Department of Anesthesia, the Second Hospital, Hunan Medical College
From 1969 to 1975, 215 patients with rheumatic mitral stenosis were operated on (valvulotomy) under acupuncture anesthesia in our hospital. 205 patients were 20 to 40 years old and 10 patients were over 40. The degree of disability of 153 patients was classified to be grade II according to Chinese cardiac functional classification and that of 62 patients to be grade III. At the beginning, we used several points and the needles were manipulated by hand (27 cases). Needling at three points on the operated side were used later, which were Hegu, Neiguan penetrating to Waiguan; Hegu, Binao penetrating to Jianyu; Sanyanglu penetrating to Ximen, the "thoracic" area (of opposite scalp) with electrical stimulation (188 cases). The efficacy of acupuncture anesthesia was excellent in 116 cases (grade I), good in 71 cases (grade II) and moderate in 20 cases (grade III) and 8 cases were unsuccessful.
Our experience can be summarized as follows:
1. The relationship between the points and the efficacy: There was no significant difference in effect of acupuncture anesthesia between different groups of points we used. The analgesia was related to the intensity of needling stimulation. Greater electric stimulation provided better analgesia.
2. The relationship between the duration of operation and the efficacy: If the duration of operation was short the effect was good, otherwise the effect was poor.
3. The relationship between the cardiac function and the efficacy: The efficacy of acupuncture anesthesia was not related to the severity of the disease and the degree of disability as well.
4. The management of the mediastinal flutter: After the chest being opened the mediastinal flutter was the main source of failure of acupuncture anesthesia. So we trained the patient to practise slow abdominal respiration before the operation. Before entering the chest cavity oxygen was given, then a small incision was made in the pleura in order to make the patient adaptable to the change of pressure. The patient was advised to do deep and slow abdominal inspiration after the chest was opened. If the analgesia was not complete, 10-15 ml. of 0.25% procaine or 1% xylocaine could be used to block the intercostal nerves. By this way a better control over the mediastinal flutter could be achieved.
From 1969 to 1975, 215 patients with rheumatic mitral stenosis were operated on (valvulotomy) under acupuncture anesthesia in our hospital. 205 patients were 20 to 40 years old and 10 patients were over 40. The degree of disability of 153 patients was classified to be grade II according to Chinese cardiac functional classification and that of 62 patients to be grade III. At the beginning, we used several points and the needles were manipulated by hand (27 cases). Needling at three points on the operated side were used later, which were Hegu, Neiguan penetrating to Waiguan; Hegu, Binao penetrating to Jianyu; Sanyanglu penetrating to Ximen, the "thoracic" area (of opposite scalp) with electrical stimulation (188 cases). The efficacy of acupuncture anesthesia was excellent in 116 cases (grade I), good in 71 cases (grade II) and moderate in 20 cases (grade III) and 8 cases were unsuccessful.
Our experience can be summarized as follows:
1. The relationship between the points and the efficacy: There was no significant difference in effect of acupuncture anesthesia between different groups of points we used. The analgesia was related to the intensity of needling stimulation. Greater electric stimulation provided better analgesia.
2. The relationship between the duration of operation and the efficacy: If the duration of operation was short the effect was good, otherwise the effect was poor.
3. The relationship between the cardiac function and the efficacy: The efficacy of acupuncture anesthesia was not related to the severity of the disease and the degree of disability as well.
4. The management of the mediastinal flutter: After the chest being opened the mediastinal flutter was the main source of failure of acupuncture anesthesia. So we trained the patient to practise slow abdominal respiration before the operation. Before entering the chest cavity oxygen was given, then a small incision was made in the pleura in order to make the patient adaptable to the change of pressure. The patient was advised to do deep and slow abdominal inspiration after the chest was opened. If the analgesia was not complete, 10-15 ml. of 0.25% procaine or 1% xylocaine could be used to block the intercostal nerves. By this way a better control over the mediastinal flutter could be achieved.
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