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- the induction was started with curare - excellent hemodynamic stability, warm
of protection, then 2mg/kg propofol, periphery;
succinylcholine 1 mg / kg; - awakening was quick, no chills,
- orotraheal intubation was performed , vomiting or respiratory depression danger.
the patient was connected to the O2 + air - no patient required analgesic
flow 1 / 1; medication in postoperative, enjoying
- electrical stimulation has been started, prolonged post acupunctural analgesia.
producing alternative unloadings of two - resumption of spontaneous micturition
frequences: 5-10 Hz and 90-130 Hz; was swift.
- propofol infusion was started with 1-3
mg / kg / hr and / or midazolam 0.05 to 0.1 Discussions
mg / kg / hr; In the case of neurosurgical
- curare administration continued in interventions, painful periods are only
bolus; related to the skin incision and suture of the
- current voltage was gradually increased teguments, meninges and periosteum, and
incentive to limit supported by the pacient, also these patients do not require relaxation
about 40V; only for intubation and mechanical
- have implanted two more pins at the ventilation.
ends of the incision, which is stimulated by
100-120 Hz;
- stimulation lasted 30 minutes before 120
completion; 80
stimulation; 20
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Results
The method of electroacupunctural Tim e (m in)
anesthesia under hypnosis and relaxation Figure 2 Variation of blood pressure (BP)
has proven effective in all cases studied. In g
one of the cases, in the middle of surgery
we found increased BP and P, when in fact 100
0:30
1:00
1:30
2:00
1
2:30
3:30
Time (min)
Given the fact that in neurosurgical respiratory pressure. The literature data
pathology we are dealing with patients who shows that hyperstimulation made by
have low cerebral compliance, a particular electroacupuncture realises analgesia and
importance is the maintenance of the blockade of thermoregulatory reaction by
cerebral circulation autoregulation, and its direct interference with the central nervous
reactivity to PaCO2. Avoiding the use of mechanisms involved in making a reaction
nitrous oxide, halogenated substances, as to nociception and cold (Litarczek).
well as the opioids,it is a great advantage to The occurrence of postoperative
not emphasize the increase of intracranial vomiting also increases the risk of increased
pressure during the operation. The usage of ICP. It is described in the specialty
propofol and/or midazolam have ensured a literature that the L6 point stimulation
cerebral protection. significantly reduces postoperative nausea
I emphasize the fact that in the presented and vomiting, a stronger effect, compared
casuistry no patient required intraoperative with prophylactic anti-emetic medication
depletive treatment, in all cases the brain (8.9).
was relaxed, without edema, facilitating Numerous studies (27,15) showed the
surgical maneuvers and avoiding risk effect of stimulating the immune system
making cerebral ischemia secondary to both cellular and humoral, which is a big
these maneuvers. advantage compared with traditional
We observed hemodynamic sensitivity of general anesthesia.
these patients to major volemic loses. Hemodynamic stability both at the
Hypovolemia could be avoided by careful microcirculation and macrocirculation level
monitoring and adequate volemic filling is another important advantage of this
pending the loses. anesthetic technique.
A great advantage is also the probability
After a few hours postoperative we have
to awaken the patient during the surgical
found an analgesic effect without having to
intervention maintaining analgesia taking
be given special medication for pain, this
into account the fact that in neurosurgery
the so-called "awake craniotomy" technique being found by other studies also (4).
is becoming increasingly used in the The only disadvantage of this technique
surgical approach of motor and speech would be the prolongation of the induction
areas, in the epilepsy surgery and Parkinson time until the beginning of surgery with
disease. about 30 minutes, needed to install
Rapid postoperative awakening is a great analgesia after starting stimulation.
advantage in neurosurgery for the Some authors consider that the
neurological evaluation,it can be made application of this method in neurosurgery
immediately, and could act quickly if there is very useful, because of avoiding the use
is clinical examination and then by fast CT of drugs that interfere with the self-
appearance of postoperative hematoma. regulation of cerebral circulation and its
Also, the absence of postoperative pain reactivity to PaCO2 and to avoid cerebral
and chills does not expose the patient to vasodilatation with increased intracranial
increased risks of cerebral edema due to pressure.
ICP by hypoxia, hypercapnia, high
Romanian Neurosurgery (2010) XVII 3: 348 353 353