I’ve always been a little skeptical of these acupuncture claims–I mean, I’ve known what a runner’s high can do for small amounts of pain, so it sort of makes sense that acupuncture might offer some relief for minor aches and pains (if it works at all). But major surgery? Yeah…dope me up with fentanyl, please.

Very interesting points. First let me answer the last one: yes, it is necessary to open one’s mind to the possibility of deliberate deceit, and the failure to do so has clearly fooled at least some Westerners, as mentioned here in regard to “Qi Gong Masters.” I can’t help but imagine, when I read about ‘acupuncture anesthesia’ demonstrations, the patients having had local anesthetics injected prior to appearing in the operating rooms—not that this was necessarily the case.

Regarding consciousness during cardiopulmonary bypass: yes, it almost certainly can occur, as evidenced by studies of intra-op awareness and/or recall in cardiac surgery patients. Unfortunately I can’t find the citation in a quick search, but during the 1980s I remember reading a report from Australia in which an alarmingly large fraction (?15%) of patients who’d been anesthetized with high-dose narcotics for open heart surgery had been able, during CPB, to respond to a simple command such as “squeeze my fingers twice if you can hear me”–although most did not recall this after surgery. A quick PubMed search today gives this and this, although the latter does not clearly demonstrate awareness during CPB per se.

Regarding blood flow during CPB, there is no question that it can be adequate to maintain normal function of organs, including brain, that have high oxygen requirements. The simple roller pumps that were probably used even in the ’70s in China were and are capable of flows much greater than usual cardiac outputs, even via the fem-fem route. You are absolutely correct that post-pump CNS impairment has been a problem, but it is usually not due to hypoperfusion. Rather, it has been associated with gas emboli and debris emboli, clots because of inadequate anticoagulation, and microaggregates of blood elements even in the face of adequate anticoagulation—more common in the early years when ‘bubble oxygenators’ were used, later to be replaced by membrane oxygenators; all of which are presumed to result in microinfarcts. It’s also associated with age, duration of CPB (probably by allowing more chance for those bad things to occur, but possibly also by speculative mechanisms such as the lack of pulsatile blood flow), and ‘activation of leukocytes,’ inflammatory states, endotoxin release from the gut, and more.

Regarding anesthesia to reduce brain oxygen demand during CPB, there was a time when that was tried (usually via high doses of barbiturates or isoflurane to abolish brain electrical activity), as you’ve written, but it was largely experimental and as far as I know did not pan out (I haven’t done cardiac anesthesia since the early ’90s; I welcome any reader who’s current in the field to let us know). Cooling the body during CPB has also been used for decades and reduces oxygen requirements of all tissues, including brain. Its main rationale, however, is not to ‘protect’ brain per se, but to reduce the necessary blood flows during CPB so as to limit damage caused by the various factors already mentioned.

Patrick Wall (MD) writes in his book “Pain” (Columbia U., 2000) about witnessing 10 surgeries under “acupuncture anesthesia” in the 1970s. He noted that the patients were all volunteers (most patients prefer drug-based anesthesia) and were strictly prepared for the procedure; he likened it to hypnosis. Narcotics and local anesthetics were used in 8 cases, making it difficult to assess acupuncture. Of the 2 without adjunct drugs, one woman had her femoral artery “explored and cannulated before the needling started” [emphasis in original]. He took that to mean she was predisposed to tolerate the ultimate surgery. The second, drugless patient came to his senses shortly before the surgery was completed. Suffice it to say the end of the procedure, with orderlies restraining the patient who was crying in pain, was not nice.

Finally, there is Barry Beyerstein’s account of an operation in China throughout which the patient babbled softly and the official interpreter translated it as “that tickles …”. Afterwards, Barry’s own interpreter told him the patient was begging them to stop the pain; but she was too drugged to really defend herself. [Sorry, I don’t have a citation for that.]

I ask this because several years ago I was involved in a study of the brain response to lowered perfusion during cardiopulmonary bypass. At the time – the early 1990’s – patients were anesthetised not only to eliminate pain but also because it reduced the oxygen demand by the brain to its lowest possible level. Even so, patients often had “post-pump” changes in their memory, reasoning and intellectual performance.

It seems incredible (in the sense of “not credible”) that “fem-fem” bypass – which is less effective than intrathoracic bypass, or so I was told – would be enough to maintain any level of consciousness.

Rather than trying to find a “natural” explanation for the observations, we should consider the possibility that the Chinese government was actively deceiving the Western visitors in order to support their use of acupuncture and other “Traditional Chinese Medicine” remedies for “the masses” instead of modern medicine.

Once you open your mind to the possibility of deliberate deceit, it becomes much easier to explain.

Prometheus