双钢板联合自体植骨治疗股骨干骨折术后骨不连

目的探讨双钢板联合自体植骨治疗股骨干骨折术后骨不连的临床疗效。方法 2010年3月至2014年5月运用双钢板联合自体髂骨植骨治疗股骨干骨折术后骨不连患者19例,男14例,女5例;年龄24~66岁,平均40.9岁;初次损伤闭合性骨折12例,开放性骨折7例;初次治疗髓内固定5例,外固定架固定4例,钢板固定10例,其中1髓内针锁钉断裂,2例钢板折断。按Judet分类法分型,肥大型7例,萎缩型12例;骨不连病程随访时间6~41个月,平均16.4个月。结果 19例均获得随访16~38个月,平均20.5个月,术后骨折在4~8个月内全部愈合,平均愈合时间5.3个月,均无感染及内固定断裂松动。结论双钢板联合自体植骨治疗股骨干骨折术后骨不连疗效满意。     

增加钢板与更换髓内钉治疗股骨髓内钉失败骨不连的比较

[目的]比较增加钢板与更换髓内钉治疗非感染性股骨髓内钉失败肥大型骨不连的临床疗效。[方法]2012年1月～2016年12月,本科手术治疗40例非感染性股骨干骨折髓内钉失败肥大型骨不连患者。其中,10例采用保留原有股骨髓内钉,增加钢板固定,但不行自体髂骨植骨(单纯钢板组);13例采用保留髓内钉,增加钢板固定结合自体髂骨植骨(钢板植骨组);17例采用更换髓内钉结合自体髂骨植骨(换钉植骨组)。对比三组患者的术中出血量、手术时间、术后引流量、并发症、骨不连愈合时间和愈合率。[结果]术中出血量、手术时间和术后引流量依次为单纯钢板组钢板植骨组换钉植骨组,三组间差异均有统计学意义(P0.05)。除单纯钢板组1例患者失访外,所有患者获得12～60个月的随访,平均随访(25.22±6.25)个月。钢板植骨组骨折愈合最快,单纯钢板组次之,换钉植骨组骨折愈合最慢,钢板植骨组显著优于其他两组(P0.05)。术后9个月单纯钢板组和钢板植骨组的患者均达到骨性愈合,而换钉植骨组有1例再次行增加钢板固定术,半年后骨折愈合。[结论]相比之下,保留髓内钉增加钢板固定联合自体髂骨植骨是治疗股骨干骨折髓内钉失败肥大型骨不连的最佳手术方式。     

锁定钢板联合自体髂骨植骨治疗股骨干骨不连13例

目的观察13例股骨干骨不连患者采用自体髂骨块联合锁定钢板双固定治疗后的临床疗效。方法 13例股骨干骨不连患者均采取自体髂骨取骨,联合锁定钢板采用双固定骨折端方法进行治疗。结果 13例患者随访时间12~26个月,平均18个月。骨折均获骨性愈合,1例患者伤口延迟愈合,经换药后愈合,无一例发生切口皮肤坏死、深部感染、内固定松动或断裂,无成角畸形。根据HSS膝关节评分为88~97分,平均93分,Rasmussen膝关节功能评分法进行综合评分:优10例,良2例,可1例,差0例。结论符合文献报道:自体髂骨块联合锁定钢板双固定治疗股骨干骨不连临床疗效确切,是一种经济、有效的治疗方法。     

锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连

目的 探讨锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连的手术技巧与临床疗效. 方法 回顾性分析2006年3月至2008年6月收治且获得随访的26例肱骨干骨折术后骨不连患者资料,男19例,女7例;平均年龄为46 7岁(19 ～63岁).骨不连类型:肥大型17例,萎缩型7例,假关节型2例.患者本次手术与上次手术的时间间隔平均为9.3个月(9.1～9.6个月).22例内固定治疗的患者行原内固定物取出、切开复位、自体髂骨植骨锁定加压接骨板内固定术,4例带外固定支架患者先去除外固定支架,行石膏固定1个月后再行切开复位、自体髂骨植骨锁定加压接骨板内固定术.术后肩关节及肘关节功能评估分别采用Constant肩关节评分和Mayo肘关节评分.结果 26例患者术后获平均25.6个月(25～33个月)随访.25例患者术后骨折获愈合,平均愈合时间为5 2个月(4 ～9个月);1例因术后伤口感染致骨折不愈合,经抗感染治疗5个月后骨折获愈合.2例发生桡神经不全损伤.Constant肩关节评分平均为(79.1±0.1)分,Mayo肘关节评分平均为(85 7±0 8)分.结论 锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连的关键是尽量彻底清理骨折断端、加压、充分有效的自体髂骨植骨.该方法可以极大地提高骨折愈合率,减少并发症的发生,且能获得较好的肩、肘功能.     

双钢板技术结合自体髂骨植骨治疗髓内钉术后股骨骨不连

目的:探讨双钢板结合髂骨植骨治疗髓内钉术后股骨骨不连的临床效果。方法:2008年12月至2017年12月应用双钢板结合自体髂骨植骨治疗髓内钉术后股骨骨不连患者11例,男10例,女1例;年龄35～62岁;骨折至骨不连时间12～20个月。根据Judet分类法分型:萎缩型骨不连8例,增生型骨不连3例。术后定期随访,记录患者骨折愈合时间、负重活动时间及并发症等情况,观察双钢板固定联合髂骨植骨对股骨干骨折术后骨不连的修复效果。结果:11例患者均获得骨性愈合,随访时间12～22个月。手术切口均Ⅰ期愈合,手术时间70～130 min,出血量180～350 ml。术后2例出现膝关节僵硬,经CPM机被动锻炼2周后恢复;1例出现髂骨供骨区疼痛,3个月后缓解。骨折愈合时间24～40周;患者完全负重活动时间14～32周。末次随访时SF-36生活质量评分:躯体疼痛70～82分,活动评分70～82分,社会功能72～83分,总体健康72～82分。随访结束时,患者均未发生患肢短缩、感染、切口愈合不良、内固定物失效(断裂、松动)等并发症。结论:采用双钢板结合自体髂骨植骨,是治疗髓内钉术后股骨骨不连的有效治疗方法,能获得满意的临床愈合结果。     

锁定钢板内固定联合植骨治疗股骨骨不连或伴骨缺损

目的 探讨锁定钢板内固定联合植骨治疗股骨骨不连或伴骨缺损的疗效。方法 2005年6月至2010年6月应用锁定钢板治疗80例股骨骨折术后骨不连或伴骨缺损的患者,男60例,女20例;年龄8～68岁,平均38.2岁。骨不连部位：股骨近端16例,股骨远端40例,股骨干24例。骨不连原因：内固定失效60例,外固定失败5例,感染15例。骨不连病理分型：非感染性骨不连65例,其中肥大型15例,营养不良型10例,萎缩型40例（其中20例伴有骨缺损）;感染性骨不连15例。骨不连病程6～150个月,平均16.5个月。58例患者使用微创内固定系统钢板固定,22例患者使用锁定加压钢板固定。所有患者均进行植骨,其中自体髂骨移植35例,局部滑行加骨痂植骨10例,自体植骨结合同种异体松质骨移植8例,同种异体松质骨结合人工骨移植7例,吻合血管游离腓骨移植20例。结果 所有患者术后获6 ～ 36个月（平均13.8个月）随访。骨不连均在4～8个月（平均5.3个月）牢固愈合。无切口感染、内置物断裂及松动等并发症发生。16例股骨近端骨不连患者采用Sanders 创伤后髋关节评分标准评定疗效：优10例,良5例,差1例,优良率为93.8％。40例股骨远端骨不连患者采用美国膝关节协会评分系统( KSS)评定疗效：优25例,良12例,差3例,优良率为92.5％。24例股骨干骨不连患者采用Sanders创伤后髋关节评分标准和KSS评定疗效：优21例,良2例,差1例,优良率为95.8％。结论 锁定钢板内固定辅以植骨能明显促进骨愈合,是治疗股骨骨不连或伴骨缺损的有效方法之。     

带蒂骨痂植骨交锁髓内钉内固定治疗胫骨硬化型骨不连

[目的]观察交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗胫骨硬化型骨不连的临床疗效.[方法]本组胫骨硬化型骨不连12例,男8例,女4例;年龄26～64岁,平均45岁,全部采用开放置入交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗.[结果]经12～72个月,平均48个月的随访,所有病例均于4～6个月内获得骨性愈合.[结论]交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗胫骨硬化型骨不连具有：（1）合理的生物力学设计;（2）抗骨折旋转及短缩功能;（3）对局部血运破坏小;（4）带蒂骨痂植骨的＂架桥＂作用和自体髂骨植骨的成骨作用促进骨愈合,值得推荐使用.     

四肢非感染性管状骨术后骨不连的再次手术治疗体会

目的 探讨四肢非感染性管状骨内固定术后骨不连再次手术治疗的疗效. 方法 对2009年7月至2011年10月收治的57例四肢非感染性管状骨术后骨不连患者的临床资料进行回顾性研究,男43例,女14例;年龄16 ～ 70岁,平均41.5岁;骨不连类型:肥大性23例,萎缩性34例.骨不连病程9 ～ 72个月,平均16.4个月.采用单纯更换髓内钉治疗18例,更换钢板加植骨治疗24例,单纯自体髂骨植骨治疗15例.结果 所有患者术后获6 ～ 22个月(平均12.8个月)随访.其中56例患者获得骨折愈合,愈合时间5 ～ 16个月,平均8.8个月.1例植骨治疗后8个月钢板发生断裂,经再次植骨及更换内固定治疗,11个月后骨折获愈合. 结论 根据患者的具体情况选择个体化的手术方式,同时辅以正确的术后康复指导,四肢管状骨骨不连再次手术可以取得较好的疗效.     

附加锁定接骨板结合自体髂骨植骨治疗股骨干骨折交锁髓内钉固定术后骨不连

目的探讨附加锁定接骨板结合自体髂骨植骨治疗股骨干骨折交锁髓内钉固定术后骨不连的临床疗效。方法对10例股骨干骨折交锁髓内钉固定术后骨不连采用附加锁定接骨板结合自体髂骨植骨治疗。结果10例术后均获得平均12（8-18）个月随访。骨折均获愈合,愈合时间平均5．2（4～6）个月,膝关节屈伸功能恢复良好。结论附加锁定接骨板结合自体髂骨植骨治疗股骨干骨折交锁髓内钉固定术后骨不连创伤小、操作简单、骨折愈合快、功能恢复好,是一种理想的治疗方法,临床上值得推广。     

重组合异种骨植骨治疗四肢长骨骨不连的疗效观察

目的 探讨重组合异种骨与自体髂骨两种不同植骨材料植骨治疗四肢长骨骨不连的临床疗效.方法 对255例1992年以来四肢长骨骨不连进行回顾性分析,其中男182例,女73例:6～75岁,平均34.9岁.骨不连部位:肱骨骨不连51例(男36例,女15例),尺、桡骨骨不连57例(男36例,女21例),其中尺桡骨同时骨不连10例,股骨骨不连67例(男43例,女24例),胫骨骨不连80例(男67例,女13例).所有患者均行切开复位,并内固定或外固定.植骨来源:自体髂骨植骨88例,重组合异种骨(recombinant bone xenograft,RBX)植骨69例,自体髂骨联合RBX植骨74例,其他材料或不植骨22例.结果 255例患者中12例失访.243例随访10个月～12年,平均4年6个月.总愈合率95.1%,自体髂骨组愈合率95.5%,RBX植骨组愈合率97.1%,自体髂骨联合RBX植骨组愈合率93.2%.各组之间差异无统计学意义(P＞0.05).结论 RBX与自体髂骨植骨治疗四肢长骨干骨不连,其愈合率差异无统计学意义.RBX植骨治疗骨不连,安全、生物相容性好,对促进骨愈合疗效可靠.     

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.