| BackgroundThe use of narcotics has been developing for a hundred years since the analgesiceffect of local application of cocaine was discovered by Keller of Vienna, which hasbrought great progress for the development of surgry. At present, anesthesiology hasentered a stage of rapid development. With the anesthetic technology and anaestheticconstantly being updated, the anesthesia complications tend to have less. In1944, themortality of anesthesia is1/1000by Gillespie. However, in the60’s of last century,Memery (1965) reported that anesthesia mortality at private hospitals has been reduced to 1:3145. In1999the United States medical institutions (Institute of Medicine, IOM) of thehealth care quality Commission reported that the safety of anesthesia greatly improved,and anesthesia mortality rate which from two hundred thousand to1/300000has beenconfirmed by the2/10000decline in nineteen eighties to the end of the twentiethCentury.The safety of anesthesia is increasingly being recognized. However, this does notmean that anesthesia is safe. It is not accepted if death is due to anesthesia in today’smedical condition, and is a very serious incident. There are a lot of reasons for anesthesiadeath. The main reason is the excessive amount of narcotic drugs. Therefore, in order toreduce the death, an important strategy of anesthesia is that it is should be reducedconsumption of narcotic drugs. Regional anesthesia has been confirmed abroad, whichcombined with general anesthesia can reduce the dosage of narcotic drugs. It is a veryeffective way to reduce the amount of anesthetic drugs that regional anesthesia combinedwith general anesthesia. For regional anesthesia complications, there are a alarge samplesurvey of many clinical center in developed countries, France, Sweden, the United Statesof America, but it is still no information in China. Therefore, the situation allows ofno delay about current investigation situation regional anesthesia complications in China.This study led by The Fourth Military Medical University Xijing Hospital, cooperatedwith11anesthesia Center. The study is for25months by clinical multicenter survey on theregional anesthesia. The major surveys is about patients type, gender differences,distribution of departments and some related factors. It provide a reliable reference dataabout the current Chinese regional anesthesia complications.In addition to regional anesthesia can reduce consumption of narcotic drugs,acupuncture can be used effectively in sedative action in the1950s and1960s, includingcraniotomy in highly complex operation. We also confirmed that acupuncture has asynergistic effect of narcotic drugs, and can reduce the dosage of narcotic drugs in generalanesthesia. It will further promote the acupuncture anesthesia that is one of the ways ofgeneral anesthetics dosage reduction. It is important scientific significance and applicationvalue to study the effect and mechanism of acupuncture anesthesia. In the animalexperiment, acupuncture has been proved to be brain protection, sedation and anesthesia. Sedation is another important mechanism of acupuncture in the general anesthesia. Butthere is not related experiments. In our study, we try to address the sedative action ofacupuncture experimental study in the human body and the further related mechanism bythe method of functional magnetic resonance imaging.Part1: Clinical Investigation on Complications of Regional Anesthesia by MultipulcentersObjectiveTo investigate the patients of neurological complications of regional anesthesia in11anesthesia centers, and patients type, gender differences, distribution of departments andsome related factors.MethodsWe convened anesthesiologist from11national level hospitals to training and uniformstandards, In the doctor’s guidance and supervision, the anesthesia doctors fill in the"regional anesthesia complications record", and follow-up investigation of thepostoperative complications by the anesthesiologist full-time. And timely record the datainput to the ACCESS2003database. The investigations were carried out in25months.Finally we carries on the data collection using the SQL server system, and analysisinfluence and relevant factors of current regional anesthesia complications in China.ResultsIn the research of25months, we collected106569cases that operated egionalanesthesia from11three level of first-class hospital. Because emergency and not timelyinput, the loss cases is4228,and the loss rate is4%. The completion of the investigation inall cases include35698cases of epidural anesthesia,49673cases of combinedspinal-epidural anesthesia,12723cases of spinal anesthesia,8316cases of brachial plexusanesthesia and701cases of cervical plexus anesthesia. Various complications occurred ina total of cases is313. The incidence rate is29.4/104, including:37cases of seriouscomplications (including9cases of Horner syndrome, recurrent laryngeal nerve block in6 cases,1cases,2cases with cardiac arrest,5cases of hematoma, tic catheter fracture in1cases;1cases of paraplegia,2cases of cauda equina syndrome and abnormal widely10cases of block), the incidence is3.5/10000;145cases of headache, the incidence is1.4/103,131cases of temporary nerve irritation, the incidence is1.2/103. Residualsymptoms is23cases. There are more than7days of complications occurred in313patients. Men of the serious complications rate was3.3/104. Women of the incidence ofcomplications is3.4/104,and no significant differences between men and women.Thehighest incidence of serious complications in Investigation Department of is VascularSurgery7.7/104, and the least is obstetric,Orthopaedic Surgery and Department of thoracicsurgery.Spinal anesthesia in serious complications were highest in sacral anesthesia(28/104). Nerve block anesthesia complication rate was highest in the cervical plexusanesthesia (1.4%).In the brachial plexus anesthesia with susceptible method positioning ofserious complications of anesthesia is19cases, and the application method of theultrasonic guided brachial plexus anesthesia occurred complicated with severe disease isonly2case.ConclusionBy the clinical investigation of national multicenter, large sample, prospective, weprovide proportional incidence of serious complications, the proportion, the distribution ofevery clinical surgical, gender distribution, intraspinal anesthesia and nerve blockanesthesia in all kinds of anesthesia methods may be severe complication occurred inChina, overall complications of regional anesthesia and the anesthesia complications dataof B ultrasound guided under brachial plexus. The clinical investigation filled the gaps inthe complications of regional block anesthesia, and provided data for the study of clinicalstrategies and regional anesthesia.Part2: The Mechanism of Acupuncture treatment on SedationObjective Discussion about acupuncture treatment can reduce the BIS value to reach sedation,and mechanism of acupuncture sedative action with the method of functional magneticresonance imaging study.MethodsWe analyzed15volunteers (subjects) age from20to35, including8females and7males. Divided into3groups randomly (n=15): Acupuncture group (EA): Stimulating aimacupoints by EA, Conduction group (Con): Stimulating the conduction acupoints in thesame panel of aim acupoints, Control group (Sham): Fasten the electrode plate on aimacupoints without stimulation. Every subject received all of three projects above, in threerandom days from6pm to9pm. Comparison of the effect themselves before and after thetest carried out under following conditions, same temperature(18-20℃),samehumidity(30%-40%),avoiding of any unnecessary noise, subjects take15min rest beforereceiving the30min test, simultaneously, observe their blood pressure, heart rate, pulseoxygen saturation and BIS Value in every5min.According to location, like T2,T1weighted precontrast scan,BOLD (blood oxygenation level dependent scanning) and PASLsequence,and then immediately17min electroacupuncture stimulation.In the EA processevery5min record subjects blood pressure,heart rate,pulse oxygen saturation and the BISvalue,electroacupuncture stimulation after the end of fMRI scanning17min,sequence ispositioned like,weighted T1scan and BOLD(blood oxygenation level dependent scan).Results1)EA group:Statistical BIS Value difference between0min and other timecheckpoints (P<0.001),no significant BIS Value difference in between other timecheckpoints.Con group:Statistical BIS Value difference between0min and5min,10minand15min(P=0.007,0.004,0.010),no significant BIS Value difference in between othertime checkpoints.Sham group:Statistical BIS Value difference between0min and10min(P<0.05), no significant BIS Value difference in between other time checkpoints; sameBIS Value at0min on all three projects was also observed; Statistical BIS Valuedifference between EA group and other two groups at5min (P=0.010, P=0.045);StatisticalBIS Value difference between EA group and other two groups at10min (P=0.035,P=0.014);Statistical BIS Value difference between EA group and Sham group at15min (P=0.036),no BIS Value difference between EA group and Congroup(P=0.067),Statistical BIS Value difference between EA group and Sham group at20min (P=0.031),Statistical BIS Value difference between EA group and Con group at20min (P=0.008),Statistical BIS Value difference between EA group and other two groups at25min (P=0.014, P=0.018),Statistical BIS Value difference between EA group and Congroup at30min (P=0.043),no significant BIS Value difference between EA group andSham group(P=0.229).2)Functional magnetic resonance imaging results:analysis of variance resultsshow:compared with side group and the control group, after EA,the difference ReHo brainregion are bilateral anterior cingulate gyrus,bilateral superior frontal gyrus,left medialfrontal gyrus.These brain regions of ReHo are reduced.The P value is less than0.05. UsingAlphaSim,we didn’t find increased ReHo brain regions of agglomerate size more than85voxel conditionsConclusions(1) Electroacupuncture could significantly reduce the BIS value, and have a certainsedative effect, which may be one of mechanisms of acupuncture anesthesia effect.(2) In the experiment,there are negative significant effect in brain bilateral anteriorcingulate (ACC),bilateral superior frontal gyrus (MPFC) and in the left superiorfrontal gyrus activation.It reduce the human brain default network(DMN)to monitorspontaneous activation of psychological state of the office of the priesthood andmake other advanced cognitive activity weakened, and achieve the sedation effect ofsubjects. |
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