经椎弓根及伤椎内固定治疗胸腰段椎体骨折体会

目的总结跨伤椎和经伤椎椎弓根置钉复位固定治疗胸腰椎骨折的临床效果。方法 2003年1月至2010年4月我们收治126例胸腰段椎体骨折,年龄23～61岁。采用后路减压椎管成形椎弓根内固定植骨融合术,跨伤椎固定97例,经伤椎置钉固定29例。结果所有伤椎椎体前缘高度与后缘高度（PVH）的比值由术前（0.34±0.11）增加到术后（0.84±0.10）;矢状位后凸Cobb角由术前（25.46±2.59）°减少至术后（12.12±1.23）°。跨椎体组伤椎椎体前缘高度与后缘高度的比值由术前（0.36±0.12）增加到术后（0.83±0.11）;矢状位后凸Cobb角由术前（25.40±2.50）°减少至术后（12.2±1.21）°。经伤椎组伤椎椎体前缘高度与后缘高度的比值由术前（0.345±0.11）增加到术后（0.882±0.12）,矢状位后凸Cobb角由术前（25.43±2.53）°减少至术后（10.17±1.21）°。两组间结果对比显示经伤椎组椎体高度恢复和矫正后凸畸形效果好于跨椎体组（P〈0.01）,末次随访显示跨椎体组矫正角度有所丢失。跨伤椎组发生断钉3例,松动2例,经伤椎椎弓根螺钉内固定组无松动,无断裂、断棒。结论椎弓根钉固定是治疗胸腰椎骨折的一种有效方法,经伤椎固定可以有效维持脊柱复位效果。     

胸腰椎骨折患者经伤椎置钉与跨节段椎弓根螺钉内固定治疗的临床效果比较

[目的]比较胸腰椎骨折患者经伤椎置钉与跨节段椎弓根螺钉内固定治疗的临床效果。[方法]选择本院2012年1月~2013年12月间收治的96例胸腰椎单一椎体骨折患者,随机数字法将其分为2组,每组48例。伤椎置钉组给予伤椎置钉内固定术,跨节段组给予跨节段椎弓根螺钉内固定术。统计两组手术时间、出血量;术后随访2~3年,对患者视觉模拟评分(VAS)、Cobb角、伤椎前缘高度压缩率、日本骨科协会(JOA)评分变化进行观察。[结果]两组在手术时间、出血量方面差异无统计学意义(P>0.05)。术后1周、1年时两组VAS、Cobb角较术前均显著改善(P<0.05),但两组间差异无统计学意义(P>0.05)。术后1周、1年时两组伤椎前缘高度压缩率较术前均显著减少(P<0.05),且伤椎置钉组伤椎前缘高度压缩率明显低于跨节段组(P<0.05)。术后1年两组JOA评分较术前均显著升高(P<0.05);但两组间差异无统计学意义(P>0.05)。[结论]经伤椎置钉椎弓根螺钉内固定术可有效治疗胸腰椎骨折,具有内固定牢固、矫正效果好的优点。     

终板破裂程度对胸腰椎骨折椎弓根螺钉内固定手术预后的影响

目的研究终板破裂程度对胸腰椎骨折椎弓根螺钉内固定预后的影响。方法纳入2013年1月~2016年6月治疗的145例胸腰椎骨折合并终板破裂患者,根据CT矢状位重建终板破裂横面积或终板最低点下陷高度50%、≥50%设为轻度破裂组(83例)与中重度破裂组(62例)。采用后路开放式或经皮椎弓根螺钉内固定治疗,随访26~46个月,记录术前、术后1个月、6个月、末次随访时的伤椎高度压缩率、Cobb角以及疼痛视觉模拟评分(VAS)。结果两组术后1个月、6个月、末次随访的伤椎高度压缩率、Cobb角以及疼痛VAS评分均显著低于术前(P0.05);末次随访时,轻度破裂组的伤椎高度压缩率、Cobb角以及疼痛VAS评分均显著低于中重度破裂组,差异有统计学意义(P0.05)。结论终板破裂程度对胸腰椎骨折行椎弓根螺钉内固定手术的早期矫正效果以及疼痛改善程度无明显影响,终板破裂程度高者远期可加重椎体高度丢失。     

经伤椎植入固定螺钉和万向螺钉对胸腰椎骨折手术疗效的影响

目的 探讨经伤椎植入固定螺钉和万向螺钉对胸腰椎骨折行后路钉棒内固定手术疗效的影响。方法 纳入2014年4月-2017年6月收治的147例胸腰椎骨折患者,按照伤椎固定螺钉的不同,分为固定螺钉组(68例)和万向螺钉组(79例)。所有患者均于术前、术后1周及随访12个月时进行X线和CT检查,测定并比较两组间的伤椎前缘高度及Cobb角变化。结果所有患者均获随访1-3年(平均1.6年),两组患者术前椎体压缩率及Cobb角之间无显著差异(P0.05);相较于术后1周,固定螺钉组术后12个月的椎体压缩率及Cobb角均无显著丢失(P0.05),而万向螺钉组术后12个月的上述指标均出现明显丢失现象(P0.05);术后12个月时,两组患者的椎体压缩率及Cobb角差异有统计学意义(P0.05)。结论 相较于万向螺钉,选用固定螺钉有助于恢复伤椎形态、维持术后的椎体高度和减少Cobb角丢失。     

后路短节段内固定结合伤椎椎弓根植骨治疗胸腰椎骨折的临床观察

目的观察后路短节段内固定结合伤椎椎弓根植骨治疗胸腰椎骨折的临床疗效。方法胸腰椎骨折患者56例,随机分为两组:伤椎植骨组30例,采用后路短节段固定结合伤椎椎弓根植骨术治疗;单纯固定组26例,采用单纯后路短节段固定术治疗。比较两组患者术后椎体前缘高度恢复率、Cobb角以及神经功能Frankel分级评分变化。结果 56例患者均获随访,时间12～20月,平均(15.8±3.7)月。所有患者均未出现伤口感染、断钉等并发症。组内比较,两组术后伤椎椎体前缘高度压缩率、Cobb角较术前差异均有统计学意义(P<0.01);组间比较,术前及术后1周时两组椎体前缘高度压缩率及Cobb角差异均无统计学意义(P>0.05),而末次随访时两组间差异有统计学意义(P<0.05),伤椎植骨组明显优于单纯固定组。两组术后神经功能Frankel分级评分无统计学差异(P>0.05)。结论后路短节段椎弓根内固定结合伤椎椎弓根植骨治疗胸腰椎骨折疗效确切,能减少椎体高度丢失以及后凸畸形的复发加重,降低内固定并发症的发生率,且操作安全,值得临床推广。     

两种不同术式治疗胸腰椎骨折的对比研究

目的探讨微创经皮与开放短节段椎弓根螺钉固定结合伤椎内植骨治疗胸腰椎骨折的临床疗效。方法回顾性分析2013年1月至2015年1月收治的60例胸腰椎爆裂或压缩骨折患者的临床资料,其中30例采用微创经皮椎弓根螺钉固定结合伤椎内植骨治疗,30例采用开放短节段椎弓根螺钉固定结合伤椎内植骨治疗,观察两组患者的手术时间、术中出血量,比较两组患者手术前后疼痛视觉模拟评分(visual analog scale,VAS)、伤椎前缘高度压缩率、椎体Cobb角情况。结果 60例患者均获随访,随访时间8~18个月,平均12.8个月。所有患者术后切口均Ⅰ期愈合,无感染、深静脉血栓形成等并发症发生,无内固定物松动、断裂。微创组手术时间、术中出血量较开放组明显减少,差异有统计学意义(P0.05)。两组患者术后1周、末次随访VAS评分、伤椎前缘高度压缩率及椎体Cobb角较术前均有改善,差异有统计学意义(P0.05);术后同组内不同时间点伤椎前缘高度压缩率、椎体Cobb角比较差异无统计学意义(P0.05);术后两组患者同一时间点伤椎前缘高度压缩率、椎体Cobb角比较差异无统计学意义(P0.05)。微创组术后1周疼痛缓解较开放组明显,差异有统计学意义(P0.05);末次随访时两组患者疼痛程度相当,差异无统计学意义(P0.05)。结论微创经皮椎弓根螺钉固定结合伤椎内植骨治疗胸腰椎骨折具有出血少、创伤小、用时少等优点,能有效恢复并维持伤椎高度,矫正脊柱后凸畸形,对伤椎高度恢复及脊柱后凸畸形矫正与开放手术相当,短期内对术后患者疼痛缓解优于开放手术。     

经伤椎置钉椎弓根螺钉内固定治疗胸腰椎骨折临床体会

目的探讨同时经伤椎置钉椎弓根螺钉系统固定治疗胸腰椎骨折的可行性和有效性。方法自2008年7月至2011年1月．采用椎弓根螺钉系统同时经伤椎置钉固定治疗胸腰椎骨折24例,均为单椎体骨折,采用5钉或6钉三椎体固定。患者术前、术后即刻和术后12个月随访均行X线及CT检查,测量比较Cobb角、伤椎前缘压缩率、椎管占位率及神经功能Frankel分级。结果随访12～27个月,平均15．5个月。椎体前缘高度、Cobb角、椎管占位以及Frankel分级均较术前有显著改善。结论同时经伤椎置钌椎弓根螺钉系统固定治疗胸腰椎骨折是一种可行而有效的方法。     

微创经皮椎弓根钉内固定联合伤椎椎体植骨治疗胸腰椎骨折的疗效分析

目的探讨微创经皮椎弓根钉内固定联合伤椎椎体植骨治疗胸腰椎骨折的临床疗效。方法回顾性分析自2013-01—2015-01采用微创经皮椎弓根钉内固定联合伤椎椎体植骨治疗的32例胸腰椎骨折。观察术前、术后1周、末次随访时伤椎前缘高度压缩率、椎体Cobb角、疼痛视觉模拟评分(VAS)。结果本组手术时间(72.5±9.2)min,术中出血量(50.4±12.3)ml。32例均获得随访6~18个月,平均12.4个月。切口均一期愈合,无椎弓根钉松动、断裂,无脊髓神经损伤。术后1周、末次随访时伤椎前缘高度压缩率、椎体Cobb角及VAS评分较术前明显改善,差异有统计学意义(P0.05)。术后1周与末次随访3项指标比较差异无统计学意义(P0.05)。结论微创经皮椎弓根钉内固定联合伤椎椎体植骨治疗胸腰椎骨折具有创伤小、出血少、固定可靠等优点,能有效恢复并维持伤椎高度,矫正脊柱后凸畸形,短期疗效确切。     

经伤椎双节段与跨伤椎短节段固定治疗胸腰椎骨折3年以上随访结果

目的比较经伤椎双节段固定与跨伤椎短节段固定治疗胸腰椎骨折的中期随访结果。方法对63例经伤椎双节段与跨伤椎短节段固定治疗并获得3年以上随访的胸腰椎骨折患者的资料进行分析。比较两组患者的手术时间及术中出血量;测量术前、术后3 d和末次随访时伤椎及其上下相邻正常椎体的前缘高度、伤椎后凸Cobb角,比较两组的椎体前缘高度比、末次随访矫正度丢失情况。结果跨伤椎短节段固定组的手术时间和术中出血量明显少于经伤椎双节段固定组(P0.05)。患者均获得随访,时间37~77(52.8±11.5)个月。末次随访时患者满意率:经伤椎双节段固定组为90.3%、跨伤椎短节段固定组患者为84.4%(P0.05)。术后两组患者椎体前缘高度及Cobb角较术前均显著恢复(P0.05)。末次随访时,经伤椎双节段固定组对椎体前缘高度和矢状面Cobb角的保持优于跨伤椎短节段固定组(P0.05)。结论经伤椎双节段固定术及跨伤椎短节段固定术都能较好地恢复胸腰椎骨折的椎体高度和Cobb角。经伤椎双节段固定术对术后矫正度的保持优于跨伤椎短节段固定术,但手术时间相对较长、出血量相对较多。     

后路经伤椎椎弓根螺钉固定在胸腰椎骨折治疗中的应用

目的探讨经伤椎椎弓根螺钉固定对胸腰椎骨折的复位和固定效果。方法对23例胸腰段单节段骨折采用后路经伤椎置入椎弓根螺钉治疗,观察术后伤椎椎体复位情况。结果23例均取得良好复位及固定效果,伤椎压缩百分比从术前(41.2±9.6)%到术后(4.2±4.8)%。随访1年复查X线片椎体高度无丢失,内固定无松动或断裂。结论经伤椎椎弓根螺钉固定治疗胸腰椎骨折可达到有效复位,获得良好固定效果。     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.     

Anesthésie générale chez l’enfant : quid des pratiques en 2010 ?

Introduction

The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France.

Material and methods

One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated.

Results

There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N₂O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7–8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL).

Discussion

This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.     

Intérêt d’une rééducation précoce pour les patients neurologiques

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.