Acupuncture and related techniques during perioperative period: A literature review.

Acupuncture has been used in the Far East for more than 2000 years. Since the early 1970s, this technique has been gaining popularity among Western medical community. A number of studies suggest that its mechanism of effect can be explained in biomedical terms. In this context, a number of transmitters and modulators including beta-endorphin, serotonin, substance P, interleukins, and calcitonin gene-related peptide are released. For that reason, acupuncture can be used in a wide variety of clinical conditions. Studies showed that acupuncture may have beneficial effect in perioperative period. It relieves preoperative anxiety, decreases postoperative analgesic requirements, and decreases the incidence of postoperative nausea and vomiting. In this review article, we examine perioperative use of acupuncture for a variety of conditions.

Acupuncture points in the book of Serefeddin Sabuncuoglu, a 15th century Turkish physician.

Serefeddin Sabuncuoglu (1385-1468?), the author of Cerrahiyetü'l-Haniyye (Imperial Surgery), was a distinguished Ottoman Turkish surgeon. The first illustrated Turkish surgical textbook, Cerrahiyetü'l-Haniyye consisted of three chapters (ie, cauterisation treatments, surgical procedures and fractures and dislocations). Although the main source of the book was Al-Tasrif (Textbook of Surgery) by Albucasis (Abu al-Qasim al-Zahrawi; 936-1013 AD), Sabuncuoglu added much new information, his clinical experiences and suggestions. The original illustrations and human figures made Cerrahiyetü'l-Haniyye the first illustrated medical textbook in Turkish and Islamic medicine literature. Cerrahiyetü'l-Haniyye was also a valuable source for acupuncturists. Some new sections and additions revealed that Sabuncuoglu had knowledge of Chinese medicine. In four sections of Cerrahiyetü'l-Haniyye (ie, toothache, haemorrhoids, eczema and dermatophytosis) Sabuncuoglu described acupuncture techniques and point locations. It is likely that the Chinese medicine content of Cerrahiyetü'l-Haniyye was derived from Central Asian roots of Anatolian Turkish people.

Acupuncture on Yintang point decreases preoperative anxiety.

OBJECTIVES: The aim of this study was to investigate the effect of ear-press needle acupuncture on Yintang point for preoperative anxiety. DESIGN: This was a prospective, randomized, single-blind, controlled study. SETTINGS/LOCATION: The study setting was the Department of Anesthesiology in Ankara Training and Research Hospital of Ministry of Health, Ankara, Turkey. SUBJECTS: The study comprised 52 adult surgical patients. INTERVENTIONS: A single, 20-minute session of single-point acupuncture was applied on Yintang (acupuncture group) or sham point (sham acupuncture group). OUTCOME MEASURES: The efficacy of acupuncture was evaluated by means of the changes in bispectral index (BIS) and STAI (State-Trait Anxiety Index). RESULTS: BIS values in the acupuncture group were significantly lower than in the sham group in all time intervals (p<0.0042). BIS values were lower than baseline in the study group during the entire study period (p<0.0004) while no such effect has been observed in the sham group (p>0.0004). Mean values of state anxiety (STAI-S) decreased after acupuncture in the study group (p=0,018), while no change was observed in trait anxiety (STAI-T) (p=0.156). Patients of the sham group showed no change in both parameters (p=0.387 and p=0,116). CONCLUSIONS: Ear-press needle acupuncture on Yintang point reduces preoperative anxiety in adult surgical patients.

Capsicum plasters on acupoints decrease the incidence of emergence agitation in pediatric patients.

AIM: To detect the effect of capsicum plasters on bilateral HT 7 acupoints for decreasing Emergence agitation (EA) in pediatric patients undergoing tonsillectomy and/or adenoidectomy. BACKGROUND: Emergence agitation with its incidence of 10% to 80% may have deleterious effects in postoperative period. Children may harm themselves and/or care providers who require extra nursing care and additional sedatives and/or analgesics that may cause a delay in discharge from hospital. The studies dealt with the potential benefits of the use of adjuvant drugs have yielded controversial results. Some may have side effects as well as the absence of a positive effect on EA. METHODS/MATERIALS: Fifty patients undergoing elective adenoidectomy and/or tonsillectomy who aged between 2 and 10 were included to the study. Patients were divided into two groups, and capsicum plasters (acupuncture) or inactive plasters (sham) were applied on bilateral HT 7 points preoperatively. Pain, emergence agitation, and side effects were evaluated for 15 min postoperatively. RESULTS: Incidence of EA (PAED scale) (28.0% vs 60.0) and postoperative side effects was lower in acupuncture group than in sham group while there was no significant difference in the severity of EA between groups. Duration of recovery was shorter in acupuncture group. Pain scores (CHEOPS scale) were comparable between groups. EA patients were noted to have greater age and more retching than non-EA patients. Postoperative side effects such as retching, laryngospasm, and vomiting were seen more frequently in the patients with EA. CONCLUSIONS: Application of capsicum plasters on acupoints offers a valuable choice in the prevention of EA in children.

The effects of acupuncture on the levels of blood pressure and nitric oxide in hypertensive patients.

Hypertension possess a significant risk factor for a variety of diseases and affects millions of people all around the world. Recent studies suggest that NO plays a role in pathogenesis of hypertension while some investigators find a close relationship between acupuncture treatment and NO levels. We therefore aimed to investigate the effect of acupuncture on the levels of blood pressure and nitric oxide (NO) in hypertensive patients. After obtaining institutional ethics committee approval and patients' informed consent, 32 essential hypertensive patients aged between 32-65 and taking antihypertensive drugs were included to the study. A total of 10 sessions of manual acupuncture were applied on body acupoints (EX-HN3 (Yintang), KI 3, LIV 3, SP 9, LI 4, HT 7, ST 36, SP 6) in 10 weeks. Systolic (SBP) and diastolic blood pressure (DBP) levels and blood NO levels were measured for 3 times (i.e. before & after the first session, and after the 10th session). Main outcome measures of our study were the changes in SBP and DBP as well as nitric oxide levels between 3 measurements were compared. Our study showed that SBP and DBP values decreased both after the 1st and 10th sessions of acupuncture treatments (p<0.05). The NO concentration also increased both after the 1st (71.5%) and 10th sessions (184.6%) (p<0.05).

Accidental oral poisoning caused by RDX (cyclonite): a report of 5 cases.

The explosive RDX (hexogen, cyclonite) is usually used for the production of C-4 explosive. The rare occurrence of accidental and intentional RDX intoxications has been reported during manufacturing process or in wartime. In this article, the authors report 5 cases of accidental oral RDX poisoning. On admission, observed signs and symptoms included repetitive generalized tonic-clonic convulsions, postictal coma, lethargy, confusion, hyperreflexia, postictal amnesia, nausea, vomiting, abdominal tenderness, sinusal tachycardia, dysrhythmia with frequent ventricular premature beats, generalized muscle spasms, and myoclonus. Leukocytosis, mild anemia, methemoglobinemia, elevated levels of blood glucose, serum aspartate transaminase, alanine transaminase, lactic dehydrogenase, creatine phosphokinase, amilase, hypokalemia, metabolic acidosis, proteinuria, glucosuria, and myoglobinuria were also noted. Plasma RDX concentrations were 268 to 969 ng/mL at 3 hours of ingestion. For management, supportive and symptomatic measures were taken. Whole-bowel irrigation might have been an effective therapeutic procedure due to probable slow gastrointestinal absorption of RDX. Three patients who developed severe metabolic acidosis underwent urgent hemodialysis. All patients were discharged 7 to 21 days after admission without any sequelae. Plasma RDX levels were strongly correlated with the clinical and laboratory manifestations. The available toxicological data on this rare accidental poisoning are reviewed in light of the literature.