精浆弹性硬蛋白酶与精液主要参数及精子功能相关性分析

目的 探讨精浆弹性硬蛋白酶与精液主要参数及精子功能指标的关系.方法 按照WHO<人类精液及精子-宫颈粘液相互作用实验室检验手册>要求,对170例不孕夫妇中的男性患者进行精液常规检测及精子功能分析,根据精浆弹性硬蛋白酶的检测结果将所有患者分为A、B、C3组.A组为精浆弹性硬蛋白酶含量＞1 000ng/ml;B组为精浆弹性硬蛋白酶含量290～1 000 ng/ml;C组为精浆弹性硬蛋白酶含量＜290ng/ml.通过比较三组的精液主要参数及精子功能指标来分析精浆弹性硬蛋白酶与男性不育各因素的相关性.结果 170例患者中A组56例(32.9%)、B组38例(22.4%)、C组76例(44.7%).与C组相比A组在精子活率、活力、头部畸形、顶体酶活性指标方面均显著低下(P＜0.01),而B组与C组相比上述指标差异无统计学意义(P＞0.05),各组间精子密度及DNA完整性的差异无统计学意义(P＞0.05).结论 精浆弹性硬蛋白酶与精液质量密切相关,精浆弹性硬蛋白酶作为男性生殖道感染的指标,在评估男性生育力、男性不育症的诊断和治疗,以及精子功能等方面有着重要的临床意义.     

精浆弹性蛋白酶水平与精液主要参数和精子功能的相关性分析

目的:探讨精浆弹性蛋白酶与精液主要参数和指标的关系。方法:用酶联免疫吸附法(ELISA)检测精浆中的弹性蛋白酶,按照WHO人类精液实验室手册要求进行精液常规分析、精子形态分析,检测精子顶体酶活性、精浆抗体(AsAb)、解脲支原体等,分析弹性蛋白酶与男性不育相关因素的关系。结果:209例男性不育患者中,43例患者精浆弹性蛋白酶≥290ng/ml,设为炎症组;166例患者精浆弹性蛋白酶<290ng/ml,设为非炎症组。炎症组的精子密度、精子活动率、a+b级活力精子率、精子顶体酶阳性率均低于非炎症组(P<0.05);而精子畸形率、精浆抗体(AsAb)、解脲支原体阳性率均高于非炎症组(P<0.05)。两组的精液量、PH值和液化时间差异无统计学意义。结论:精浆弹性蛋白酶水平与精液质量有密切的关系,生殖道感染是导致男性不育的重要原因。     

精浆弹性蛋白酶与精液常规参数及精子DNA完整性的相关性研究

目的:观察男性不育患者精浆弹性蛋白酶水平与精液质量及精子DNA完整性之间的关系,探讨生殖道炎症隐性感染对男性不育的影响。方法:选择202例男性不育患者依照精浆弹性蛋白酶实验结果并结合其他生殖道感染炎症标志物将男性不育分为确认感染组和隐性感染组,选择同期因女方因素不孕前来检查的生育力评估正常,排除生殖道炎症及其他影响生育的致病因素的健康男性32例作为对照组。统计分析不育组与正常对照组、不育组中确认感染组与隐性感染组、不育组中弹性蛋白酶水平正常者与升高者之间精浆弹性蛋白酶水平与精液质量及精子DNA完整性之间的差异。精子浓度及活力用计算机辅助精子分析系统检测,精子形态检查采用Diff-Quik染色法,精子DNA完整性分析用精子染色质扩散法(SCD),精浆弹性蛋白酶用酶联免疫吸附法。结果:正常对照组和不育组的正常形态精子百分率分别为(11.9±9.2)%和(4.1±3.3)%、精子DNA碎片指数(DFI)分别为(10.9±8.7)%和(21.3±12.7)%,精浆弹性蛋白酶分别为(220.9±73.1)ng/ml和(1687.3±1621.2)ng/ml,前向运动精子百分率(PR)分别为(49.7±10.8)%和(19.1±10.3)%,两组相互比较各指标均具有统计学差异(P均0.05)。不育组中弹性蛋白酶升高者较弹性蛋白酶正常者,PR显著降低,DFI显著升高,差异均具有统计学意义(P0.05)。隐性感染和确证感染患者间精液量、精子浓度、PR、正常形态精子百分率和DFI的差异均无统计学意义(P均0.05)。结论:生殖道炎症感染无论是显性或者是隐性有可能导致DNA损伤程度增加,从而影响男性生育。     

精浆piRNA对精子DNA完整性及辅助生殖技术结局的影响

目的通过检测男性不育症患者精浆中存在的睾丸特异piRNA与精子DNA损伤程度的关系,探讨其对精子DNA完整性及辅助生殖技术(ART)结局的影响。方法分析149例男性不育症患者精液质量及精子DNA完整性;按精子DNA碎片指数(DFI)将不育症患者分为:A组(DFI≤15%)、B组(15%DFI30%)、C组(DFI≥30%),采用实时荧光定量聚合酶链式反应(Q-PCR)检测各组患者精浆中piRNA-013423和piRNA-023386的表达量,比较各组患者受精率、卵裂率、优胚率、生化妊娠率及临床妊娠率的差异。结果与A、B组比较,C组的精子密度、前向活动精子、精子活动率、正常形态率均明显下降(P0.05),A、B两组比较,B组精子活动率下降(P0.05)。A、B、C三组中,C组患者piRNA-013423、piRNA-023386表达均低于A、B组(P0.01);C组患者受精率、卵裂率、优胚率、生化妊娠率及临床妊娠率均低于A、B组(P0.01)。结论男性不育症患者存在精子DNA不同程度的损伤,精浆中piRNA的水平与精子DNA完整性有关,DNA完整性差的患者精浆piRNA表达降低,且影响ART临床结局。提示piRNA可能通过某些信号通路调控精子DNA损伤,但具体机制需要下一步深入研究探讨。     

男性不育症患者精浆酸性磷酸酶与精浆生化指标的相关性研究

目的：探讨男性不育症患者精浆酸性磷酸酶与精浆生化指标的相关性,为精液质量的变化和前列腺炎的诊断、治疗寻找一个可靠的检测指标。方法：收集我院2009年1月～2011年3月治疗的资料完整的男性不育症患者精液分析记录616份,建立Excel数据库,采用SPSSl6．0统计软件,对精浆酸性磷酸酶和精浆生化指标进行相关性分析;并将精浆酸性磷酸酶48．8~208．6U／ml设为正常组,将〈48．8U／mI设为异常组,比较两组之间精浆生化指标的差异性。结果：①精浆酸性磷酸酶与精浆弹性蛋白酶呈负相关（P〈0．05）,与精浆锌呈正相关（P〈0．05）,与精浆a一糖苷酶、果糖无明显相关性（P〉0．05）;②按精浆酸性磷酸酶水平分组比较,显示精浆酸性磷酸酶异常组的精浆弹性蛋白酶明显增高,精浆锌明显降低（P〈0．05）;而两组精浆a一糖苷酶、果糖的表达差异则无统计学意义（P〉O．05）。结论：精浆酸性磷酸酶是前列腺炎可靠判断指标,与精浆锌、精浆弹性蛋白酶一道可作为生殖道感染及精液质量变化的检测指标。、     

男性不育伴乙型肝炎病毒感染患者精子DNA完整性的初步研究

目的:探讨男性不育伴乙型肝炎病毒感染患者精子DNA完整性。方法:应用精子染色质结构分析检测90例男性不育伴乙型肝炎病毒感染者(A组)、82例男性不育者(B组)及70例正常生育者(C组)的精子DNA完整性:DNA碎片化指数(DFI)和高DNA可染性(HDS),分别比较3组之间精子DNA完整性的差异。结果:精子DNA完整性:DFI:A组为(28.17±13.06)%,高于B组(26.64±9.79)%和C组(15.67±4.73)%,A组及B组分别与C组比较差异有统计学意义(P<0.05),A组与B组比较差异无统计学意义(P>0.05);HDS:A组为(10.83±5.60)%,高于B组(9.04±3.48)%及C组(8.04±2.25)%,A组与C组比较差异有统计学意义(P<0.05)。结论:男性不育患者的精子DNA完整性与正常生育者存在差异,若伴乙型肝炎病毒感染,会进一步加重精子DNA损伤,主要表现为精子核成熟异常。     

男性年龄与精子质量和精浆生化的关系

目的探讨不同年龄段男性精子质量与精浆弹性硬蛋白酶和精浆中性α-葡萄糖苷酶的关系。方法回顾性分析在嘉兴市妇幼保健院门诊检测精子质量和精浆生化(精浆弹性硬蛋白酶、精浆中性α-葡萄糖苷酶)的3 262例患者的临床资料。根据年龄分为5组:25岁组、25~29岁组、30~34岁组、35~39岁组和≥40岁组;并按精子质量分为少弱精子症(301例)、少精子症(193例)、弱精子症(1 335例)及正常精子组(1 433例)。统计分析不同精子质量不同年龄段男性的精浆弹性硬蛋白酶、精浆中性α-葡萄糖苷酶资料。结果 (1)3 262例精液分析,精浆中性α-葡萄糖苷酶异常发生率7.14%,精浆弹性硬蛋白酶水平确诊感染率29.25%;(2)各年龄组总体精浆中性α-葡萄糖苷酶异常发生率相似(P0.05),生殖道感染发生率随年龄增加有增高趋势(P0.05);(3)不同精子质量各组总体精浆中性α-葡萄糖苷酶异常发生率不同(P0.05),其中少精子症和少弱精子症组均显著高于弱精子症组及精子正常组(P0.05),但生殖道感染发生率相似(P0.05);(4)随着年龄增加,不同精子质量各组精浆中性α-葡萄糖苷酶异常发生率相似(P0.05),而精浆弹性硬蛋白酶异常发生率有增高趋势(P0.05),其中少弱精子症、少精子症患者各年龄组间比较均有统计学差异(P0.05);(5)各精子质量组精浆弹性硬蛋白酶测定值均随着年龄增加呈增高趋势,且正常精子组的精浆弹性硬蛋白酶测定值在35~39岁组及≥40岁组均显著高于25岁组(P0.05)。结论男科门诊患者中生殖道感染具有普遍性;伴随难以自愈的生殖道感染的少弱精子症、少精子症和弱精子症可能与男性患者年龄增加有关,亦可能与附性腺病变严重程度、病程进展所处不同阶段有关。     

精索静脉曲张不育患者的精液常规、精子动态参数和精浆生化指标分析

目的观察精索静脉曲张（VC）伴不育患者的精液质量和精浆生化水平的变化。方法利用计算机辅助精液分析系统（CASA）及酶免法分别检测52例VC不育患者、85例非精索静脉曲张不育患者和21例正常生育男性的精液常规、精子动态参数以及精浆酸性磷酸酶、精浆锌（Zn）、果糖、α-糖苷酶的含量。结果与对照组相比,VC组患者A级精子率、（A＋B）级精子率、精子直线速度（VSL）、直线性（LIN）、侧摆幅度（ALH）、精浆锌含量、α-糖苷酶的含量与对照组相比显著下降（P〈0.05）。与非VC不育组相比,VC不育组（A＋B）级精子率、精子直线速度（VSL）、侧摆幅度（ALH）、精浆锌含量、α-糖苷酶的含量也明显降低（P〈0.05）。并且随着精索静脉曲张程度的增加,VC患者A级精子率、（A＋B）级精子率、精子曲线速度VCL、直线速度VSL、直线性LIN、平均路径速度VAP、前向性STR、侧摆幅度ALH、精浆中锌含量、α-糖苷酶的含量有下降趋势。结论 VC能够降低精子活动率、精子动态活动能力以及改变了精浆微环境,从而导致男性生育力下降。     

慢性前列腺炎伴不孕不育患者精液结果及精浆PSA和果糖的分析研究

目的：探讨慢性前列腺炎（CP）伴不孕不育患者精液质量及果糖和PSA的变化。方法：研究对象均为男性CP患者。根据精液液化时间是否大于60min分为两组：精液液化正常组22例,精液延迟液化组20例;另选择正常对照组15例。分析各组精液理化指标,并测定各组精浆中果糖和PSA的含量。结果：精液液化正常组、精液延迟液化组在精子密度、精子活率、活动A级和活动A＋B级较正常对照组差异有统计学意义（P〈0．01）;PSA浓度较正常对照组差异有统计学意义（P〈0．01）。精液延迟液化组果糖含量较正常对照组差异有统计学意义（P〉0．05）。结论：CP可以引起精子质量降低和化学组分的改变,有可能影响精液的液化过程,导致男性不育。     

精子DNA完整性检测在男性不育诊断中的应用价值

目的分析精子DNA完整性与精液主要参数的相关性,探讨其在男性不育诊断中的临床应用价值.方法收集2010年6月至2012年2月在门诊就诊的465例男性患者的精液标本,参照第5版《世界卫生组织人类精液检查与处理实验室手册》严格标准进行精液常规及精子形态学分析,然后采用精子染色质扩散法检测精子DNA完整性,计算DNA碎片指数(DNA fragmentation index,DFI),按DFI值分为3组,分别为A组DFI≤15%(n=183)、B组15%0.05).结论精子DNA完整性检测结合精液常规分析有助于评估男性精液质量及生育力.     

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.