延期联合入路三钢板内固定治疗Pilon骨折合并腓骨骨折

目的：探讨采用踝关节前内侧入路联合后外侧入路延期内固定治疗Pilon骨折合并腓骨骨折的临床疗效。方法：自2016年12月至2018年12月采用踝关节前内侧入路联合后外侧入路三钢板复位固定治疗18例Pilon骨折合并腓骨骨折患者,男12例,女6例;年龄38~51（44.00±3.45）岁;根据Rüedi和Allgöwer分型,Ⅱ型9例,Ⅲ型9例。所有病例为闭合性骨折。术后7 d采用Burwell-Charnley标准对关节面骨折复位情况进行评价,比较术后9、12个月Mazur踝关节评分以评价术后踝关节功能改善情况。结果：18例患者均获随访,时间12~18（14.00±1.57）个月。术后7 d根据Burwell-Charnley标准对关节面骨折复位质量进行评定：优13例,良5例。所有骨折愈合,愈合时间9.5~15（12.00±1.43）个月。所有患者术后无感染、皮肤坏死、内固定松动断裂及骨折复位丢失等并发症。根据Mazur踝关节评分标准,术后12个月（92.11±5.28）分较术后9个月（89.33±5.20）分明显提高（t=7.976,P<0.001）。结论：延期踝关节前后联合入路三接骨板内固定治疗Pilon骨折合并腓骨骨折,术中操作便捷,复位满意,固定持续可靠,术后并发症少,踝关节功能恢复满意。     

后方Pilon骨折特征及治疗的临床观察

目的:探讨后方Pilon骨折的临床特征及治疗方法。方法:回顾分析自2010年1月至2013年1月收治的18例后方Pilon骨折患者, 男13例, 女5例;年龄22～63岁, 平均46岁。所有患者为闭合性骨折, 肿胀消退后切开复位内固定, 先采用健侧卧位后外侧入路显露外踝及后Pilon骨折块, 分别用钢板予以固定, 再改仰卧位用螺钉或小钢板固定内踝后丘。采用美国足踝外科协会踝-足评分(AOFAS)对其疗效进行评价。结果:18例均获得随访, 平均随访时间22个月(12～48个月).除1例复位不满意外, 其余均解剖复位;骨折均愈合, 平均愈合时间11周。末次随访采用美国足踝外科协会踝-足评分(AOFAS)进行临床疗效评估, 结果优7例, 良9例, 中2例, 平均(86.8±9.2)分。结论:后方Pilon骨折在临床上并不少见, 其受伤机制、创伤解剖、手术方式和预后均有别于经典踝部骨折与一般Pilon骨折。     

AGH分型指导胫骨后Pilon骨折个体化治疗的临床疗效分析

目的 探讨AGH分型指导胫骨后Pilon骨折个体化治疗的临床疗效。方法 回顾性分析2017年3月至2020年4月苏州大学附属张家港医院收治的19例胫骨后Pilon骨折病人的临床资料,其中男9例,女10例,平均年龄为49.89岁（24~67岁）,行走跌倒14例,交通伤4例,重物砸伤1例。所有病人行CT检查,根据CT及AGH分型结果采用不同的手术入路和内固定方法。术后采用Burwell-Charnley放射学标准评价踝关节面的复位情况,同时采用美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足功能评分系统和疼痛视觉模拟量表（visual analogue scale,VAS）评价病人踝关节功能恢复情况。结果 病人术中平均失血量为64.74 mL,手术时间平均为129.47 min。病人均获得随访,平均随访时间为15.79个月（12~24个月）。根据Bruwell-Charnley评价标准评估术后踝关节面复位质量：优13例,可6例。术后1年AOFAS评分平均为85.95分,VAS评分平均为1.11分。结论 胫骨后Pilon骨折根据受伤机制,骨折类型多样,结合CT及AGH分型指导胫骨后Pilon骨折分型及个体化治疗后临床疗效满意。     

经前外侧改良型切口治疗Pilon骨折

目的 :观察经前外侧改良型切口在Pilon骨折治疗中疗效及并发症。方法 :2012年3月至2014年12月13例Pilon骨折患者采用前外侧改良型切口治疗,男12例,女1例;年龄28~58岁,平均46.3岁;病程18~47 d。按Rüedi-Allg觟wer分型:Ⅰ型4例,Ⅱ型7例,Ⅲ型2例;其中开放性1例,闭合性12例。患者皆因小腿外伤入院,影像学检查显示Pilon骨折,闭合性Pilon骨折均延期手术,跟骨牵引及消肿处理后行前外侧改良型切口治疗Pilon骨折,按Burwell-Charnley放射学复位标准评定手术复位质量,按照AOFAS Ankle-Hindfoot Scale标准分别在入院时及末次随访中评定踝关节功能。结果:所有患者术后获得随访,时间6~12个月,平均11.5个月。Burwell-Charnley放射学复位评价:解剖复位11例,尚可复位2例。切口Ⅰ期愈合11例,延期愈合2例(1例为双侧Pilon骨折发生延期愈合)。踝关节功能AOFAS评分由术前的(42.15±17.11)分提高到末次随访的(79.15±11.31)分;优3例,良7例,可3例。结论:经前外侧改良型切口治疗Pilon骨折具有骨折愈合率高、切口感染率低、术后并发症少、踝关节功能恢复满意等优点。     

闭合复位技术治疗外展嵌插型股骨颈骨折

目的: 探讨C形臂X线监测下闭合复位技术3枚螺钉固定外展嵌插型股骨颈骨折的可行性。方法: 回顾性分析2014年1月至2019年12月接受手术的17例外展嵌插型股骨颈骨折患者,男10例,女7例,年龄21~59(42.09±7.30)岁。根据术前的X线和CT资料,明确股骨头后倾及外展移位角度,2枚直径2 mm克氏针交叉从股骨头外侧和前方轻敲入髋臼顶盖骨质内,将近骨折段固定在髋臼上,在C形臂X线监测下逆骨折移位方向,逐渐内旋内收下肢(远骨折段),使远骨折端对合近骨折端完成解剖复位后3枚空心螺钉内固定。评价Garden指数,观察术后并发症,进行Harris功能评分。结果: 17例外展嵌插型股骨颈骨折均顺利完成闭合复位内固定,手术时间36~68(43.87±7.63) min,术中出血15~50(28.36±5.93) ml。术中Garden指数评价骨折复位质量,解剖复位12例,可接受复位5例,无复位不成功改开放复位病例。17例获得随访,时间3~41(27.5±8.4)个月。无股骨头坏死、骨折不愈合、髋关节撞击征、股骨颈缩短等并发症出现,MRI检查未发现有股骨头坏死及关节软骨损伤表现。术后2年髋关节Harris评分优13例,良4例。结论: 闭合复位3枚螺钉内固定手术技术治疗外展嵌插型股骨颈骨折可获得良好的解剖复位率及治疗效果。     

计算机虚拟技术联合骨盆复位架治疗骨盆C型骨折的疗效

目的: 探讨计算机虚拟技术联合骨盆复位架闭合复位经皮螺钉固定治疗复杂骨盆骨折的近期临床疗效。方法: 回顾性分析2018年4月至2020年4月采用骨盆复位架经皮微创治疗的30例Tile C型骨盆骨折患者,男21例,女9例,年龄19~57(39.40±9.85)岁。将患者的骨盆CT DICOM数据导入Mimics软件重建骨折虚拟模型,在骨折模型上进行虚拟复位及置钉,然后进行模拟透视记录理想的透视方位和角度以指导术中正确透视。记录手术时间、透视次数和术中出血量。患者骨折复位质量采用Matta影像评分标准评价,术后功能采用Majeed功能评分标准评价。结果: 30例患者均实现了闭合复位经皮螺钉固定,根据Matta评分标准骨折复位优良率为93.3%(28/30);共置入通道螺钉67枚,置钉优良率98.5%(66/67)。手术时间(173.54±79.31) min,术中透视次数(90.81±41.11)次,术中出血量(81.21±43.97) ml。所有切口Ⅰ期愈合,无断钉、无骨折再移位。所有患者随访满12个月,末次随访时Majeed功能评分73~94(85.66±5.33)分。结论: 计算机虚拟技术联合骨盆复位架可快速、准确和安全地复位和固定不稳定骨盆骨折,计算机虚拟技术有助于外科医生对骨盆骨折的认识和理解,骨盆复位架可提高外科医生闭合处理复杂不稳定骨盆损伤的能力。     

石膏临时固定延期切开复位内固定治疗Pilon骨折

目的探讨石膏临时固定延期切开复位内固定治疗Pilon骨折的临床疗效。方法回顾性分析自2015-01—2016-12采用石膏临时固定延期切开复位内固定治疗的14例Pilon骨折,入院时手法牵引简单复位后行踝关节功能位石膏托固定,6~9 d后采用前正中略弧向内侧的弧形切口并L形胫骨远端锁定接骨板内固定。结果本组手术时间120~180 min,平均161 min;术中出血量300~700 ml,平均500 ml。14例均获随访,随访时间平均16.4(12~24)个月。采用Burwell-Charnley放射学标准评价骨折复位质量:解剖复位13例,复位一般1例。骨折愈合时间12~24周,平均15.3周。采用AOFAS评分标准评定踝关节功能:优10例,良4例。结论石膏临时固定延期切开复位内固定治疗Pilon骨折安全可行、疗效满意。     

克氏针联合PEEK锚钉治疗WagstaffeⅡ型骨折

目的:探讨采用克氏针联合PEEK带线锚钉固定WagstaffeⅡ型骨折中腓骨骨块的临床疗效。方法:自2018年1月至2020年12月,采用克氏针固定腓骨撕脱骨块,PEEK带线锚钉修复加固,石膏外固定治疗29例踝关节WagstaffeⅡ型骨折,男18例,女11例;年龄27~69(46.3±10.2)岁;均为单侧手术;左踝10例,右踝19例;受伤至手术时间3~5(4.05±0.63) d。分别于术前及术后6个月采用美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)的踝-后足功能评分系统和疼痛视觉模拟评分法(visual analogue scale,VAS)进行临床疗效评价。结果:29例患者均获得随访,时间6~12(9.7±2.1)个月。术后2例行走时出现踝关节疼痛,加强康复锻炼及消炎镇痛药物治疗后缓解。AOFAS评分由术前的(62.16±19.73)分提高至术后6个月的(91.35±6.37)分(t=5.51,P<0.01);其中优15例,良12例,一般2例。VAS由术前的(5.91±1.57)分降至术后6个月的(0.41±0.37)分(t=10.54,P<0.01)。结论:采用克氏针联合PEEK锚钉固定WagstaffeⅡ型骨折的腓骨骨折块,加强修复了下胫腓联合韧带和距腓前韧带,术后有效缓解踝关节疼痛症状,功能恢复良好,撕脱骨折块固定稳妥,可获得良好的临床疗效。     

不同直径空心钉闭合复位内固定治疗股骨颈骨折疗效分析

目的:比较两种直径空心钉治疗股骨颈骨折的临床疗效差异.方法:2008年6月至2013年6月,采用闭合复位空心钉内固定治疗117例青壮年股骨颈骨折患者,分别使用6.5 mm空心钉和8.0 mm空心钉,其中6.5 mm组48例,年龄19~60岁,平均(45.61±11.99)岁,男30例,女18例,Garden Ⅰ/Ⅱ型17例,Garden Ⅲ/Ⅳ型31例;8.0 mm组69例,年龄18~60岁,平均(45.17±9.95)岁,男40例,女29例,Garden Ⅰ/Ⅱ型31例,Garden Ⅲ/Ⅳ型38例.记录并比较分析两组病例的一般资料、手术时间、住院时间、复位质量、股骨颈头颈部直径、骨折愈合时间、骨折愈合率、术后并发症情况,术后髋关节功能评分采用Harris评分.结果:两组患者均获随访,时间18~24个月,平均19.6个月.两组病例的手术时间、住院时间、复位质量差异均无统计学意义(P>0.05).两组病例的股骨颈头颈部平均直径、骨折愈合时间、骨折愈合率、术后并发症差异均无统计学意义(P>0.05).两组病例术后髋关节功能Harris评分均较好,疗效显着.Garden Ⅲ/Ⅳ型股骨头坏死发生率高于Garden Ⅰ/Ⅱ型,差异有统计学意义.结论:对于青壮年的股骨颈骨折,闭合复位空心钉内固定治疗是首选的手术方法,两种不同直径空心钉闭合复位内固定治疗股骨颈骨折时不会影响骨折愈合的时间及术后并发症的发生.     

超声在闭合复位内外侧交叉穿针固定治疗儿童肱骨髁上骨折中保护尺神经的可行性研究

目的:探讨超声在闭合复位内外侧交叉穿针固定治疗儿童肱骨髁上骨折中保护尺神经的可行性。方法:自2018年1月至2019年12月收治63例肱骨髁上骨折患儿,根据引导方式不同分为超声引导组和X线引导组。超声引导组32例,采用超声引导下闭合复位经皮内外交叉克氏针固定,男20例,女12例,年龄3~11(6.06±2.02)岁。X线引导组31例,采用X线引导下闭合复位经皮内外交叉克氏针固定,男17例,女14例,年龄2~10(5.61±1.96)岁。记录两组患者的手术时间,接受电透次数,骨折愈合时间,尺神经损伤情况,术后12个月采用Flynn疗效评分评价功能恢复情况。结果:所有患儿获得随访,超声引导组随访时间9~12(11.53±0.76)个月,X线引导组随访时间10~13(11.51±0.72)个月,两组患儿手术时间、随访时间、骨折愈合时间比较,差异无统计学意义(P>0.05)。X线引导组接受电透次数(21.65±5.58)次明显多于超声引导组(3.06±1.24)次(P<0.01)。超声引导组术后未发生医源性尺神经损伤,X线引导组术后2例出现尺神经损伤,两组比较差异无统计学意义(P>0.05)。术后12个月超声引导组Flynn临床功能评定结果优27例,良4例,可1例;X线引导组优23例,良6例,可1例,差1例,两组比较差异无统计学意义(P>0.05)。结论:超声引导与X线引导治疗儿童肱骨髁上骨折在手术时间、骨折愈合方面疗效相当,但超声引导可以在术中清晰地探测到尺神经所在的位置,最大程度避免因尺侧穿针时而导致的医源性尺神经损伤,是一种安全有效的治疗手段。     

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.     

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.     

Risiko Schlaganfall — Öffentlichkeitsarbeit und Aufklärung dringend erforderlich

Zusammenfassung Das wesentliche — und zugleich noch wenig ausgeschöpfte — Potenzial der Schlaganfallmedizin liegt in der langfristigen Prophylaxe. Durch Beeinflussung von Lifestylefaktoren wie Ernährungsgewohnheiten, Zigarettenkonsum und körperlichem Training durch entsprechende Aufklärung ließe sich ein erheblicher Teil an zerebralen Ereignissen vermeiden. Ein weiterer in Deutschland noch zu wenig beachteter Faktor ist die konsequente Blutdruckeinstellung. Breitgestreute Aufklärung könnte außerdem potenziellen Patienten helfen, bereits auftretende Warnsymptome wie die transiente ischämische Attacke richtig einzuschätzen, um eine rechtzeitige Behandlung zu ermöglichen.