COMBINED ACUPUNCTURE ANAESTHESIA FOR MITRAL COMMISSUROTOMY

Shao Huaibi, Li Gang, Song Zhenrui.

(Department of Anesthesia, Shandong Provincial People's Hospital, Jinan)

This article is a report of the preliminary experience of mitral commissurotomy under combined acupuncture anesthesia in 600 cases from April, 1966 till July, 1982. 4 points, namely, Hegu, Neiguan, Binto and Yifeng were used. Having got needling reaction, G 6805 electric acupuncture apparatus was utilized for maintaining the anesthesia. The respiratory function of the mitral stenotic cases was originally affected in varying degrees, and after the opening of the chest, it would be more deleterious. This article fully discussed the necessity of conscious intratracheal intubation and manual assisted respiration. During the operation, routinely appropriate dosage of analgesic was given and intercostal nerve block was done. The successful rate of acupuncture anesthesia was 96.1%, the failure only 3.9%. With the application of this method, not only the myocardial depression by general anesthetic could be avoided but also the effect of stabilizing and improving the circulatory function would be achieved. Among 600 cases in this series, 113 cases were with IV degree cardiac function and 172 cases with orifice below 0.8 cm. The blood pressure was rather stable through out the whole operation. Besides, the following measures should be taken: careful preoperative preparation and chosing the most optimum time for operation. It was important to have full effect of acupuncture upon the activity of the meridian and in regulating the function of vital energy and the state of the blood.

The advantage of acupuncture anesthesia for mitral stenosis could be summarized as follows: (I) enhancing the safety for the serious cases with poor cardiac function and small orifice. (2) prompt diagnosing cerebral embolism- After exploring or dilating the opening of the orifice, if the patient became unconscious or bilateral anisocoria, accompanied with localized signs such as hemiplegia or hypomyotonia, the diagnosis of cerebral embolism would be established. In this group altogether there were 7 cases of cerebral embolism. Except one case in which the patient died of middle cerebral artery embolism, the others recovered after treatment.