CT三维重建区分股骨颈扭转角与前倾角

目的:利用CT三维重建技术描述股骨颈扭转角与前倾角,显示二者区别并测量数据。方法:2010年3月至2010年10月,采用CT重建扫描30例健康成人志愿者股骨结构,男15例,女15例;年龄25～65岁,平均(43.66±7.57)岁。进行图像后处理显示股骨颈扭转角及前倾角,用"圆心法"测量扭转角,直接测量股骨颈前倾角。结果:股骨颈前倾角是股骨头颈中心轴线与股骨冠状面的夹角,测量结果为(13.326±6.085)°;扭转角是股骨颈截面的长轴面与股骨冠状面的夹角,测量结果为(31.335±2.079)°。两角度左、右侧比较差异无统计学意义。结论:股骨颈前倾角与扭转角是股骨上段完全不同的两个角度参数,前倾角是线与面的夹角,角尖朝向外下,扭转角是面与面的夹角,角尖朝向后下。     

粉碎性股骨干骨折带锁髓内钉内固定术中旋转及成角畸形的预防

目的探讨闭合复位带锁髓内针内固定治疗粉碎股骨干骨折术中旋转及成角畸形的预防。方法自2001年4月～2003年6月应用闭合复位带锁髓内针内固定治疗粉碎性股骨干骨折50例,术中采用骨科牵引床和C型臂X线机透视。采用髋、膝、踝关节中点连线为下肢轴线,测量中立位双侧股骨颈、股骨髁、小转子到股骨皮质投影的长度,健侧及患侧一致后锁死锁钉。术后CT扫描测量股骨前倾角了解旋转畸形程度,摄骨盆平片测量颈干角。结果患侧组前倾角值为(14.98°±10.26°),最大值为34.26°,最小值为-5.00°,健侧组前倾角值为(12.98°±1086°),最大值为32.20°,最小值为-4.60°,使用配对资料t检验,P>0.05,差异无非常显著性的意义。患侧组颈干角值为(128.44°±11.24°),最大值为137.36°,最小值为109.12°。健侧组颈干角值为(129.98°±10.66°),最大值为134.36°,最小值为112.26°。P>0.05,差异无非常显著性的意义。结论股骨干骨折采取闭合复位带锁髓内针治疗,术中应在影像监视器监控下以髋、膝、踝关节中点为下肢轴线,测量中立位双侧股骨颈、股骨髁、小转子到股骨皮质投影的长度可预防股骨旋转及成角畸形。     

骨性关节炎全髋置换术术前股骨前倾角与术后前倾角对比分析:一项基于计算机辅助手术的研究

正计算机辅助手术已应用于全髋置换术,作者分析了3个骨科中心共362例全髋置换术患者资料,发现患者术前股骨前倾角为5.0°±9.6°,股骨假体前倾角为6.4°±9.7°,股骨前倾角与股骨假体前倾角差异为1.6°±9.8°。平均联合前倾角为28.2°±7.9°,股骨假体前倾角与联合前倾角显著相关,3个骨科中心的股骨假体前倾角均存在显著性差异。因此作者认为,即使使用计算机辅助手术,股骨假体前倾角仍然与不同医     

髋关节假体安装参数的计算机模拟研究

目的 研究不同颈干角股骨假体在前倾角变化时获得理想髋关节活动度所需要的髋臼安装参数.方法 建立人工全髋关节三维计算机模型,髋臼杯假体采用半球形,臼杯直径480mm,颈干角分别为127°、131°和135°.股骨假体前倾角变化范围为0°~30°,臼杯假体俯倾角变化范围为30°~60°、前倾角变化范围为0°~40°.每变化5°重复一次髋关节在6个方向(屈曲、后伸、内收、外展、内旋、外旋)的活动,选出符合最佳髋关节活动度的假体安装参数.采用SAS 6.12统计学软件对数据进行分析.结果 颈干角分别为127°、131°和135°的假体,其最佳的臼杯俯倾角安装位置分别为45°、40°和35°;在活动满足后伸>40°、内收>50°、外展>50°、内旋>80°、外旋>40°的条件下,髋关节最大屈曲度分别为135.64°±3.45°、126.00°±3.57°和118.29°±3.29°;臼杯假体前倾角(Y)和股骨假体前倾角(X)的关系分别为Y+0.69×X=36.93°,Y+0.71×X=37.10°和Y+0.64×X=36.79°.结论 臼杯俯倾角最佳安装位置随着假体颈干角的变大而逐渐变小,髋关节在安全范围可以达到的最大屈髋度数随假体颈干角变大而逐渐减小,股骨假体前倾角度和臼杯前倾角度呈负相关.     

3D打印技术测量儿童发育性髋关节脱位股骨颈前倾角

目的:探讨利用3D打印技术测量发育性髋关节脱位儿童股骨颈前倾角的方法及准确性以期找到准确测量该类患儿股骨颈前倾角的方法并指导制定手术方案。方法:纳入2016年6月至2018年9月需行手术治疗的单侧发育性髋关节脱位患者17例,男2例,女15例;年龄2～13(5.47±0.81)岁;左侧11例,右侧6例。用CT测量法(CT法)、3D打印的股骨实物模型测量法(模型法)和术中股骨颈前倾角测量法(术中法)分别测量患儿股骨颈前倾角,以术中法测量值作为标准参考值,进行统计学分析,比较前两种测量方法的准确性。结果:CT法测量平均值为(36.00±1.66)°,模型法测量平均值为(43.91±1.62)°,术中法测得股骨前倾角平均值为(44.21±1.62)°。CT法测量值与模型法测量值、术中法测量值的比较差异均有统计学意义(P0.05)。模型法测量值与术中法测量值差异无统计学意义(P0.05)。结论:利用3D打印技术的模型法测量儿童发育性髋关节脱位股骨颈前倾角与传统CT测量法相比更简单、准确、可重复性强,而且可以术前模拟术中操作,是目前比较理想的测量股骨颈前倾角的方法。     

术中股骨截面后侧皮质线作为股骨前倾角参照在人工全髋关节置换术中的应用

目的通过CT三维重建,模拟验证后侧皮质线作为人工全髋关节置换术中股骨柄前倾参照的有效性。方法接受双侧髋关节至双侧的股骨髁CT扫描病人43例。经Mimics软件三维重建后,在股骨颈水平横断面及不同斜行截骨面上测量皮质中间线、T线及后侧皮质线前倾角,并同股骨颈自然前倾角比较。结果股骨颈自然前倾角平均值为(15.8±4.9)°。在水平横断面上,T线前倾角与后侧皮质线前倾角比较差异无统计学意义(P0.05),骨皮质中间线前倾角与T线前倾角、骨皮质中间线前倾角及后侧皮质线前倾角比较差异有统计学意义(P0.05)。在不同高度斜行截骨面上,骨皮质中间线前倾角与T线前倾角、骨皮质中间线前倾角及后侧皮质线前倾角比较差异均有统计学意义(P0.05),而T线前倾角与后侧皮质线前倾角差异则无统计学意义(P0.05)。股骨颈水平横断面与不同高度斜行截骨面水平,骨皮质中间线前倾角、T线前倾角和后侧皮质线前倾角比较差异均无统计学意义(P0.05)。结论人工全髋关节置换术中,斜行截骨切面上的后侧皮质线可以作为股骨柄植入前倾方向的参考。     

基于C形臂股骨颈前倾角测量在股骨中近段骨折闭合复位髓内钉固定术中的旋转控制

目的探究与评价基于C形臂股骨颈前倾角测量在股骨中近段骨折闭合复位髓内钉固定术中旋转控制的可行性和效果。方法纳入自2015年6月到2017年6月应用闭合复位髓内钉固定术治疗股骨干中近段骨折患者共46例,其中观察组25例采用Brunner提出的C形臂测量患肢股骨颈前倾角进行旋转控制,对照组21例采用常规方法进行旋转控制。所有病例均为单侧闭合性骨折,术前行双侧股骨CT扫描,并测量健侧股骨颈前倾角。术中采用Brunner法,将股骨远端放置标准正位,通过调整近端旋转,将患侧前倾角调整至正常侧的值。所有病例术后行CT扫描并测量患侧股骨颈前倾角。结果所有纳入病例均顺利完成手术,两组手术时间、出血量、骨折愈合时间无统计学意义,两组健侧与患侧股骨颈前倾角差异比较有统计学意义(观察组4.62°±2.35°,对照组7.28°±2.93°,t=3.41,P0.001)。随访6~24个月,平均16.8个月,未见骨不连、螺钉切出等并发症。术后6个月St.Michael髋关节评分比较有统计学意义(观察组22.2±1.8,对照组20.6±2.0,t=2.86,P=0.01)。结论基于C形臂股骨颈前倾角测量可指导股骨干骨折闭合复位髓内钉固定中骨折端的旋转对位,准确判断股骨近端旋转角度和状态,提高术中的复位效果,明显降低术后旋转对位不良的发生率。     

股骨干骨折闭合复位髓内钉内固定术中利用小粗隆-股骨干切线控制股骨旋转

目的探讨闭合复位髓内钉内固定治疗股骨干骨折术中利用股骨小粗隆-股骨干切线控制股骨旋转的可行性及准确性。方法选择志愿者20名,行CT扫描并分别测量两侧股骨小粗隆-股骨干切线与股骨后髁连线夹角,并比较两侧股骨该夹角的差异。采用C型臂X线机对20具股骨标本于截骨前后分别测量股骨小粗隆-股骨干切线与股骨后髁连线夹角及股骨颈前倾角,比较2种方法的测量结果。结果志愿者左侧股骨小粗隆-股骨干切线与股骨后髁连线夹角为(65.9±7.5)°,右侧为(64.9±7.2)°;两侧间差值为1.2°~8.7°(3.9±2.2)°,差异无统计学意义(t=0.927,P=0.365)。20具股骨标本股骨小粗隆-股骨干切线与股骨后髁连线夹角为50.5°~80.0°(65.7±8.0)°,股骨颈前倾角为9.0°~19.5°(9.0±8.4)°。股骨小粗隆-股骨干切线法残留旋转移位为1.0°~7.0°(3.7±1.9)°,股骨颈前倾角法残留旋转移位为1.0°~8.5°(4.4±2.1)°,二者间差异无统计学意义(t=1.113,P=0.279)。结论股骨小粗隆-股骨干切线法依靠确切的测量点来测量,准确性较高;此外,旋转程度可以量化,便于矫正;无需特殊投照体位,简便易行。     

全髋关节置换术中髋臼假体位相的安全范围及杯颈前倾角的优化组合

目的 探讨全髋关节置换术(THA)中髋臼杯的安全范围及杯颈前倾角的优化组合方法. 方法 建立THA三维可视化模型,定义两种髋关节活动度标准:一般标准(髋关节屈曲≥110°、屈曲90°时内旋≥30°、后伸≥30°和中立位外旋≥40°而没有假体撞击)和严格标准(髋关节屈曲≥120°、屈曲90°时内旋≥45°、后伸≥30°和中立位外旋≥40°而没有假体撞击).头颈比变化范围为2.00 ～2.92,股骨假体前倾角变化范围为0～30°,髋臼假体外展角变化范围为10°～60°,髋臼前倾角变化范围为0 ～ 70°,计算满足髋关节两组活动标准、臼杯外展角每变化5°相应的髋臼假体前倾角的安装参数.结果 严格标准下的安全范围较一般标准小,两种标准下的髋臼杯安全范围面积随着头颈比增大而增大.当颈干角为130°时,一般标准和严格标准下髋臼杯前倾角(Y)与股骨假体前倾角(X)的关系分别为Y1=-0.840X1+38.41,Y2=- 1.007 X2 +47.46;允许的最小髋臼外展角(OImin)和头颈比(GR)的关系分别为OImin'1=168.13 GR1-2.504,OImin'2=213.79 GR2-2.272.当颈干角从135°移向130°时,杯安全范围移向杯前倾角较小的区域,面积也有所减小.结论 THA中可以通过增大头颈比来扩大臼杯安放的安全范围.允许的最小髋臼外展角随着头颈比增大而变小,杯前倾角与股骨颈前倾角呈负相关.股骨颈前倾角的增大和颈干角的变小均使得杯安全范围移向杯前倾角较小的区域.     

股骨颈扭转角的CT测量及临床价值

[目的]通过CT成像描述股骨颈旋转角并测量数据,探讨临床价值。[方法]用螺旋CT扫描15个健康成人志愿者双侧股骨上段,三维成像,描述并用二种方法测量股骨颈扭转角。[结果]股骨颈扭转角是股骨颈截面最长径与股骨上段长轴的夹角,"圆心法"测得成角左侧30.00°±3.23°,右侧29.07°±3.65°,股骨颈不同部位及左右侧差别无统计学意义。[结论]三维CT成像能良好显示股骨颈扭转角并测量,"圆心法"测量值理论上更接近真实值。此角度对股骨上端手术操作及内固定设计有参考价值。     

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.     

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.     

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.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

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.