected to intracardiac surgery under acupuncture anesthesia with extracorporeal circulation. Operative time lasted 3-6 hours and time for cardiopulmonary bypass from 9-105 minutes. The series comprised ventricular septal defects (16 cases), pulmonary stenosis (1), mitral valve prosthetic replacement (2), atrial septal defects (5), ruptured aneurysm of sinus Valsalvae (1) and tetralogy of Fallot (2). Anesthesia went on smoothly in all cases except one, to whom general anesthesia had to be resorted instead.
1. Method of anesthesia.
Patients were given instructions with drills in proper breathing for 3-5 days before operation. Premedication included intramuscular sodium luminal 2-3 mg/kg, and in apprehensive cases pethidine 1-2 mg/kg as necessary.
Points selected for acupuncture were "Hegu", "Neiguan" and "Qiemen" through "Sanyangluo" on both sides. Needles inserted were connected to an electric pulse stimulator and oxygen was given via a nasal catheter throughout the operation.
2. With the advantages such as no adverse effect to heart from anesthetics, and median sternotomy making it easy to handle patients' respiration, acupuncture anesthesia seems to be one of the most preferrable choices for open-heart surgery under extracorporeal circulation.
3. The need of adjuvant in adequate dosage. Since acupuncture anesthesia could not afford a completely anesthetic operative field, suitable adjuvant drug was usually mandatory. Recently compound anesthesia which has been emphasized and recommended, combining two or more narcotics exerting supplementary action upon one another, would provide an ideal balanced anesthesia easily to be managed. It is rational to adopt such measures. During acupuncture one should endeavour to strengthen the needling effect to its utmost extent. In the mean while, timely administered adjuvant in proper dosage would be considered in accordance with the surgical trauma induced at the operation site.
Basing on the data documented including subjective feeling of the patients we routinely administered 0.25% xylocaine 20-105 ml for local infiltration of the skin and periosteum. Prior to the skin incision or spliting up the sternum, Fentanyl 0.0015-0.0025 mg/kg or 0.15-0.2mg intravenously or instead, Innovar 0.04-0.06 ml/kg or 5-10 ml may be given. After the establishment of extracorporeal circuits repeated doses would be administered as necessary.
4. Prophylaxis of rigor. Patients who remained awakened during operation couldn't stand hypothermia well. Even though the priming solution was preheated to around 36ºC and rectal temperature was maintained between 33.5 and 36.5ºC, mainly above 35ºC during cardiopulmonary bypassing. Nevertheless, rigor did occur in 16 cases thereafter, about 20 minutes afterwards. Rigor may prevent patient's cooperation and increase the oxygen consumption in the course of operation. However, rigor usually subsided after intravenous pethidine 25-30 mg and rewarming with hot water bags at 45ºC or so. Prerequisits would be, therefore, to keep warm the priming solution and to keep dry the operating table. As the intracardiac operations was carried out in the room temperature, brain tissue would get beyond the protection from hypothermia. Once the machine failed to function well, it would be disastrous to the patient and hence prophylactic measures must be made ready for prompt security.
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