Liu Yingtao, Wan Dening, Shi Lanzhen, Zeng Qingda (Department of Anesthesiology, Second Hospital, Hupei Medical College, Wuchang)
From March 1973 to December 1978, 180 cases of esophageal carcinoma were operated under acupuncture anesthesia. With this new anesthesia procedure, tracheal intubation was usually unnecessary and the patients remained fully conscious and calm and co-operated throughout the entire course of operation.
1. Effect of anesthesia:
The 180 cases of esophageal carcinoma patients were divided into two groups, 90 patients each, using different sets of acupuncture points for comparison. In the first group, the acupuncture points of Jianyu, Tianzong, Zusanli and Shangjuxu were chosen. A blockade of Geguan and Yixi with 4-6 ml of a local anesthetic was supplemented. In the 2nd group, the points of Xiayifeng, Sanyangluo, Ren Channel and Du Channel were used without supplementary blockade. The results of this study clearly showed that the effect of anesthesia in the two groups was different significantly (P<0.01) and the effect in the first group was much better than that in the second group.
In order to study relationship between the location of the carcinoma and the effects of acupuncture anesthesia, 144 cases with gastric cardia cancer and esophageal carcinoma in the lower part were compared with 36 cases of carcinoma in the middle part of esophagus. The anesthetic effect showed significantly (P<0.05) better in the former cases than in the latter. The reason seemed to be that when the operation was performed on the middle part of the esophagus it was quite easy to lacerate the opposite pleura with result of bilateral preumothorax. However, if the intercostal approach was adopted without removing the rib and entered the thoracic cavity by initial small incision on pleura and stretching the ribs gradually, the majority of the patients responded to the treatment well with a fairly-good rate of 96.11% and an excellent rate of 78.89%.
Eight patients were chosen to observe their response to painful stimuli by the finger plethysmograph test. The plethysmograph showed that acupuncture anesthetic effect was excellent. However, when the drainage tube was applied the skin sutured and the stomach tracted the amplitude of the plethysmogram were very significantly reduced (P<0.01). These changes coincided with that of some painful feeling patients under accupuncture anesthesia showing incomplete analgesia.
2. Effect on respiration:
The patients were trained to take a slow and deep breath. So prior to operation the respiration rate and the tidal volume of the patients was correspondingly less and greater than normal. After the chest was open, the respiration rate increased the tidal volumes decreased, both significantly (P<0.01), but the ventilation volumes in the first hour after opening the chest was slightly less than normal with no clinical significance. The present study also suggested the function of the collapsed lobes of the lung could be compensated by those of the opposite lobes, when the operation was going on.
Ten cases were selected randomly to have their arterial blood pH, bicarbonate, buffer base, PO[2], PCO[2] and base excess measured. No statistical difference in blood analysis could be demonstrated in any stage (before, during and after) of the entire surgical procedure. These data indicated that operation would be quite safe under acupuncture anesthesia.
3. Effect on circulation:
The change of systolic pressure of 180 cases under acupuncture anesthesia was compared with that of 125 cases of conventional general anesthesia. Majority of the cases with acupuncture anesthesia showed greatly increased systolic pressure, while the conventional anesthesia cases showed a great decrease of BP. This would mean that acupuncture might have a role in stimulating the circulatory system in addition to its anesthetic effect.
From March 1973 to December 1978, 180 cases of esophageal carcinoma were operated under acupuncture anesthesia. With this new anesthesia procedure, tracheal intubation was usually unnecessary and the patients remained fully conscious and calm and co-operated throughout the entire course of operation.
1. Effect of anesthesia:
The 180 cases of esophageal carcinoma patients were divided into two groups, 90 patients each, using different sets of acupuncture points for comparison. In the first group, the acupuncture points of Jianyu, Tianzong, Zusanli and Shangjuxu were chosen. A blockade of Geguan and Yixi with 4-6 ml of a local anesthetic was supplemented. In the 2nd group, the points of Xiayifeng, Sanyangluo, Ren Channel and Du Channel were used without supplementary blockade. The results of this study clearly showed that the effect of anesthesia in the two groups was different significantly (P<0.01) and the effect in the first group was much better than that in the second group.
In order to study relationship between the location of the carcinoma and the effects of acupuncture anesthesia, 144 cases with gastric cardia cancer and esophageal carcinoma in the lower part were compared with 36 cases of carcinoma in the middle part of esophagus. The anesthetic effect showed significantly (P<0.05) better in the former cases than in the latter. The reason seemed to be that when the operation was performed on the middle part of the esophagus it was quite easy to lacerate the opposite pleura with result of bilateral preumothorax. However, if the intercostal approach was adopted without removing the rib and entered the thoracic cavity by initial small incision on pleura and stretching the ribs gradually, the majority of the patients responded to the treatment well with a fairly-good rate of 96.11% and an excellent rate of 78.89%.
Eight patients were chosen to observe their response to painful stimuli by the finger plethysmograph test. The plethysmograph showed that acupuncture anesthetic effect was excellent. However, when the drainage tube was applied the skin sutured and the stomach tracted the amplitude of the plethysmogram were very significantly reduced (P<0.01). These changes coincided with that of some painful feeling patients under accupuncture anesthesia showing incomplete analgesia.
2. Effect on respiration:
The patients were trained to take a slow and deep breath. So prior to operation the respiration rate and the tidal volume of the patients was correspondingly less and greater than normal. After the chest was open, the respiration rate increased the tidal volumes decreased, both significantly (P<0.01), but the ventilation volumes in the first hour after opening the chest was slightly less than normal with no clinical significance. The present study also suggested the function of the collapsed lobes of the lung could be compensated by those of the opposite lobes, when the operation was going on.
Ten cases were selected randomly to have their arterial blood pH, bicarbonate, buffer base, PO[2], PCO[2] and base excess measured. No statistical difference in blood analysis could be demonstrated in any stage (before, during and after) of the entire surgical procedure. These data indicated that operation would be quite safe under acupuncture anesthesia.
3. Effect on circulation:
The change of systolic pressure of 180 cases under acupuncture anesthesia was compared with that of 125 cases of conventional general anesthesia. Majority of the cases with acupuncture anesthesia showed greatly increased systolic pressure, while the conventional anesthesia cases showed a great decrease of BP. This would mean that acupuncture might have a role in stimulating the circulatory system in addition to its anesthetic effect.
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