Liaoning Cooperative Group of Acupuncture Anesthesia for Gastrectomy
In order to improve the effect of acupuncture anaesthesia in subtotal gastrectomy, we had carried out the following studies:
(1) The selection of points: The conventional point of choice in gastrectomy is Zusanli, but it was unsatisfactory with visceral pulling reaction. We have achieved better result by using points on the face.
In a trial of 58 cases, the grades I and II cases made up 88.9% in 36 cases using points on face (Zanzhu through Zanzhu, Tingxue) as compared with 59.0% in 22 cases using points on abdomen (Zhangmen through Jiuwei). The difference was statistically significant (P<0.01). The reactions to visceral pulling was milder in the former. The surgeons and the anaesthetist were the same in both groups.
Since then, 148 patients have been operated using the facial points, and grades I and II cases still persisted at 87.2%.
(2) Prediction test before operation: Observations on the changes of some physiological indices (BP, P, pulse wave and sweating etc.) during gastrectomy under acupuncture anaesthesia indicated that the efficacy of acupuncture anaesthesia had a close relation with the functions of autonomic nervous system. We studied the patterns of reactions of autonomic nervous system of patients so as to clarify the dependent factors in individuality and to improve the selection of candidates for operation.
The patients were divided into 4 types according to their patterns of reactions to adrenalin and pressure on the eyeballs:
1. Sympatho-sensitive: After subcutaneous injection of 8 µg/kg adrenalin, the elevation of BP exceeded 20 mmHg, the acceleration of pulse rate exceeded 10 per min. and the amplitude of pulse wave diminished over 1/3 of that before injection. The oculo-cardiac reflex was unremarkable. 16% of these patients were of grade I.
2. Parasympatho-sensitive: The oculo-cardiac reflex was prominently shown (Pulse rate decreased more than 10 per min.), but the reactions to adrenalin were not remarkable. Grade I made up 28.6% in this group.
3. Insensitive: No significant reactions to both stimuli. Grade I cases were of 37%.
4. Mixed sensitive: Sensitive to both stimuli. Grade I cases as low as 9%.
The differences between groups were statistically significant.
(3) The modification of operative procedures: The procedures on closure of the stump of duodenum and retrocolic gastro-jejunal anastomosis were modified and unnecessary pullings on stomach and intestine were avoided.
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