针麻用于颅脑手术是可取的麻醉方法之一。但针麻对颅内压的影响如何

尚未见有数据的报导。为探索针麻对颅内压的影响

借以进一步掌握针麻用于颅脑手术的适应证

自1980年6月至9月共对9例针麻颅脑手术病人进行了颅内压监测。初步报导如下:The effect of acupuncture anesthesia on ICP has not been repoted asyet.In 1980

ICP in 9 patients with intracranial operations under acupun-cture anesthesia were monitored.All of them were male

aged from 25 to57

with patent cerebral spinal fluid(esf)pathway and in calm spirits.Before anesthesia

there were no clinical sign of significantly increased ICPbeing observed.Any drugs that can lower the ICP would not be used for 12hours before anesthesia

and that can depress the respiration would be avo-ided in premedication.The csf pressure of 18 cases were measured directlythrough a catheter in the subarachinoid space

while the 9th one who suffur-red from posterior fossa lesion was measured directly through a cannula in thelateral ventricle.The pressure gauge we used is specially made for the measur-ement of csf pressure only

which is highly sensitive and precise.During the procedure of puncture

we did our best to avoid too much loss of csf.After the successful catheterization

a small amount of normal saline csf wasinjected slowly into the subarachinoid space

so as to make the csf complete.After the patient well lying on his back

we began to connect the catheterto the pressure-gauge and waited at least for 5 minutes in order to allowthe csf pressure becoming stable.Then

acupuncture anesthesia was started

and the data were recorded.The csf pressure measured before acupuncture anesthesia was used as thecontrol Value.The control values were:less than 200 mmH_2O in 5 cases

slightly higher than 200 mmH_2O in 3

and 260 mmH_2O in one.After obviousneedling-sensation was experienced

there were a slight incrase in ICP in 7cases

but in one of them the increase in ICP was up to the highest control value(260 mmH_2O).The mean value of increase was 20±22.64 mmH_2O

andpresumably this increase was due to pain or strong needling-sensation.Therange of increase was comparable to the effect of venous puncture on ICP(10—30mmH_2O).During the induction period

the ICP bell very little andgradually

the mean value of decrease was 4.44±2o.46 mmH_2O at the 15thminute of induction.ICP unchanged or decreased in 5 cases when 50 mg ofpethidine was given intravenously;but ICP increased in 4 cases with 75 mginstead of 50 mg.The mean value of increase for all the 9 cases was 11.55±21.93 mmH_2O

Gertainly it was related to the slight depression of respi-ration.When the scalp was infiltrated with adrenaline-normal saline solu-tion

ICP increased only in 3 cases

the mean value of increase for 9 caseswas 0.55±14.66 mmH_2O.Provided there is no significant increase in arterialblood pressure because of the infiltration of adrenaline

adrenaline could notinfluence the cerebral blood flow per se.When incision being made

ICP in-creased slightly in 3 cases

the range of increasing was eqivalent to that ofinserting needles

and the mean value for 9 cases was 6.66±20.68 mmH_2O.Thereafter

when the introducer of gurgling saw was introduced

the meanof increase of ICP was 7.77±20.28 mmH_2O because of the external pressure.When the skull and dura Were opened

ICP decreased significantly.According to the result mentioned above

we believe that such an increasein ICP is of no importance to patients without significantly increased ICPbefore anesthesia

but for patients with significantly increased ICP

anyfactor that can raise the ICP might result in dangerous increase.Thereforeit is necessary to consider all the conditions of the patients and judge whetheracupuncture anesthesia is suitable for such patients.