内侧腘绳肌延长术对双侧痉挛性脑瘫下肢肌肉长度的影响

目的 观察内侧胭绳肌延长术对双测痉挛性脑瘫下肢肌肉长度的影响.方法 将双测痉挛性脑瘫患者分为两组,一组为髂腰肌组5例(10侧肢体),即内侧胭绳肌延长,股直肌远端转位加髂腰肌延长术.另一组为非髂腰肌组5例(10侧肢体),即内侧胭绳肌延长,股直肌远端转位术.利用计算机模拟骨肌肉步态模型技术,选择性计算术后下肢相关肌肉的肌肉长度,并对比分析.结果 髂腰肌组中患者的股二头肌长头肌肉长度,在步态周期中的平均值、最小值和总长度分别为0.5000±0.0080、0.4800±0.0059、50.8600±0.8084,明显长于非髂腰肌组患者(P＜0.05).股二头肌短头肌肉长度最小值在步态周期中所出现的时间(81.6700±4.3221)%GC,较非髂腰肌组患者(75.1300±1.8851)%GC明显延迟(P＜0.01),半腱肌和半膜肌肌肉长度最小值在步态周期中出现的时间分别为(72.6700±3.0768)%Gc和(73.0000±3.6332)%GC,较非髂腰肌组出现的时间(68.500±1.5119)%Gc和(68.1300±1.5526)%Gc明显延迟(P＜0.05).结论 屈髋肌挛缩组患者在施行内侧胭绳肌延长、股直肌远端转位和髂腰肌延长术后,出现胭绳肌功能不全模型的原因,是由于外侧腘肌肌肉长度较长和内侧腘绳肌肌肉长度相对较长.     

Ilizarov技术联合腘绳肌延长矫正脑瘫重度屈膝畸形

[目的]探讨Ilizarov技术联合腘绳肌延长治疗痉挛型脑瘫重度屈膝畸形的临床效果。[方法]回顾性分析2017年8月—2020年4月采用腘绳肌延长和Ilizarov技术矫正痉挛型脑瘫重度屈膝畸形15例患者的临床资料,评价临床治疗效果。[结果]所有患者均顺利完成手术，术中无血管、神经损伤。7例患者同时行髋部及足部畸形矫正术，包括髋内收肌松解、闭孔神经缩窄术、跟腱延长术、腓肠肌腱膜切断术等。所有患者屈膝畸形在术后28 d内调整完毕，继续佩戴Ilizarov外固定架维持矫正。佩戴外固定架时间为36～50 d，平均（41.1±3.5）d。15例患者随访时间平均为（1.6±0.3）年。术后3个月、末次随访时膝关节静态屈曲角度均比术前显著减少（P<0.05），被动ROM、主动ROM较术前显著增加（P<0.05）。GMFCS分级由术前Ⅳ级提高为末次随访时Ⅲ级，根据Herzenberg标准，临床结果优9膝、良21膝，优良率100.0%。[结论]应用Ilizarov技术联合膝后内侧腘绳肌延长治疗痉挛型脑瘫重度屈膝效果满意。     

腘绳肌麻痹肌移位治疗方法探讨(附4例报告)

腘绳肌包括股二头肌、半腱肌和半膜肌,小儿麻痹后遗症腘绳肌瘫痪如合并股四头肌和腓肠肌瘫痪,称谓连枷膝,邬华彬曾报道用骶棘肌加碳纤维移位替代腘绳肌以重建伸髋、屈膝功能,但因骶棘肌收缩幅度小,续腱太长故难以获得良好的屈膝效果。当腘绳肌瘫痪、股四头肌正常时易继发膝反屈畸形,     

脑瘫分型治疗研究(141例远期随诊观察)

因脑瘫所致髂腰肌、股内收肌、腘绳肌及小腿三头肌、前臂屈肌群痉挛性瘫痪引起的股内收、内旋及“剪刀”畸形,马蹄内外翻足及肩内收、屈肘垂腕畸形,在临床上,常采用神经外科及矫形手术治疗。通过手术协调肌力,纠正畸形,恢复负重力线,使患者能独立或基本生活自理,减轻社会及家庭负担。我院从1988～1991年,共进行脑瘫矫治手术153例,根据临床表现及病理定位分型,采用不同的手术及康复训练方法,取得了较好的效果。     

改良手术治疗脑瘫痉挛性双侧下肢瘫

[目的]2004年以来对重症脑瘫痉挛性双侧瘫治疗方法进行改进,探索提高其治疗效果的方法.[方法]23例重症脑瘫痉挛性双侧瘫.男14例,女9例;年龄3～12岁,平均5.7岁;主要症状不能独自站立和行走,双下肢肌紧张,家长扶持站立,双下肢呈剪刀步态,双髋、膝关节屈曲,踝关节跖屈,双足马蹄内翻畸形,足尖着地行走.体格检查双髂腰肌、内收肌、腘绳肌、小腿三头肌、胫前肌、胫后肌、(足母)长屈肌、趾长屈肌部分或多数不同程度肌张力增高.依Ashworth分级,为3～4级.治疗方法对动态性肌痉挛,采用肌内肌腱切断或肌筋膜切断;对静态性肌痉挛行肌腱滑动延长,胫前肌腱劈开外侧1/2移位.然后用自制外固定器矫形固定,保持膝关节伸直,双踝、足中立位,双下肢外展30°,6周后去除外固定康复训练.[结果]本组病例随访1～3年,平均2.2年.优良21例,有效2例.[结论]严重脑瘫痉挛性双侧瘫,一期多关节软组织松解,肌力平衡,外固定矫形,术后配合家庭长期康复训练,是一种有效的治疗方法.     

盆腔内闭孔神经切断治疗脑瘫髋内收痉挛畸形近期疗效观察

目的:探讨盆腔内闭孔神经切断治疗脑瘫髋内收痉挛畸形的疗效.方法:20例脑瘫髋内收畸形患儿均行盆腔内闭孔神经切断术,足部畸形病例给予矫形手术,术后康复训练.结果:经过8～20个月随访观察,所有病例髋内收痉挛畸形完全解除,步态明显改善,无交叉剪刀步态,Phelps-Baker试验全部阴性.结论:盆腔内闭孔神经切断能有效持久解除髋内收痉挛畸形,改善步态姿势,为功能康复创造了有利条件,是一种安全简单有效的治疗方法.     

尺侧腕屈肌及旋前圆肌移位重建前臂旋后功能

目的 探讨尺侧腕屈肌及旋前圆肌移位重建脑性瘫痪前臂旋前畸形患者前臂旋后功能的临床疗效.方法 对脑瘫患者单侧前臂旋前畸形无明显智力障碍的6例,将尺侧腕屈肌转位至桡侧腕短伸肌,旋前圆肌绕桡骨转位重建止点,修复其前臂旋后功能.结果 6例术后随访1～4年,前臂主动旋前由术前10°恢复到术后平均为80°,主动旋后由术前0°恢复到术后平均为60°,旋后肌力由术前0级恢复到术后Ⅳ级,均能完成正常生活和工作,对屈腕功能无明显影响.结论 尺侧腕屈肌及旋前圆肌移位重建脑瘫患者前臂旋后功能可以达到较理想的临床效果.     

术前超声预测腘绳肌腱直径在前交叉韧带重建中的应用

目的应用超声显像对腘绳肌腱进行术前测量,并与手术重建韧带时的测量值进行对比验证。方法 2017年9月至2018年9月对24例单侧前交叉韧带重建的患者进行前瞻性研究,男18例,女6例;平均年龄(28.8±7.3)岁。对24例患者行半腱肌肌腱和股薄肌肌腱超声测量,然后行同侧半腱肌肌腱和股薄肌肌腱移植,行前交叉韧带重建手术,术中自体移植物大小用标准移植物测量工具测定。结果超声测量与术中测量半腱肌肌腱直径、股薄肌肌腱直径、半腱肌肌腱与股薄肌肌腱直径之和的结果,差异无统计学意义(P0.05)。超声测量半腱肌肌腱直径、股薄肌肌腱直径、半腱肌肌腱与股薄肌肌腱直径之和与术中测量半腱肌肌腱与股薄肌肌腱直径之和有正相关性,分别为0.484、0.469、0.481(P0.05),与术中最终移植物直径有正相关性,分别为0.589、0.556、0.579(P0.01)。结论在用腘绳肌腱重建前交叉韧带的患者中,腘绳肌腱的超声测量是预测肌腱最终移植物直径的一种有效方法。     

两下肢外展固定支架

临床上大脑性瘫痪并不鲜见,下肢主要表现为髋关节内收、内旋畸形,重者合并膝关节屈曲痉挛性马蹄足等,呈剪刀步态。常采用的手术治疗方法为股内收肌和股薄肌切断以及闭孔神经前支切断术。术后处置初采用髋人字石膏外展固定,后改良为两下肢外展位用石膏固定两膝关节之间用一横木棍支撑。通过临床实践又研制出两下肢外展固定支架,经过我们应用40余例,并推     

腘绳肌髌韧带转移代股四头肌术（附80例报告）

近一年来，笔者采用腘绳肌髌韧带转移代股四头肌术８０例，效果满意，优良率为９３．７５％。该术式增加了替代肌之力臂，通过髌韧带直接作用于胫骨结节，有力地起到伸小腿作用。对３．５级肌力的　绳肌替代股四头肌术后，出能达到较好的效果。该术式扩大了手术适应证及手术范围，较　绳肌髌骨转移操作简便，省时省力，为代股４头肌术增加了一种新的术式     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92