GASTRECTOMY UNDER COMBINED ACUPOINT LASER IRRADIATION EPIDURAL ANESTHESIA

Yu Zhiqin, Sun Zhifeng, Wang Xiuwen, Bian Xueping, Wu Gaosheng, Cao Renjiang, Zhao Ruitang,

(Rongcheng County Hospital, Shandong)

Wang YouUang, Wang kuan, Wang Sulin

(The Third Hospital of Beijing Medical College, Beijing)

Laser anesthesia had already achieved success in clinical use. Experimental studies showed that general analgesic effect and after analgesic effect were the characteristics of laser action. Because laser analgesia could be obtained without acupuncture, it was easy to be accepted by the patient. But there was also a defect, i.e., its analgesic effect was incomplete.

In order to improve its analgesic effect, we incorporated separate small dosage epidural anesthesia in point laser irradiation and applied this method to radical treatment of carcinoma ventriculi (15 cases) and subtotal gastrectomy of peptic ulcer (24 cases). Results were compared to those of similar surgical operations (carcinoma ventriculi 24 cases, peptic ulcer 43 cases) under combined acupuncture-epidural anesthesia, continuous epidural anesthesia, and acupuncture anesthesia. Average of pain score, cutaneous pain score, visceral pain score; average range of blood pressure fluctuations and pulse rates; average total dosage of anesthetics, dosage of anesthetics in the first hour, dosage of anesthetics per unit time and dosage of pressure-rising agents were parameters for examination.

Administration of drugs before operation: Sodium luminal O.lg i.m. was administered 1 hour before the operation. In 5 cases, Atropine 0.5 mg was injected hypodermically at the same time. During the induction period, Haloperidol 5 mg and Dolantinum 50 mg i.m. were given.

Methods of anesthesia: Routine epidural puncture and intubation at T8-9 (in 1 case, at T7-8), tube was inserted 3 mm towards the head. Bilateral Zusanii was irradiated with He-Ne laser. After 5 min., a mixture of 2% Lidocaine and 0,3% Dicaine was administered in 5 patients; after 15 min., 2% Lidocaine was infused through the epidural intubation in 34 patients. The dosage was 5 ml. Induction period was 20 min. If the analgesic effect was not sufficient for surgical operation at the beginning, every 3 ml were added until the patient felt no pain.

Results: Combined laser epidural anesthesia maintained the characteristics of acupuncture anesthesia. Its anesthetic effect was undoubtedly. The average rates of pain, cutaneous pain, and visceral pain differed from the acupuncture anesthesia group obviously, thus the anesthetic effect was improved. The dosage for supplementary epidural anesthesia •was only 1/2 of the commonly used and could not ensure the accomplishment of surgical operations of the same kind alone.

In all age groups, the amount of drugs used in combined laser epidural anesthesia was less than that used in epidural anesthesia. Patients felt no pain basically and the needs for surgical operations were satisfied.

The average ranges of blood pressure and pulse rate fluctuation were smaller than those of the epidural group. During surgical operation, dosage for blood pressure rising was not more than 1/3 of the epidural group.

Usually patients with carcinoma ventriculi were old and weak, their general conditions were bad. Thus, there were some risks in drug anesthesia. This method had the advantage of great safety and little physiological disturbance and it was worthy to be accepted and popularized. But the effect of combined laser epidural anesthesia had a disparity between individuals.