QUESTIONS
1. One of the following statements is not correct. Indicate the incorrect statement:
a Acupuncture analgesia (AA) is a misnomer. It should really be called AP hypoalgesia. AA, induced by electrical stimulation via AP needles, often is sufficient to allow surgery without the use of other anaesthetics.
b Consciousness is retained throughout the operation but many animals become slightly drowsy (as if slightly sedated) during and for a short time after AA stimulation.
c All other sensations (touch, traction, pressure, tickle etc) and reflexes (to sight or sound stimuli, fear, traction etc) are intact.
d Simple AP (manual twirling of the needles) or acupressure can not induce the AA effect.
e Insufficient research has been done to allow a good assessment of the efficacy of with cold lasers in inducing AA
2. One of the following statements is not correct. Indicate the incorrect statement:
a Stimuli via the AA points are carried in the peripheral sensory nerves to the spinal cord. They reach the midbrain via the ascending spino-thalamic tracts.
b In the midbrain the ascending signals cause release of endorphin, serotonin and other neurotransmitters which activate a "descending inhibition mechanism" and prevent the "pain signals" from the surgical area from reaching the cerebral cortex.
c AA can be said to "close" various "pain gates" in the nervous system. These gates are thought to be located in the spinal cord, thalamus and possibly other areas. The result is that the human (and, presumably, the animal) patient can feel the knife, the touch and traction etc but does not "feel pain".
d Vaginal stimulation (electrical or mechanical) can cause potent whole-body analgesia in rats. Naloxone abolishes the effect, indicating that vaginal stimulation analgesia has similar mechanisms to AA.
e Electro-Narcosis, Electro-Anaesthesia and Electro-Sleep (Cerebral Electro-Therapy) differ from the other techniques, as they cause unconsciousness during Electro-Stimulation (ES)
3. One of the following statements is not correct. Indicate the incorrect statement:
a It is safer to use bipolar electrostimulators than models which give a (+) charge at one electrode and a (-) charge at the other
b In analgesia for childbirth, <40% of women were helped by transcutaneous electro-stimulation (Travisens equipment) analgesia of the thoraco-lumbo- sacral region
c In large animals, operations may be performed under AA with the animal in the standing position or in dorsal, lateral or ventral recumbency, depending on the type of operation and whether or not the animal is quiet
d Small animals are normally operated on in lateral, dorsal or ventral recumbency. If a special operation-harness is not available they are restrained by tying bandages from the hocks and elbows to suitable anchor-points on the operating table.
e A blindfold over the animal's eyes helps to avoid fright by visual stimuli
4. One of the following statements is not correct. Indicate the incorrect statement:
a Before operation under AA, the operation site is tested for analgesia using a clamp- or pin prick-test every 5 minutes or so after the electrical stimulator is switched on. The operation may commence when the animal gives no reaction to the pain test.
b In the first few minutes after AA stimulation begins it is usual for the animal to show a mild stress reaction (dilated pupils, increased blood pressure, faster respiration and heart rate). These quickly return to normal or near normal levels, and should remain at that level during the operation.
c It usually takes less than 10 minutes of electrostimulation to induce the degree of AA sufficient for surgery
d At certain stages of the operation, especially during incision and suturing of the skin, serosa (peritoneum, pleura etc) and incision of periosteum and nerves, pain stimuli may induce a pain response. During these stages, the frequency or output voltage should be increased.
e Occasionally it may be necessary to use small volumes of local anaesthetic injection or spray at these stages.
5. One of the following statements is not correct. Indicate the incorrect statement:
a EEG patterns in animals under AA indicate that brain waves are in the high beta range (18-28 cycles per second) i.e., similar to those of marked mental arousal
b Pupillary dilation and salivation occurs during AA in some animals. If salivation is excessive or retching/vomiting occurs, this usually indicates that excessive traction on mesentery/internal organs is the cause. This may be partly counteracted by increase in frequency or output of the AA stimuli.
c The choice of points for AA depends on the species of animal, the operation site and personal preference/experience. Many different combinations are effective.
d The general rule is to use local points (near the operation site). This rule is not always obeyed. Other workers pay particular attention to the points or nerves supplying or related to the operation site. In human EAA, same workers add two needles, one on each side of the incision.
e AP points used in large-animal AA include: BaiHui, WeiGan, TianPing, SanTai. All of these are on the GV Channel
6. One of the following statements is not correct. Indicate the incorrect statement:
a The most commonly used AA points include: LU01; TH08 to PC04.5; PC06; LI04; BL23; GB34; ST36; SP06; TH17
b HuaToChiaChi points are on the paravertebral line, lateral to the outer line of the BL Channel, from vertebra cervical 1 to sacral 4
c ChihYi points are on the human GV Channel (over vertebral spines T 3,5,6,11 and L 1) but are not classic GV points
d Para-incisional points are not often used in vet AA, as the needles may impede access to the site
e ChiehKou points are local points at each end of the incision
f InKoTen and BoKoKu (are between the 3rd and 4th metacarpal or metatarsal bones respectively; GeiKo is on the lateral margin of the naso-labial fold in mice and rats
7. One of the following statements is not correct. Indicate the incorrect statement:
a BaiHui is in the lumbo-sacral space in animals
b WeiGan is the dorsal midline between coccygeal vertebrae 2-3
c TianPing is in the dorsal midline, in the thoraco-lumbar space
d SanTai is in the dorsal midline, between the spines of thoracic vertebrae 4-5 (some texts say T5-6)
e The LU01 + TH08 (ChungFu + SanYangLo) combination is useful in small animals but not in large animals
8. One of the following statements is not correct. Indicate the incorrect statement:
a Clinical assessment of AA can be divided into 3 main categories: excellent, good, fair/poor. Only the excellent category is acceptable in modern western veterinary practice. This means that AA alone is inadequate in many cases
b Cats resent needles placed in the feet. Lambardt got poor results with AA in cats but Still (1987) claimed very good results using pre- and post-auricular points, plus GV06b, BL23,23a,24, lumbo-sacral space (GV03a and SP06)
c Combination anaesthesia (AA plus tranquilliser or anaesthetic drugs) is safe and effective, especially in allergic or high-risk patients. The amounts of narcotic/barbiturate drugs needed to maintain adequate anaesthesia is reduced. There is less deviation from the baseline in heart rate, blood pressure, EEG and body heat loss than in subjects under drug anaesthesia alone
d Recovery of consciousness after combination anaesthesia is more rapid and post-operative complications are less than in subjects under drug anaesthesia alone
e EAA combined with diazepam gave very poor analgesia in surgery for fracture of the femoral head in elderly high-risk patients (Glennie-Smith 1986)