The Effects of Acupuncture on Hemodynamic Changes During Endotracheal Intubation for General Anesthesia

A randomized-controlled trial assessing the effect of intraoperative acupuncture on anesthesia-related parameters during gynecological oncology surgery

CONTEXT AND OBJECTIVES

The present study examined the impact of intraoperative acupuncture on anesthesia-related parameters in patients undergoing gynecological oncology surgery.

METHODS

Participants underwent preoperative integrative oncology (IO) touch/relaxation treatments, followed by intraoperative acupuncture (Group A); preoperative IO treatments without acupuncture (Group B); or standard care only (Group C). Mean arterial pressure (MAP), heart rate (HR), MAP variability (mean of MAP standard deviation), bispectral index (BIS), and calculated blood pressure Average Real Variability (ARV) were measured intraoperatively.

RESULTS

A total of 91 patients participated: Group A, 41; Group B, 24; Group C, 26. Among patients undergoing open laparotomy, Group A showed lower and more stable MAP and HR compared to Group B, (MAP, p = 0.026; HR, p = 0.029) and Group C (MAP, p = 0.025). Mean BIS, from incision to suture closing, was lower in Group A (vs. controls, p = 0.024). In patients undergoing laparoscopic surgery, MAP was elevated within Group A (p = 0.026) throughout surgery, with MAP variability significantly higher in Group A (P = 0.023) and Group B (P = 0.013) 10 min post-incision (vs. pre-incision). All groups showed similar intraoperative and post-anesthesia use of analgesic medication.

CONCLUSION

Intraoperative acupuncture was shown to reduce and stabilize MAP and HR, and reduce BIS in gynecology oncology patients undergoing laparotomy, with no impact on perioperative analgesic medication use. In the laparoscopic setting, intraoperative acupuncture was associated with elevated MAP. Further research is needed to explore the hemodynamic and BIS-associated benefits and risks of intraoperative acupuncture, and the impact on the use of analgesic drugs in response to these changes.

Effect of electroacupuncture on haemodynamic changes during intubation for general anaesthesia is mediated by nitric oxide synthase‑3 via the regulation of microRNA‑155, microRNA‑335 and microRNA‑383

Intubation for general anaesthesia is a life‑threatening risk because it can cause haemodynamic changes. Electroacupuncture (EA) has been reported to alleviate the risk of intubation. In the present study, haemodynamic changes were measured at different time points before and after EA. Reverse transcription‑quantitative PCR was performed to measure the expression of micro (mi)RNAs and endothelial NO synthase (eNOS) mRNA. Western blotting was performed to evaluate the expression of eNOS protein. A luciferase assay was used to explore the inhibitory role of miRNAs in eNOS expression. The transfection of miRNA precursors and antagomirs was performed to assess their effect on eNOS expression. The systolic blood pressure, diastolic blood pressure and mean arterial pressure of patients were significantly decreased by EA, while the heart rate of patients was markedly increased. The expression of micro RNA (miR)‑155, miR‑335 and miR‑383 was effectively inhibited by EA in the plasma and peripheral blood monocytes of patients, whereas eNOS expression and NOS production were markedly elevated by EA. The luciferase activity of the eNOS vector was significantly inhibited by miR‑155, miR‑335 and miR‑383 mimics but activated by miR‑155, miR‑335 and miR‑383 antagomirs. miR‑155, miR‑335 and miR‑383 precursors suppressed the expression of eNOS, while miR‑155, miR‑335 and miR‑383 antagomirs enhanced the expression of eNOS. The present study demonstrated that EA may exert a vasodilative effect during intubation for general anaesthesia by promoting NO production and upregulating eNOS expression. The effect of EA on upregulating eNOS expression may be mediated by its inhibitory effect on the expression of miRNA‑155, miRNA‑335 and miRNA‑383.

Perioperative Acupuncture Optimizes Surgical Outcomes: Theory, Clinical Practice and Future Perspectives

A growing body of evidence supports the use of perioperative acupuncture as part of an enhanced postsurgical recovery protocol. Data from both clinical trials and animal studies has shown that the integration of acupuncture into perioperative patient care leads to a reduction of perioperative complications such as preoperative anxiety, intraoperative hemodynamic instability, postoperative pain, postoperative cognitive dysfunction, and postoperative nausea and vomiting in surgical patients. Despite these favorable outcomes, perioperative acupuncture has yet to be widely adopted in current anesthesia practice. This review summarized data from clinical perioperative acupuncture studies and cites recent discoveries regarding the anatomical location and characteristics of acupoint(s), acupuncture stimulation techniques, and treatment practice protocols, as well as identified the areas of deficiency in perioperative acupuncture applications. To facilitate acupuncture integration in perioperative care practice, the authors propose to establish a perioperative acupuncture registry which can be used for data mining as well as a resource for studying the underlying mechanisms of acupuncture. Through this acupuncture registry, clinical guidelines and research protocols can be established, additional large/multi-center clinical and pragmatic trials can be easily performed to determine if the integration and expansion of perioperative acupuncture practice is cost-effective.