脊髓减压术后神经功能恢复机理的实验研究

目的 脊髓减压术是治疗急慢性脊髓压迫症的常用方法,但治疗机理尚不十分明显了。我们通过免疫组化的方法以探讨脊髓前角神经元中胆碱乙酰化酶在神经功能恢复中的作用。方法 采用免疫组化方法对大鼠脊髓压迫模型及减压后的脊髓前角细胞中乙酰胆碱转化酶（ＣｈＡＴ）的表达进行了经时变化的比较研究。结果 脊髓压迫可使脊髓前角神经细胞中的ＣｈＡＴ的表达受抑制。在这些ＣｈＡＴ表达受抑的细胞中部分可恢复其ＣｈＡＴ的表达。根据     

大鼠臂丛神经根性回植后脊髓病理改变和轴突再生

目的 探讨臂丛神经根性撕脱后神经根再植入脊髓的可行性。方法 采用大鼠颈5-7，神经根性撕脱伤实验动物模型，伤后将C5-7，神经根即刻植入脊髓。分别于神经根植入后3周、3个月、6个月取材。应用组织病理活检、免疫组化技术及神经示踪技术，对神经中枢及吻合口下段神经干检查。观察脊髓前角运动神经元和神经元内尼氏体数目和形态的改变；周围神经纤维再生数目、距离，轴索和髓鞘发育情况。结果 臂丛神经根性撕脱伤对动物生长和存活有较大的影响。脊髓前角运动神经元数目在3个月内持续减少，3个月后趋于稳定，6个月时脊髓前角大型运动细胞坏死比率在40％左右，残存的神经元多为受损的神经元，尼氏体减少或消失。脊髓前角运动神经元再生轴突可重新生长入周围神经干，再生神经纤维轴索较细，大部分髓鞘发育不完全，轴突再生距离较短，肌皮神经6个月内无神经纤维再生。结论 臂丛神经根性撕脱伤，神经根回植入脊髓后，脊髓前角运动神经元坏死比率为40％左右，残存神经元多为受损神经元，再生神经纤维表现为动力不足和发育不全，对终末器官功能恢复没有意义。     

白细胞介素1促进外周神经再生作用的形态学研究

目的 从形态学角度了解白细胞介素1局部应用对外周神经损伤后神经再生的作用。并通过对脊髓前角神经元的研究，初步探讨其有关机制。方法 用昆明小鼠单侧坐骨神经切割伤后一期端端缝合为损伤模型。按是否给予白细胞介素1分为实验组和对照组，分别在术后28d和42d切取坐骨神经和相应脊髓节段，测定神经纤维面数密度比，神经纤维断面面积，髓鞘厚度及脊髓前角神经元计数，脊髓前角神经元等效圆直径，等效圆面积，作定量比较。结果 术后28d，神经纤维面数密度比，神经纤维断面面积实验组均优于对照组，髓鞘厚度无显著性；术后42d，除近端神经纤维断面面积两组差异无显著性外，余各指标实验组均优于对照组。损伤侧脊髓前角神经元计数。等效圆直径，等效圆面积在28d和42d，实验组均优于对照组。结论 外周神经损伤局部应用白细胞介素1能促进神经再生，保护脊髓前角神经元。     

周围神经嵌压后脱髓鞘改变的实验研究

目的：探讨周围神经嵌压后脱髓鞘改变与压力的关系。方法：新西兰大白兔２０只（４０条坐骨神经），按压力大小分为０、４、８、１２ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）４组。将坐骨神经从神经压迫器的孔隙内通过，持续加压１小时后解除压迫，术后１周取坐骨神经受压段及其远端行横、纵断切片和神经单丝纤维撕梳，在光镜和电镜下行组织形态学观察。结果：各压力组神经受压段发生不同程度的节段性脱髓鞘改变；压力升高其病理改变则加重，受压神经段和气囊两端的神经纤维水肿和脱髓鞘改变较重，粗神经纤维较细神经纤维损伤重；神经的外周区较中心区脱髓鞘明显；神经的远端脱髓鞘不明显。结论：神经受压后呈节段性脱髓鞘，其程度与压力成正比，受压神经的远端脱髓鞘不显著。     

兔胚胎脊髓移植修复周围神经缺损的实验研究

目的：对用胚胎脊髓移植修复周围神经缺损的可行性进行研究。方法：将36只新西兰家兔制成兔双侧坐骨神经缺损模型。按脊髓桥接长度分为3组,每组两侧神经桥接长度不同。第1组桥接长度为坐骨神经直径的4倍,第2组为8倍,第3组为16倍;左侧选用胎兔脊髓桥接,右侧为自体神经桥接。于术后1、2、3个月任选2只动物行辣根过氧化物酶（HRP)逆行示踪,另外10只取移植段中、远段组织作透射电镜观察。结果：在兔脊髓前角3组均发现被标记的神经元细胞。扫描电镜下见到胚胎脊髓移植段及远段有大量的正常神经纤维,其轴突直径、髓鞘厚度与对照侧相比,差异均无显著性意义（P＞0．05）。结论：用兔胚胎脊髓移植修复周围神经缺损的方法是可行的。     

甲基强的松龙预防牵张性脊髓损伤的实验研究

为探索甲基强的松龙（ＭＰ）对牵张性脊髓损伤的防治作用，选用日本大耳白兔４８只，随机分为对照组（Ａ、Ｂ）、实验组（Ｃ、Ｄ）。实验组于伤前３０分钟一次静脉缓慢推注ＭＰ３０ｍｇ／ｋｇ；伤后１５分钟开始，每１小时静脉滴注ＭＰ５．４ｍｇ／ｋｇ，持续５小时。对照组用生理盐水治疗。采用皮质体感诱发电位（ＳＣＥＰ）监护、组织形态学、脊髓组织生化测定、运动功能评定等方法评价。结果表明，Ｃ组、Ｄ组较Ａ组、Ｂ组ＳＣＥＰＰ１波波幅恢复快速、稳定；伤后８小时及１４天运动功能评定其障碍率低于Ａ组、Ｂ组（Ｐ＜０．０５）；脊髓前角灰质神经元体积密度及１００μｍ白质范围内有髓神经纤维数高于Ａ组、Ｂ组（Ｐ＜０．０５）；丙二醛含量低于Ａ组、Ｂ组，过氧化物歧化酶含量高于Ａ组、Ｂ组（Ｐ＜０．０５）；神经元及神经纤维变性、坏死，灰质出血范围及脊髓微血管痉挛程度明显轻于Ａ组、Ｂ组。认为，在脊柱畸形矫正术前应用大剂量ＭＰ，具有预防牵张性脊髓损伤的作用；伤后及时给予ＭＰ，可减轻脊髓继发性损伤     

慢性压迫性颈脊髓病山羊模型的建立与评估

目的验证一种慢性压迫性颈脊髓病动物模型的建立方法,并评估其可行性。方法选取12只崇明山羊(雌性),随机分为实验组(9只)和对照组(3只)。通过颈椎前路手术将一种新型脊髓压迫装置固定在C3椎体内,实验组术后每周经外置注射器向球囊内注射0.1mL造影剂,使球囊逐渐膨胀,从而对实验动物脊髓造成持续性压迫;对照组安装压迫装置后,每周仅经皮穿刺但不注射造影剂。造模后4周、8周、12周采用Tarlov评分法对实验动物进行脊髓运动功能评分,颈椎行X线、CT检查,并在不同时间点分别处死2只实验动物,取压迫节段脊髓切片进行病理学检查。结果对照组各时间点Tarlov评分均为5分。实验组术后4周(n=9)Tarlov评分不变;术后8周时(n=7)Tarlov评分3只4分,4只5分;术后12周时(n=5)Tarlov评分3只3分,2只2分。影像学显示对照组脊髓未见明显异常;实验组球囊压迫系统表现稳定,随着每周不断注入造影剂后球囊增大,脊髓逐渐受压。病理学检查对照组未见明显异常。实验组术后4周未见明显异常;术后8周受压节段脊髓前角内神经元细胞变性,胞体萎缩变小,但数量未见明显减少,部分白质出现轻度脱髓鞘改变,部分轴突出现空泡样变性;术后12周,神经元细胞变性明显,部分出现坏死,细胞核固缩,白质弥漫性脱髓鞘,轴突空泡样变性明显。结论建模术后实验动物脊髓运动功能、影像学和病理学检查结果均符合慢性压迫性颈脊髓病特点,说明该新型脊髓压迫系统可以建立稳定的、可重复的慢性脊髓压迫动物模型。     

实验性脊髓缺血性损伤后神经元病变的神经丝免疫组织化学研究

目的：观察实验性兔腰髓缺血４０ｍｉｎ和再灌流４ｈ的脊髓运动神经元胞体和轴突的病理学改变。方法：用免疫组织化学方法观察神经丝（ｎｅｕｒｏｆｉｌａｍｅｎｔｓ，ＮＦ）抗体特异标记神经元胞体和轴突，并对其结果进行图像分析。结果：缺血４０ｍｉｎ，脊髓前角运动神经元胞体和轴突内神经丝反应异常增强，胞体内神经丝分布紊乱聚集。再灌流４ｈ，脊髓前角运动神经元胞体和轴突内神经丝反应阳性，胞体内神经丝散乱、稀疏、崩溃和溶解，轴突肿胀、扩大、消失。图像分析了脊髓前角运动神经元胞体内神经丝的面积、灰度和脊髓前索内轴突的数量，其结果具有明显的统计学意义。结论：神经丝免疫组织化学方法能更清楚地显示脊髓运动神经元胞体和轴突的病理学改变，脊髓损伤后细胞骨架紊乱在神经元的病理发病机制中起重要作用。     

脊髓型颈椎病早期诊断的研究进展

脊髓型颈椎病 (ｃｅｒｖｉｃａｌｓｐｏｎｄｙｌｏｔｉｃｍｙｅｃｏｐａｔｈｙＣＳＭ)是严重危害中老年人健康的最常见的颈椎疾患之一[1] 。本病诊断包括 :①临床上出现颈脊髓损害的表现。②影像学证实存在脊髓压迫。③除外肌萎缩性脊髓侧索硬化症、脊髓肿瘤等疾病[2 ] 。1　ＣＳＭ早期诊断的必要性在ＣＳＭ的病理改变中 ,大部分神经纤维的脱髓鞘改变在急性损伤中被认为是可逆的 ,ＣＳＭ病灶中脱髓鞘和髓鞘再生过程同时存在 ,表明及时积极的治疗对ＣＳＭ是有意义的[3 ] 。ＣＳＭ的手术治疗被多数学者认为是解除椎管内脊髓压迫迄今为止最有效…     

不同压力对兔坐骨神经内离子含量变化的实验研究

目的：探讨不同压力对兔坐骨神经内离子含量的变化及其病理改变的关系。方法：用特制的气囊压迫装置，对３５条兔坐骨神经进行急性压迫实验。压力分别为０、４、８、１２ｋＰａ（０、３０、６０、９０ｍｍＨｇ），持续加压１小时，术后一周取受压神经段，行病理形态学观察和原子吸收分光法进行离子定量分析。结果：受压神经段内Ｋ、Ｎａ、Ｃａ离子的含量明显高于对照组（Ｐ＜０．０１）。不同压力下受压神经段均发生节段性脱髓鞘改变。随压力增加受压神经段内离子含量进一步升高，脱髓鞘改变进一步加重。结论：受压神经段内钙离子增高可能加重神经组织继发性损害。周围神经嵌压后的病理变化与其电解质分布异常可能相互影响。     

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.