新疆少数民族亲属活体肾移植供体安全性随访研究(附55例报告)

目的探讨新疆维吾尔族自治区(新疆)少数民族亲属活体肾移植中供肾切除术对供体安全性的影响。方法对55例活体肾移植供体进行随访,复查肾功能、24 h尿蛋白定量等常规检查,并与供者进行沟通,了解其心理状况和生活质量。对供者术前、术后7 d、术后6个月、术后1年、术后3年、术后5年的血清肌酐(Scr)、内生肌酐清除率(Ccr)和血压进行比较。结果 55例供体中,术后出现气胸1例,切口延迟愈合2例,切口血肿4例,经处理后均恢复正常,平均住院时间11 d。随访6～86个月,其中2例供者术后6个月内尿红细胞3～5/HP,2例出现一过性蛋白尿。术后供体各时段的肾功能(Scr和Ccr)和血压(收缩压与舒张压)均在正常范围内,术后7 d、6个月、1年、3年、5年的Scr、Ccr、血压与术前相应指标比较,差异均无统计学意义(均为P>0.05)。在随访期间所有供体家庭生活和日常工作未受到影响。结论新疆少数民族亲属活体供肾是安全可行的,供者在捐肾后肾功能未见减退,且生活质量较好。     

亲属活体供肾动脉轻度狭窄对肾移植受者术后早期肾功能和并发症的影响

目的探讨亲属活体供肾动脉轻度狭窄对肾移植受者术后早期肾功能和并发症的影响。方法回顾性分析14例供肾动脉轻度狭窄的亲属活体肾移植与50例标准亲属活体肾移植供、受者的临床资料。比较两组供者术后血清肌酐(Scr)水平。比较两组受者术后1、3、6个月的Scr水平;比较两组受者移植肾存活率及移植物功能延迟恢复(DGF)、急性排斥反应、肺部感染的发生率。结果两组供者术后Scr水平比较,差异均无统计学意义(均为P0.05)。两组术后1、3、6个月Scr水平比较,差异均无统计学意义(均为P0.05)。两组受者移植肾存活率,DGF、急性排斥反应、肺部感染的发生率比较,差异亦均无统计学意义(均为P0.05)。结论亲属活体供肾动脉轻度狭窄对肾移植受者术后肾功能和并发症的影响不大,可纳入标准供体供肾范围。     

供肾穿刺活检在亲属活体肾移植中的应用及边缘供肾对受者预后的影响

目的 分析供肾穿刺活榆在亲属活体肾移植中对供肾质量的诊断价值及边缘供肾对亲属活体肾移植受者早期预后的影响.方法 2004年2月至2008年7月142例亲属活体肾移植患者,按照供体年龄和供肾情况分为边缘供者组(51例)和非边缘供者组(91例).并对49例亲属活体供肾行细针穿刺活检术.分析2组受者的术后血肌酐(Scr)变化、Scr最低值、所需时间、术后并发症发生率.结果 49例亲属活体供肾中13例发生病理改变.边缘供者组受者Scr在术后4周、12周、6月及最低Scr水平均高于非边缘供者组(均P＜0.05),而术后12个月、24个月、36个月Scr和Scr恢复至最低水平所需时间差异无统计学意义(均P＞0.05).边缘供肾受者术后并发症发生率与非边缘供肾受者差异无统计学意义.结论 边缘供肾受者的早期临床疗效是理想的,但术后血肌酐基线较非边缘供肾患者高,应严格控制其纳入标准.供肾穿刺活检有利于发现常规无创检查难以发现的潜在肾脏疾病,对供受者具有重要诊断和治疗价值.     

亲属活体肾移植供者的选择和安全性评估(附79例报告)

目的探讨亲属活体肾移植供者的选择评估及围手术期安全性。方法 2007年6月至2010年8月,广西中医学院附属瑞康医院移植泌尿外科严格按照供体的评估程序,对79例拟行亲属活体肾移植的供体进行评估,依据供者入选和剔除标准选出合格供体。所有患者均签署知情同意书,符合医学伦理学规定。对供、受者的临床资料进行回顾性分析。收集供者的一般资料、肾功能、捐献关系,分析拟供者剔除的原因,了解供、受者的配型、手术情况,追踪供者、受者术后随访情况。结果 79名拟供者,经严格的筛选最终确定为亲属活体肾移植供体38名。剔除的41例中,糖尿病和高血压,占34%,其余依次为双侧肾功能损害、患乙型病毒性肝炎或丙型病毒性肝炎。供、受者的关系:父母捐献给子女15名,3代以内血亲捐献10名,兄弟之间捐献8名,夫妻之间捐献5名。供、受者血型相同33对、相容5对。供、受者补体依赖淋巴细胞毒性试验均为(-)、群体反应性抗体均为(-)。供者手术时间1～2h,供肾热缺血时间30～60s,冷缺血时间1～2h。供者术前及术后的血清肌酐水平都有不同程度的升高,但均于术后7d恢复正常。供者围手术期间均未发生外科及内科并发症,住院时间10～14d。本组受者中,除1例夫妻之间捐献的肾移植患者术后发生急性排斥反应外,其他病例无出现急性排斥反应、肾功能延迟恢复等状况,随访至2010年7月,移植肾均正常。结论对于亲属活体肾移植的供体安全应予重视。严格进行术前评估,选择合格的供者,术中操作规范,术后加强管理,活体肾移植的供者围手术期是安全的。     

供肾穿刺活检在亲属活体肾移植中的应用及边缘供肾对受者预后的影响

目的 分析供肾穿刺活榆在亲属活体肾移植中对供肾质量的诊断价值及边缘供肾对亲属活体肾移植受者早期预后的影响.方法 2004年2月至2008年7月142例亲属活体肾移植患者,按照供体年龄和供肾情况分为边缘供者组(51例)和非边缘供者组(91例).并对49例亲属活体供肾行细针穿刺活检术.分析2组受者的术后血肌酐(Scr)变化、Scr最低值、所需时间、术后并发症发生率.结果 49例亲属活体供肾中13例发生病理改变.边缘供者组受者Scr在术后4周、12周、6月及最低Scr水平均高于非边缘供者组(均P＜0.05),而术后12个月、24个月、36个月Scr和Scr恢复至最低水平所需时间差异无统计学意义(均P＞0.05).边缘供肾受者术后并发症发生率与非边缘供肾受者差异无统计学意义.结论 边缘供肾受者的早期临床疗效是理想的,但术后血肌酐基线较非边缘供肾患者高,应严格控制其纳入标准.供肾穿刺活检有利于发现常规无创检查难以发现的潜在肾脏疾病,对供受者具有重要诊断和治疗价值.     

供肾穿刺活检在亲属活体肾移植中的应用及边缘供肾对受者预后的影响

目的 分析供肾穿刺活榆在亲属活体肾移植中对供肾质量的诊断价值及边缘供肾对亲属活体肾移植受者早期预后的影响.方法 2004年2月至2008年7月142例亲属活体肾移植患者,按照供体年龄和供肾情况分为边缘供者组(51例)和非边缘供者组(91例).并对49例亲属活体供肾行细针穿刺活检术.分析2组受者的术后血肌酐(Scr)变...     

甲基苯丙胺中毒脑死亡器官捐献1例报道

目的探讨甲基苯丙胺中毒脑死亡器官捐献供肾肾移植的效果。方法回顾性分析2015年10月1例甲基苯丙胺中毒脑死亡器官捐献供肾用于2例肾移植的临床资料。供者为女性,22岁,因甲基苯丙胺中毒导致脑死亡而捐献器官。受者均为女性,因慢性肾功能不全尿毒症接受肾移植。结果 2例受者术后4 d血清肌酐恢复正常,未发生急性排斥反应。术后1年随访血清肌酐及尿量均正常。结论甲基苯丙胺中毒脑死亡的患者可以作为器官捐献的供体来源。     

活体肾移植供者安全性的随访观察

目的探讨活体肾移植对供者安全性的影响。方法研究对象为2003年4月至2007年4月在新疆医科大学第一附属医院完成活体供肾肾移植的62例供者。记录供者手术时间和住院时间,观察术后并发症发生情况和预后情况。术后随访,随访内容包括血清肌酐(Scr)、血尿素氮(BUN)、肾小球滤过率(GFR)、血浆白蛋白、血红蛋白及血压等指标,同时调查供肾对生活工作的影响。结果62例供者供肾手术均获成功。供者中1例开放取肾术中发生气胸,1例发生切口脂肪液化坏死,经对症治疗后痊愈。2例术后并发肺部感染,选用敏感抗生素及雾化吸入治疗后治愈,其余术后均恢复顺利。62例供者平均术后住院时间(8.2±2.6)d,随访时间为(3.2±1.1)年。所有供者均存活,家庭生活和日常工作也未受到明显影响。62例供者术前及术后7 d、3个月、1年、3年、5年的Scr、BUN、GFR、血浆白蛋白、血红蛋白及血压变化情况比较,差异无统计学意义(均为P0.05)。结论活体供肾肾切除手术安全可行。严格完善术前检查,术中仔细操作及术后严密随访对于保障供者的安全有十分重要的意义。     

老年活体供肾移植术后供者安全性及受者移植效果的分析

目的 分析老年活体供肾移植术后供者的安全性及受者的移植效果.方法 回顾性分析251例亲属活体供肾移植的临床资料.根据供者年龄,将251例活体供肾移植分为老年供肾组(≥55岁)和中青年供肾组(<55岁),对手术前后两组供、受者的血清肌酐(Cr)、肾小球滤过率(GFR)、内生肌酐清除率(Ccr)、并发症、平均住院时间以及受者的人/肾存活率、急性排斥反应发生率进行比较和分析.结果 老年供肾组和中青年供肾组供者手术前后血Cr水平的差异无统计学意义(P>0.05),而Ccr的差异有统计学意义(P<0.05).老年供肾组与中青年供肾组供者比较,术前总GFR、留存肾GFR及术后10 d留存肾GFR比较,差异均无统计学意义(P>0.05);老年供肾组供者术后10 d与术前的留存肾GFR比较,差异无统计学意义(P>0.05);中青年供肾组供者术后10 d的留存肾GFR较术前明显上升,差异有统计学意义(P<0.05).老年供肾组与中青年供肾组受者比较,手术前后各相应时间点的血Cr水平差异无统计学意义(P>0.05).老年供肾组和中青年供肾组供者平均住院时间分别为(16.67±7.78)d和(16.11±5.89)d(P>0.05),受者平均住院时间分别为(29.61±24.28)d和(28.76±19.27)d(P>0.05).两组受者6个月内急性排斥反应发生率分别为6.50%和5.75%(P>0.05).老年供肾组受者术后死亡1例,中青年供肾组死亡3例,并有1例因急性排斥反应切除移植肾.结论 老年活体供肾移植术前应对供者进行严格的选择,在进行全面系统评估的前提下,可以保证供者术后的安全以及受者的移植效果.     

高龄供者血清Klotho水平预测受者术后移植肾功能状态的临床研究

目的探讨高龄供者血清Klotho水平预测受者移植肾功能的可行性。方法选取16例高龄供者和相应27例肾移植受者的临床资料。观察肾移植受者的一般情况。检测高龄供者器官获取手术当日血清Klotho和血清肌酐(Scr)水平。检测肾移植受者术后1、3、12个月的Scr水平,计算估算肾小球滤过率(eGFR),分析供者血清Klotho水平与受者术后移植肾功能的相关性。结果肾移植术中的冷缺血时间为(649±245)min,受者移植物功能延迟恢复(DGF)发生率为26%,急性排斥反应发生率为7%。高龄供者血清Klotho水平为537(245～793)pg/m L,Scr水平为(164±62)μmol/L。受者术后1、3、12个月的Scr水平分别为(136±47)、(132±43)、(133±46)μmol/L,相应的e GFR分别为(52±20)、(52±19)、(53±21)m L/(min·1.73 m~2)。高龄供者血清Klotho水平与受者术后1个月移植肾功能呈负相关(P0.05)。血清Klotho水平预测术后1个月移植肾功能不全的灵敏度和特异度分别为0.909和0.769。结论高龄供者术前血清Klotho水平对受者术后1个月移植肾功能具有预测价值。     

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.     

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.