AURICULO ACUPUNCTURE AND BASAL ANESTHESIA FOR ABDOMINAL OPERATIONS AMONG CHILDREN

Wu Yuefeng, Song Qingxuan.

(Beijing Children's Hospital) Zhuang Ding (Institute of Acupuncture, Academy of TCM, Beijing)

For the majority of children basal anesthesia is necessary to any operation under conscious analgesia. Acupuncture anesthesia is a kind of conscious analgesia and therefore the need of basal anesthesia is reasonable. In order to evaluate the true effect of auriculo-acupuncture, we conducted a clinical comparison between the combined auriculo-acupun-cture plus basal anesthesia and the same basal anesthesia used alone,

29 unselected abdominal patients were divided into two groups: 20 received auriculo-acupuncture anesthesia and 9 controls received basal anesthesia. The ages ranged from 7 months to 10 years, and among them 21 were boys and 8 girls.

Operations performed were: Splenectomy, radical operation for Hirschsprung's disease, reconstruction of biliary tract for congenital choledochocyat, removal of abdominal tumor, closure of intestinal fistula etc. An intramuscular injection of meperidine 1 mg/kg and phe-nergan 0.5 mg-1 mg/kg was given 30 min prior to operation. For those under one year of age, scopolamine 0.01 mg/kg was used instead of meperidine.

Acupoints were selected as: Pi thru Fei and Wei thru Dachang and Xiaochang on both ears or the ear of the same side of the abdominal incision.

Before acupuncture, 2.5% sodium pentothal 20 mg/kg was given intramuscularly as a basal anesthesia. Needles were applied after the child slept soundly. Galvanic electric stimulation at a frequency from 20-100 Hz/sec, continuous wave impulse was used and the intensity was adjusted between 1-4.5 V according to the response and tolerance of patient. Induction period was 15-30 min.

For those in control group basal anesthesia and the premeditation were exactly the same but no acupuncture was given. 10-15 minutes before incision, meperidine 1 mg/kg, iv, was given to both groups. Additional dose of sodium pentothal and sometimes ketamine or Hanjisong (a herb muscle relaxant) was also given as required.

Through out the whole course of the anesthesia, the following records were made constantly: biood pressure, pulse rate, respiration, EKG and capilliary volume of the fingertip. At the end of operation all drugs used and their total dose, general reaction of the patient during the operation, and the general evaluation from the surgeons were also recorded as the criteria for evaluating the effectiveness of acupuncture anesthesia.

Results of Observation

1). Among the 20 patients of the acupuncture group, average total dose of pentothal was 34.0+9.8 mg/kg/hr. All patients, except 1 case received Hanjisong, had their operation smoothly without other adjunct medication. In 9 patients of the control group, pentothal dosage was 48.5±8.6 mg/kg/hr. 7 patients required Hanjisong 0.55+0.18 mg/kg/ and 1 of those 7 patients even required an additional dose of ketamine 5.41 mg/kg/hr.

2). Among 20 cases of the acupuncture group, 18 were good in grading. In the control group of basal anesthesia, only 2 out of 9 cases had their operation smoothly and only one was good in grading. The statistical difference is remarkable. (P<0.05).

3. Elevation of B. P. and pulse rate and decrease of capilliary volume of the fingertip were observed in both groups without significant difference. These changes represented the reaction of pain. Increase of respiration frequency was 9.9±7.4 times per minute in Acu-group, 12.9+6.1 times per minute in control group. In addition holding-breath shown in the recorded respiration curve was observed in the control group during suturing of wound or forceful retraction of viscera. Besides some moving of part of body during operation was recorded as 25±1.5 times/hr, in acupuncture group 6.6±8.4 times/hr. to the control.

Conclusion

Under the effect of basal anesthesia, psychological factor has been ruled out; we can clearly see auriculo-acupuncture plus basal anesthesia is significantly much better than the same basal anesthesia alone.