动脉旁路移植术治疗锁骨下动脉闭塞症30例分析

目的观察动脉旁路移植术治疗锁骨下动脉闭塞症的临床效果。方法回顾性分析动脉旁路移植术治疗锁骨下动脉闭塞30例的临床资料。全部患者均行动脉造影明确诊断;术后应用多普勒超声检查转流血管通畅情况。结果30例患者术后患侧与健侧血压差<10mmHg,患/健侧血压指数由术前平均0 66±0 11提高至0 99±0 09 (P<0 01 )。术后随访22例( 73 3% ),随访18个月至9年,平均51 4月。转流血管通畅率为83 3% (25 /30)。结论对于无法做腔内介入治疗的锁骨下动脉闭塞症,动脉转流目前仍是主要的治疗方法。     

锁骨下动脉闭塞69例治疗分析

目的 探讨腔内修复及外科手术治疗锁骨下动脉闭塞的方法和疗效.方法 2002年1月至2007年7月.行腔内及手术治疗锁骨下动脉闭塞症共69例患者,其中腔内治疗44例,包括单纯球囊扩张3例,同时行支架植入者41例,植入支架43枚;手术治疗25例.结果 均顺利完成手术或腔内治疗.腔内治疗组患/健侧血压比值由术前0.66±0.14提高至术后0.96±0.13(P<0.001);手术组患/健侧血压比值由术前0.63±0.16提高至术后0.95±0.18(P<0.001).61例患者随访时问2～49(平均16.7)个月,治疗组有1例术后1年出现支架结合部位狭窄,手术组随访人工血管均保持通畅,无人工血管相关并发症.结论 腔内治疗和手术治疗均是治疗锁骨下动脉闭塞的有效方法,腔内治疗因具有微创的特点,应作为治疗的首选方法.     

血管腔内技术与手术治疗锁骨下动脉闭塞症

目的探讨血管腔内技术与手术治疗锁骨下动脉闭塞症的临床效果及合适的治疗程序。方法1997年6月至2004年5月采取血管腔内技术与手术治疗锁骨下动脉闭塞症39例。26例患者采用血管腔内治疗,置入27枚支架,14例经股动脉途径,12例经肱动脉逆行支架置入,其中8例在彩色多普勒超声定位下穿刺肱动脉。13例未能行支架置入,行血管旁路转流术。9例伴有颈动脉或椎动脉严重狭窄者行支架置入。结果39例患者术后患侧与健侧血压差<10mmHg(1mmHg=0.133kPa),患侧/健侧血压指数由术前的平均0.62±0.11提高至0.98±0.04(t=4.738,P<0.01);腔内治疗患者与手术患者平均血管通畅时间分别为(57.6±3.7)和(60.2±7.2)个月。结论血管腔内治疗与手术治疗锁骨下动脉闭塞症疗效相当,由于血管腔内治疗的微创性和安全性,应优先选择血管腔内治疗。     

锁骨下动脉闭塞69例治疗分析

目的 探讨腔内及手术治疗锁骨下动脉闭寨的方法和疗效.方法 2002年1月至2007年7月腔内及手术治疗锁骨下动脉闭塞症69例.腔内治疗44例,其中单纯球囊扩张3例,同时行支架植入者41例,植入支架43枚;手术治疗25例.结果 所有患者均顺利完成手术或腔内治疗,腔内治疗组患/健侧收缩压比由术前0.66±0.14提高至术后0.96±0.13(t=9.532,P＜0.01),手术组患/健侧血压比由术前0.63±0.16提高至术后0.95±0.18(t=8.236,P＜0.01),69例患者中随访61例,随访时间2～49个月,平均16.7个月,介入治疗组有1例术后1年出现支架结合部位狭窄,手术组随访人工血管均保持通畅,无人工血管相关并发症.结论 腔内治疗和手术治疗均是治疗锁骨下动脉闭塞的有效方法,腔内治疗因具有微创的特点,应作为治疗的首选方法.     

手术治疗锁骨下动脉闭塞症

目的探讨锁骨下动脉闭塞症的有效手术治疗方法。方法 2005年12月-2010年2月,收治锁骨下动脉闭塞症53例。男40例,女13例;年龄22～77岁,平均64岁。病程15d～20个月,平均6.5个月。动脉硬化闭塞症49例,大动脉炎4例。左锁骨下动脉闭塞35例,狭窄5例;右锁骨下动脉闭塞5例,狭窄4例;双侧锁骨下动脉闭塞4例。对39例单侧锁骨下动脉闭塞伴颈、脑动脉病变者采用腋动脉-腋动脉聚四氟乙烯(polytetra?uoroethylene,PTFE)人工血管转流术;10例不伴颈、脑动脉病变者行颈动脉-锁骨下动脉PTFE人工血管转流术。4例双侧锁骨下动脉闭塞者采用升主动脉-双锁骨下动脉PTFE人工血管转流术。术后常规应用抗凝及抗血小板药物治疗。结果 1例大动脉炎患者术后48h动脉吻合口及人工血管血栓形成;余52例手术均获成功,手术成功率98.11%。术中神经钳夹损伤2例,术后双侧吻合口周围血肿4例,均经保守治疗痊愈。52例手术成功患者均获随访,随访时间1～52个月,平均24.5个月。患者均存活,术前椎基底动脉及上肢动脉缺血症状均消失。彩色超声多普勒血流探测仪检查见吻合口及人工血管血流通畅,术后1年及2年人工血管通畅率均为100%;患侧椎动脉血流方向恢复正常。1例术后18个月出现腋动脉吻合口假性动脉瘤,行介入栓塞治愈。结论锁骨下动脉闭塞症的治疗术式较多,但应根据患者全身情况和病变特点进行合理选择。围手术期的正确处理及术中严格操作,是保证手术成功的关键。     

锁骨下动脉闭塞的血管腔内治疗

目的：探讨经皮血管内成形术(PTA)和血管内支架置放术治疗锁骨下动脉起始段闭塞的疗效。方法：应用经皮血管内成形术(PTA)和血管内支架安置术治疗5例锁骨下动脉起始段闭塞的病人。结果：5例手术均获成功。术后患肢动脉搏动恢复正常，多普勒测压双上肢血压压差由术前平均54mmHg降至术后9．6mmHg．术后随访1～3月；彩超提示支架无脱落及移位，病变部位血流通畅，椎动脉恢复为正常人颅血流。结论：PTA和血管内支架安置术是治疗锁骨下动脉起始段闭塞的一种微创、安全可行和疗效满意的方法。     

股浅动脉闭塞122例治疗体会

目的总结股浅动脉支架与股-腘动脉人工血管旁路移植术治疗股浅动脉闭塞病变的效果。方法选取我院2008年1月至2011年4月期间接受经皮腔内血管成形术+支架置入术(简称"PTA/S术组")或股-腘动脉人工血管旁路移植术(简称"动脉旁路移植术组")治疗股浅动脉闭塞病变的122例患者(136条患肢)作为研究对象。记录患者的年龄、住院时间、术前合并症、术后并发症、TASCⅡ分级、远端流出道情况、一期通畅率、有无截肢、死亡等。结果 1 PTA/S术组有64例74条患肢,动脉旁路移植术组有58例62条患肢,PTA/S术组患者的年龄大于动脉旁路移植术组(P0.05);PTA/S术组TASCⅡA、B级病变肢体所占比例较动脉旁路移植术组高(P0.05),TASCⅡC、D级病变肢体所占比例较动脉旁路移植术组低(P0.05);PTA/S术组拥有1条和3条远端流出道血管的患肢数目分别较动脉旁路移植术组多(P0.05);2组患者拥有2条远端流出道血管的患肢数目、术前合并糖尿病、合病高血压、合病糖尿病及高血压以及术前吸烟史病例数比较差异均无统计学意义(P0.05)。2 2组患者均无围手术期死亡患者;PTA/S术组的住院时间短于动脉旁路移植术组〔(7.2±1.2)d和(14.1±1.4)d,P0.05〕;而术后3年死亡率PTA/S术组高于动脉旁路移植术组(4.7%比1.7%,P0.05);切口感染率PTA/S术组低于动脉旁路移植术组(0比3.2%,P0.05);2组患者截肢率比较差异无统计学意义(P0.05);2组患者术后6、12及24个月一期通畅率比较差异无统计学意义(P0.05),36个月一期通畅率动脉旁路移植术组明显高于PTA/S术组(50.0%比40.5%,P0.05)。结论对于股浅动脉闭塞采用股-腘动脉人工血管旁路移植术能够获得较高的远期通畅率,但住院时间较长,个别患者会发生切口感染。股浅动脉球囊扩张成形+支架置入术手术创伤小,患者恢复快,住院时间短,对于年龄大,身体状况较差不能耐受股-腘动脉人工血管旁路移植术的患者有重要意义,但其远期通畅率有待进一步提高。     

锁骨下动脉阻塞支架置入50例临床分析

目的探讨腔内支架置入治疗锁骨下动脉闭塞症的临床疗效。方法2001年5月~2006年4月,我院采用腔内支架置入治疗锁骨下动脉闭塞50例53支病变。45例经股动脉顺行,5例经腋动脉逆行支架置入。7例伴有颈动脉或椎动脉严重狭窄同期行支架置入。结果术后患肢血压测定均较术前明显提高,患/健侧血压指数由术前0.69±0.12提高至术后0.98±0.11(t=9.731,P=0.000)。43例随访3~60个月,平均14.5月,锁骨下动脉再狭窄率(>50%)11.6%(5/43)。结论腔内介入支架治疗锁骨下动脉严重狭窄和闭塞是一种安全、有效的方法,为临床首选。     

解剖外途径动脉转流术治疗锁骨下动脉闭塞症

为提高锁骨下动脉闭塞症的治疗效果,作者报告了１９８９年～１９９６年采用非经胸解剖外途径治疗２０例锁骨下动脉闭塞症的经验。本组男９例,女１１例。１７例有上肢缺血表现,１１例有脑部缺血症状。１７例行颈动脉－锁骨下／腋动脉转流,３例行腋动脉－腋动脉转流术。除１例大动脉炎因远端流出道差转流血管阻塞疗效不理想外,其余患者患肢及脑缺血表现均明显改善或消除。无手术死亡。作者认为采用解剖外途径治疗锁骨下动脉闭塞症,无需开胸,创伤小,操作简便安全,并发症少,通畅率高,尤其适合于手术耐受性差的患者,值得进一步推广使用。     

内膜下血管成形术治疗外周动脉闭塞性疾病13例

目的评价内膜下血管成形术在治疗外周动脉闭塞性疾病中的应用价值。方法总结2004年5月至2006年5月北京协和医院血管外科对13例髂动脉和锁骨下动脉完全闭塞患者行内膜下介入治疗,同时行球囊扩张和支架植入术的临床资料。结果13例患者中,闭塞段动脉介入治疗均获得成功,闭塞动脉平均长度4．9 cm（2-8 cm）,主要症状均得到改善,无并发症。髂动脉闭塞的术前、术后平均踝-肱比（ABI）,分别为：0．39（0-0．83）,0．94（0．73～1．3）,P=0．004,差异有统计学意义。锁骨下动脉闭塞的病例术后双上肢血压均恢复一致,平均随访时间11个月（3～18个月）,随访率76．9％,支架1年通畅率100％（12／12枚）。结论内膜下血管成形术在外周动脉闭塞性疾病中有很好的应用价值,方法可靠,安全,近期通畅率较好,远期通畅率尚需要进一步随访。     

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.