THYROID OPERATIONS UNDER ACUPUNCTURE ANESTHESIA

Chen shude, Qin Biguang Zhuang Xinliang, Yu Zhihao, Chen Benlu

(National Cooperative Group of Acupuncture Anesthesia for Thyroid Operation)

According to the unified research plan, acupuncture anesthesia method, surveying categories and grading standard, we have used three groups of points for 13,314 thyroid operations.

Including thyroid cyst 2,283; thyroid adenoma 5,951; nodular thyroid adenoma 2,813; hyperthyroidism 1,538; thyroid adenocarcinoma 322 and other 427 cases.

Acupuncture anesthesia method

1) Point prescriptions have arranged in three groups: Hegu, Neiguan, Futu and acuri-culo points (Jing, Shenmen, Fei, Jiaogan).

2) stimulating frequency: With electro-pulse wave of acupuncture anesthesia meter, for Hegu, Neiguan 2~8 Hz, for Futu and auriculo-points 40~80 Hz. Intensity was from weak to strong until the patient could be tolerated.

3) Introduction time was 15-30 mins.

4) Administrations prior to operation: Generally, Luminal, Atropine or Copolamine was to be used. In hyperthyroidism cases, other than the above mentioned, Diazepam or Droperidol might be administrated. 15 mins. before making incision, 1 mg. per kg. of body weight of Pethidine was given intravenously.

The excellent rate of all 13,514 cases was 85.3%, successful rate 95.4%. The excellent rates of the three point groups were 85.3%, 84.6% and 86,3% respectively (no significant statistic difference). The excellent rate of thyroid cystectomy or adnomectomy was better than that of subtotal or total thyroidectomy (with significant statistic difference). But as the time of operation went on, the excellent rate droped gradually. Administration of some anesthetic analgesia could appropriately improve the analgesic effect during operation. Acupuncture anesthesia in operation of hyperthyroidism might also get good effect. Blood pressure and pulse rate were usually stable throughout the whole course of operation.

There are many advantages in using acupuncture anesthesia in thyroid operations. Patients are always kept conscious and naturally cooperate with the operator; the injury of recurrent laryngeal nerve could be easily avoided, so as to reduce all side effects and other anesthesia complications to a minimum. Patients can take food and come off bed earlier than usual. All are quite beneficial to patients convalescence.

There is no need to use very special complex instruments to carry out the technique of acupuncture anesthesia, it is easily managed by ordinary surgeons and popularized easily. Acupuncture anesthesia is better for thyroid cystectomy or adenomectomy which is performed within two hours and it also may be selected for hyperthyroidism cases. In radical thyroidectomy for adenocarcinoma combined acupuncture anesthesia has been used in other hospital and the anesthetic effect has been raised.

The analgesic effect of the three point groups is comparatively stable. Any one of them will be selected to perform thyroid operations with good effect.

During thyroid operation under acupuncture anesthesia, the ordinary anesthetic guidances are still very important, such as to keep the patency of respiratory tract and the stability of circulation and to handle the intravenous infusion and blood transfusion properly etc. Patient's head should be arranged in a very comfortable position and not too extended posteriorly in order to keep the air passage free, such will give more facilities to reduce the occurrence of obstruction of respiratory tract in the operation and headache after operation,