PULMONARY RESECTION UNDER ACUPUNCTURE ANESTHESIA

Zhu Shuji, Tan Yuanliang

(Hunan Tuberculosis Hospital, Hunan)

The application of modified anterior incision to 92 cases of various pulmonary resections, including 46 wedge resections; 34 right upper lobectomies; 5 right and left lower lobectomies; 4 left apico-posterior segmentectomies; 1 right lower apical segmentectomy; 1 right middle lobectomy, under acupuncture anesthesia is reported.

The major steps of the incision are: If right upper or middle lobectomy is performed, the patient should be supine and his right side is raised to 30 degrees. If the other pulmonary resections are performed, the patient should take lateral position. The forearm of .the operative side is tied to the anesthetic supporter of the operation table in order to expose the axilla. The incision begins at the posterior axillary line, going forward and below the nipple to the edge of the sternum, (in female, the incision going below the breast). The thoracic cavity is entered through the third interspace for upper lobe or the fourth for lower lobe. The difference from traditional anterior incision is that the costal cartilages remain intact and the internal mammary vessels are preserved.

The benifits of the incision are: 1. Simplifying the operation and easing the pain. Several costal cartilages should be transectioned and internal mammary vessels should be ligated in old fashioned anterior incision. Many dorsal muscles should be severed and a rib should be rejected in posterior lateral incision. The modified anterior incision saves these procedures. The rib resection, which is the most painful step in pulmonary resection under the acupuncture anesthesia, could be avoided. The authors consider it is an important factor influencing the effect of acupuncture anesthesia to avoid pain in incision.

2. Having a good exposure: If a large field is needed, the spurator extends the interspace incision posteriorly; if the operation is a posterior hilum manipulation one, a lateral position is helpful.

3. Shortening the operation time, therefore a better acupuncture anesthetic effect is obtained.