Complete relief from pain is a fundamental human right, limited only by our knowledge to achieve it.
(John J. Bonica, 1990)
The availability and accurate application of existing information and therapeutic procedures are certainly the most important reasons for achieving tolerable perioperative analgesia, which means that it is now almost completely possible to eliminate unnecessary pain. Insufficient pain relief after surgery is described as morally and ethically unacceptable.
Anesthesiology is a scientific discipline, a branch of clinical medicine, that studies the procedures of inducing insensitivity. The term anesthesia (Greek an estos - without feeling) means reduced sensitivity of the whole or individual parts of the body and is achieved by means that depress the nervous tissue locally or the CNS completely. Numerous terms have been used to denote nervous tissue depression (analgesia, hypnosis, anesthesia, sedation, etc.), which in fact represent the pharmacological basis of certain preparations. That is why it is accepted that we use the term anesthesia for any form of nervous tissue depression, distinguishing between general anesthesia and local anesthesia. General anesthesia should cause (but does not necessarily always cause) immobilization, relaxation. Local anesthesia is a procedure that causes insensitivity to pain in a particular part of the body by administering drugs that interrupt the conduction of impulses through nerves in that region.
Mao Ze Dong initiated a plan for the development of Chinese medicine through the following phases: from 1945 to 1950. "Cooperation of Chinese and Western (modern) medicine", 1950 - 1953 "Teaching of modern medicine by Chinese doctors, 1954 - 1958" Teaching Chinese medicine from by doctors of modern medicine ”1950 - 1958 "Unification of Chinese and modern medicine", and finally in 1958, "Integration of Chinese and modern medicine" was initiated. Mao said: "In the future, there will be only one medicine guided by the principles and laws of dialectical materialism."
When physicians decide on the best anesthesia technique for outpatient or day surgery, they must necessarily change their approach over traditional hospital general anesthesia. First, the patient must go home quickly and safely; secondly, the side effects that can be tolerated in our hospital settings, such as nausea, vomiting, and pain, are completely unacceptable in modern conditions and can potentially prolong discharge home and even result in unforeseen complications overnight.
Acupuncture anesthesia is not a new concept in Chinese medicine. It is worth mentioning two doctors from the time of ancient China. In Chinese medicine, in the book Records of Great Historians (94 BC), Qin Yueren (407-310 BC) is mentioned as the first physician to use anesthesia in heart transplantation. The book states that Qin Yueren used acupuncture anesthesia. He is the most important physician of Chinese medicine and is considered the father of Chinese medicine and acupuncture. He is known in the literature under the nickname Bian Que. He lived at about the same time as Hippocrates (460-377 BC), the father of modern medicine. It is worth mentioning the doctor, surgeon Hua To (110-207 AD). He was the first Chinese doctor who found and perfected an anesthetic called Ma Fei San. This anesthetic is a combination of cannabis, wine and medicinal herbs. Dr. Hua It is usually compared in its virtuosity with the Indian doctor Jivaka who lived in the age of Buddha 500 BC and is considered the first surgeon in Chinese medicine to have valid surgical procedures in place. Until 1847, i.e. the arrival of Peter Parker in China, these two doctors did not have a worthy successor to mention.
The 1975 Chinese postage stamp is part of a collection of a total of four stamps prepared in honor of the successful integration of Chinese and modern medicine. The stamp shows the actual open-heart surgery under acupuncture anesthesia. The operation was led by prof. Dr. Yi Shan Wang, a legend of Chinese cardiothoracic surgery. The anesthesiologist was Dr. Xing Fang Li who applied acupuncture anesthesia by placing two acupuncture needles in the forearm area and two needles in the chest area. The phrase “kai xin” is written on the stamp, which means - to be happy. Literally translated kai xin means to open the heart.
This series of postage stamps celebrate the historical moment of Chinese cardiac surgery, i.e. the application of acupuncture as an integral method of Chinese medicine, most often used in the treatment of pain in the form of anesthesia in open-heart surgery.
On October 4, 1847, Dr. Peter Parker introduced modern anesthesia to China using a Charles Jackson apparatus. As early as 1848, he used chloroform as an anesthetic. A solution of ether and chloroform, i.e. local and spinal anesthesia, was used in China for up to 20th century. P.R. China was created in 1949. Many prominent Chinese doctors returned from the diaspora to China to help the devastated country after World War II. Already in 1953, doctors from the diaspora organized the first specialty of clinical anesthesiology in Beijing. During the Cultural Revolution (1966-1976), acupuncture anesthesia was established as a standard procedure, as well as anesthesia with Chinese pharmacology. Since 1987 there is an anesthesia college in Suzhou. In P.R. China education in the field of anesthesiology lasts 8, 7 or 5 years. There are currently about 80,000 anesthesiologists in China.
Acupuncture has been successfully practiced for the last 2000 years in relieving painful conditions. Acupuncture anesthesia developed from acupuncture analgesia. The first operation with the use of acupuncture anesthesia was performed on August 30, 1958, in Hospital no. 1 in Shanghai. That same year, 5 more surgeries were performed in Xi An. Successfully performed tonsillectomy, led by prof. Dr. Yin Hui Zhu with the use of acupuncture anesthesia without additional anesthetics.
Until 1971, 400,000 surgeries were performed in China using assisted acupuncture anesthesia. 1971 marked ping-pong diplomacy before the final arrival of US President Richard Nixon. The president was accompanied by a New York Times reporter who underwent an urgent appendectomy - surgical removal of the appendix - during the diplomatic protocol. During the operation, acupuncture anesthesia was used as an anesthetic. It was an important historical moment for Chinese medicine because President Richard Nixon himself became a promoter of acupuncture in the United States. Already during 1975, the first colleges of oriental medicine were opened, and after three decades of study in the USA, acupuncture and Chinese pharmacology began to be studied at medical faculties (Cornell Medical School, Harvard Medical School, etc.) as elective semester subjects or as clinical methods during specialization (e.g. anesthesia).
Selection and preparation of patients for surgery with assisted acupuncture anesthesia takes place at the request of the patient and the decision of the chief surgeon. Acupuncture anesthesia will not be used in patients with pathological fear, nervousness, manic-depressive syndrome. In open-heart surgery, i.e. intrathoracic surgery, the patient prepares for surgery a week before the operation by learning - practicing abdominal breathing. Chinese doctors are convinced that this way of breathing prevents possible surgical pneumothorax (‘bursting’ of the lungs). The anesthesiologist informs the patient one day before the operation about the advantages of acupuncture, and possible contraindications - complications of chemical anesthesia. Also, the patient is informed about the feeling (feeling of cold through the neck) that he will have during the surgical incision-incision, as well as the feeling of traction, the feeling of heaviness and the feeling of shallow breathing. Technique: Initially, in order to achieve acupuncture anesthesia, an insertion of 50 - 90 needles was performed. With the development of this technique, the number of needles decreased. By default, 3-5 needles are usually inserted, and in some cases, only one needle is sufficient to produce an anesthetic effect.
More experienced doctors will use manual methods such as rotating or hitting the needle. It is common to use electrical stimulation after inserting the needle through the use of an electrical stimulator (a small portable device) on which the set current frequency and the strongest current that can be tolerated are adjusted. A very low-frequency current is sent through the handle of the needle at the distal points, usually (5-300 Hz). A High-frequency current (3000–10000 Hz) is used at local points. Induction of acupuncture anesthesia takes 15-20 minutes, when the patient loses sensation, i.e. gets a feeling of deprivation. Occasionally 1% procaine is given intravenously at the incision site. In situations where acupuncture anesthesia does not produce the expected effect, general anesthesia is used. Efficiency: Official Chinese reports from 1958 to 2016 speak in favor of acupuncture anesthesia. Namely, the effectiveness of acupuncture anesthesia is around 90% in achieving the function of stable maintenance of pain loss during surgery as well as postoperative recovery without complications.
Acupuncture anesthesia is still a widely used method of anesthesia in N.R. China with craniotomy and thyroidectomy surgeries, but not as popular with open heart surgery as during the 1970s and 1980s. The main reason for the less frequent use of acupuncture anesthesia in open-heart surgery lies in the fact of longer preparation time, i.e. investing more time due to mandatory patient training in therapeutic breathing, which is not desirable in overbooked Chinese hospitals. Another reason is the precondition that the surgeon must be extremely careful, accurate and fast in the operation.
In the Chinese public health system, acupuncture anesthesia has significant clinical applicability as both general and local anesthesia. The clinical success of acupuncture anesthesia is reflected as a safer method in relation to the general anesthesia of modern medicine, it is an extremely safer method for use in the elderly and the disabled. Postoperative recovery is significantly shorter, and the method is low-cost to be used, and the physiological functions of the organism, such as heart rate, remain stable during anesthesia.