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Extra-1 Acupressure for Children Undergoing Anesthesia

Wang, Shu-Ming MD*; Escalera, Sandra MD†; Lin, Eric C. BS*; Maranets, Inna MD*; Kain, Zeev N. MD*†‡§¶

doi: 10.1213/ane.0b013e3181804441
Pediatric Anesthesiology: Research Report

BACKGROUND: Acupuncture and related techniques have been used as adjuncts for perioperative anesthesia management. We examined whether acupressure in the Extra-1 (Yin-Tang) point would result in decreased preprocedural anxiety and reduced intraprocedural propofol requirements in a group of children undergoing endoscopic procedures.

METHODS: Fifty-two children were randomized to receive acupressure bead intervention either at the Extra-1 acupuncture point or at a sham point. A Bispectral Index (BIS) monitor was applied to all children before the onset of the intervention. Anxiety was assessed at baseline and before entrance to the operating room. Anesthetic techniques were standardized and maintained with IV propofol infusion titrated to keep BIS values of 40–60.

RESULTS: We found that after the intervention, children in the Extra-1 group experienced reduced anxiety whereas children in the sham group experienced increased anxiety (−9% [−3 to −15] vs 2% [−6 to 7.4], P = 0.012). In contrast, no significant changes in BIS values were observed in the preprocedural waiting period between groups (P = ns). We also found that total intraprocedural propofol requirements did not differ between the two study groups (214 ± 76 μg · kg−1 · min−1 vs 229 ± 95 μg · kg−1 · min−1, P = 0.52).

CONCLUSIONS: We conclude that acupressure bead intervention at Extra-1 acupoint reduces preprocedural anxiety in children undergoing endoscopic procedures. This intervention, however, has no impact on BIS values or intraprocedural propofol requirements.

IMPLICATIONS: Acupressure applied at the Extra-1 point results in lower levels of preprocedural anxiety in children undergoing endoscopic procedures. This intervention, however, has no effect on intraprocedural anesthetic requirements.

From the Departments of *Anesthesiology, †Pediatrics, and ‡Child and Adolescent Psychiatry, Yale University School of Medicine, New Haven, Connecticut; and §Departments of Anesthesiology, Pediatrics, and Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, and ¶Children’s Hospital of Orange County, Orange, California.

Accepted for publication May 1, 2008.

Supported by National Institutes of Health NCCAM, grant R21AT001613-02) to S.M.W., Bethesda, MD and NICHD, grant R01HD37007-02 to Z.N.K., Bethesda, MD.

Address correspondence and reprint requests to Shu-Ming Wang, MD, Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510. Address e-mail to

© 2008 International Anesthesia Research Society