顺铂与三甲氧基二苯乙烯对胃癌BGC823细胞作用的研究

目的:研究三甲氧基二苯乙烯与顺铂对人胃癌BGC823细胞的抑制作用。方法:设空白对照组、顺铂治疗组、三甲氧基二苯乙烯治疗组、顺铂及三甲氧基二苯乙烯联合治疗组。用MTT法测定顺铂和三甲氧基二苯乙烯对细胞的抑制作用;用电镜、流式细胞仪观察其细胞变化。结果:顺铂与三甲氧基二苯乙烯合用,细胞存活率较单用时明显降低。顺铂100μg/L细胞存活率为(67.23±8.91)%,三甲氧基二苯乙烯100μg/L细胞存活率为(51.42±9.56)%;细胞存活率在合并用药时细胞存活率明显下降,顺铂10μg/L和三甲氧基二苯乙烯10μg/L的细胞存活率为(43.62±8.34)%,浓度150μg/L时细胞存活率最低为(17.33±7.93)%。联合用药后,顺铂使用量的IC50是(110.0±9.8)μg/L,三甲氧基二苯乙烯使用量的IC50是(18.0±10.0)μg/L,增效倍数分别为2.51、4.03合并指数CI50是0.58,CI500.95。细胞生长多停滞在S期(58.0±4.0)%。结论:顺铂对胃癌BGC823细胞有抑制作用,少量的顺铂与三甲氧基二苯乙烯合用后可达到大剂量顺铂单药化疗的效果,产生了协同作用。     

腹腔注射小剂量氯胺酮对小鼠吗啡诱发急性瘙痒的影响

目的 观察小剂量氯胺酮对小鼠吗啡诱发急性瘙痒的作用. 方法 40只雄性C57/BL6小鼠按完全随机分组方法分为5组(每组8只):空白对照组(C组),鞘内注射生理盐水5μl;吗啡组(M组),鞘内注射1.0 nmol吗啡5 μl;生理盐水对照组(N组),鞘内注射1.0 nmol吗啡5μl,5 min后腹腔注射5 mg/kg生理盐水;氯胺酮给药组(K组):鞘内注射1.0 nmol吗啡5μl,5 min后腹腔注射5 g/L氯胺酮;氯胺酮对照组(KC组):鞘内注射5μl生理盐水后腹腔注射5g/L氯胺酮.以5 min为间隔记录小鼠40 min内搔抓次数. 结果 与C组比较,M组小鼠搔抓次数明显增加,0～5 min小鼠开始出现搔抓反应[(5.0±1.2)次],6 min～10 min搔抓反应达到高峰期[(13.1±1.9)次],随后减少,持续约40 min;与N组比较,K组搔抓次数在6 min～10min[(4.8±1.4)次]、11 min～15 min[(4.1±1.2)次]、16min～20 min[(2.2±0.7)次]均有不同程度的下降(P＜0.05);与KC组比较,K组搔抓次数除31 min～40 min外,差异均有统计学意义(P＜0.05).腹腔注射氯胺酮后K组搔抓次数明显减少(P＜0.05).结论 腹腔注射小剂量氯胺酮能在一定程度上缓解小鼠吗啡诱发的急性瘙痒.     

不同剂量异丙酚对顺铂致大鼠肝细胞毒性的影响

目的 评价不同剂量异丙酚对顺铂致大鼠肝细胞毒性的影响.方法 健康雄性SD大鼠80只,体重200 ～ 250 g,3月龄,采用随机数字表法,将其随机分为8组(n=10)∶对照组(C组)、顺铂7.5 mg/kg组(Cis组)、异丙酚180 mg/kg组(P组)、脂肪乳15 ml/kg组(Ⅰ组)、顺铂7.5 mg/kg+脂肪乳15ml/kg组(CisI组)、顺铂7.5 mg/kg+异丙酚60 mg/kg组(CisP1组)、顺铂7.5 mg/kg+异丙酚120 mg/kg组(CisP2组)、顺铂7.5 mg/kg+异丙酚180 kg/mg组(CisP3组).每组均按体重予腹腔注射,C组、Cis组、P组和Ⅰ组分别单次注射生理盐水、顺铂、异丙酚和脂肪乳剂.CisI组、CisP组、CisP2组和CisP3组于注射异丙酚或脂肪乳剂后1 min注射顺铂.注射顺铂后24 h,采集下腔静脉血,全自动生化分析仪检测血浆谷丙转氨酶(ALT)及谷草转氨酶(AST)活性,取肝组织,于光镜下观察肝组织病理学结果.结果 与C组比较,Cis组、CisI组、CisP1-3组血浆ALT和AST活性升高(P＜0.05),肝组织病理学损伤加重;Cis组、CisP1-3组血浆ALT和AST活性依次降低(P＜0.05),肝组织病理学损伤减轻.结论 异丙酚可呈剂量依赖性地减轻顺铂致大鼠肝细胞毒性.     

氯胺酮对大鼠全肝缺血/再灌注后肺损伤的保护作用及机制

目的 观察10 mg/kg氯胺酮对于大鼠全肝缺血/再灌注诱发的急性肺损伤保护作用及其机制.方法 30只9～10周龄雌性SD大鼠以区组随机法随机分为3组(每组10只),假手术组(Sham组),全肝缺血/再灌注组(IR组)以pringle's法阻断门静脉和肝动脉30 min后再灌注1h.全肝缺血/再灌注氯胺酮预处理组(Ket组),以10 mg/kg氯胺酮于全肝血流阻断前20 min经尾静脉注射预处理.测定各组肺组织干湿重比值(W/D比值);血清中天冬氨酸氨基转移酶(AST)、血清丙氨酸氨基转移酶(ALT)含量;逆转录/实时聚合酶链式反应( RT-PCR)法测定肺组织中血清肿瘤坏死因子-α(TNF-α)mRNA、细胞间黏附分子-1( ICAM-1 )mRNA含量;Western blot法测定肺组织中核因子-kb( NF-kJ )/P65含量;各组肺组织HE染色后病理评分.结果 血清AST、ALT含量:IR组[AST:(91±25)U/ml,ALT:(67.0±19.4) U/ml]和Ket组[AST:(85±12) U/ml,ALT:(51.3±9.9) U/ml]均高于Sham组[AST:(29±9) U/ml,ALT:(7.8±2.7) U/ml] (P＜0.05).血清TNF-α、ICAM-1含量:IR组[TNF.α:(23.1±4.8) μg/L,ICAM-1:(34±9)μg/L]和Ket组[TNF-α:(19.1+5.8)μg/L,ICAM-1:(41±7) μg/L]均高于Sham组[TNF-α:(8.7±2.4) μg/L,ICAM-1:(13±5)μg/L](P＜0.05).而Ket组和IR组之间无统计学差异(P＞0.05).W/D比值:IR组(6.9±1.7)和Ket组(5.1±1.1)高于Sham组(3.7±0.7)(P＜0.05),IR组高于Ket组(P＜0.05).肺组织中TNF-α mRNA、ICAM-1 mRNA和NF-kb/P65含量:IR组[TNF-α mRNA:(2.91±0.49)μg/L,ICAM-1 mRNA:(2.39±0.58) μg/L,NF-kb/P65:(1.97±0.17) μg/L]高于Sham组[TNF-αmRNA:(1.75±0.29) μg/L,ICAM-1 mRNA:( 1.63±0.33) μg/L,NF-kb/P65:(1.06±0.24) μg/L]和Ket组[TNF-α mRNA:(2.19±0.52) μg/L,ICAM-1 mRNA:(1.78±0.28)μg/L,NF-kb/P65:(1.33±0.30μg/L](P＜0.05).Sham组和Ket组之间无统计学差异(p＞0.05).肺组织病理评分:Sham组低于IR组和Ket组(P＜0.05),Ket组低于IR组(P＜0.05).相关性:TNF-α mRNA与NF-kb/P65正相关,R=0.849(P＜0.05),ICAM-1 mRNA与NF-kb/P65正相关,R=0.639(P＜0.05).结论 10 mg/kg氯胺酮20 min前预处理对于全肝缺血/再灌注肺损伤有保护作用.     

椎体内注射医用生物蛋白胶对松质骨创面出血影响的实验研究

目的:探讨椎体内注射医用生物蛋白胶减少松质骨创面出血的有效性与安全性.方法:10只成年家犬全麻下前路暴露L2～15椎体,其中6只动物L2～L5椎体随机分为实验组与对照组,每组每只2个椎体.实验组椎体内注射医用生物蛋白胶,对照组未注射给药.给药30s后同时于L2～L5椎体前方作直径8mm、深6mm的骨缺损,记录骨创面的控制出血时间、止血时间、出血量及各组10min内止血百分比.另4只动物L2～L5椎体内注入医用生物蛋白胶与欧乃派克混合物.给药30min后行CT扫描计算椎体内药物扩散体积百分比,观察药物局部渗漏及静脉渗漏情况.所有动物实验前后检测血浆凝血酶原时间(PT),术后3d拍胸部X线片后处死,剖胸探查有无肺梗死灶.结果:实验组和对照组的控制出血时间分别为97±48s和417±101s(P<0.001),止血时间分别为291±167s和890±237s(P<0.001),出血量分别为0.80±0.67g和4.39±1.84g(P<0.001),10min 内止血百分比分别为91.67%和16.67%(P=0.001).药物扩散体积百分比为72.1%±11.2%.药物造影组CT扫捕未发现静脉渗漏,椎间孔渗漏1个(6.25%),椎管内渗漏5个(31.25%).所有动物实验前、后PT转异率无显著性差异(P=0.628).所有动物术后未发现神经损伤症状,胸片未见肺梗死征象,剖胸探查末发现肺梗死灶.结论:成年家犬椎体内注射医用生物蛋白胶可明显减少松质骨创面出血,安全性较好.     

骨形态构建蛋白-2在气道高敏感反应小鼠模型肺组织中的表达

目的 观察骨形态构建蛋白-2(bone morphogenetic protein-2,BMP-2)在气道高敏感反应模型小鼠肺组织中的表达. 方法 Balb/C小鼠20只,按随机数字表法分为2组.对照组在0 d和7 d腹腔注射氢氧化铝2 mg(溶于生理盐水0.3 ml),于14、21、22 d用生理盐水雾化吸入,每天1次,每次30min.气道高敏感反应模型组在Od和7 d腹腔注射抗原混悬液(卵清蛋白20μg加氢氧化铝2 mg溶于生理盐水0.3 m1)致敏,于14、21、22 d用20 g/L卵清蛋白雾化吸入,每天1次,每次30 min.通过免疫学、组织学及气道反应性检测气道高敏感反应;Western检测肺组织BMP-2蛋白,荧光定量PCR检测肺组织mRNA含量表达. 结果模型组发生了气道高敏感反应.模型组较对照组肺组织BMP-2蛋白(1.64±0.05 vs 0.85±0.08)及mRNA(1.47±0.19vs 0.45±0.09)表达水平增高,差异有统计学意义(P<0.01).结论 卵清蛋白致敏并激发可产生小鼠气道高敏感反应,BMP-2参与了气道高敏感反应.     

JMJD3在顺铂致急性肾损伤小鼠肾纤维化中的作用

目的评价含十字形结构域蛋白3(JMJD3)在顺铂致急性肾损伤小鼠肾纤维化中的作用。方法健康C57BL/6雄性小鼠48只, 8～10周龄, 体重20～30 g, 采用随机数字表法分为4组(n=12):对照组(CON组)、对照+ JMJD3抑制剂组(CON-A组)、顺铂组(CIS组)和顺铂+ JMJD3抑制剂组(CIS-A组)。CIS组和CIS-A组分别于第1和14天时腹腔注射顺铂15 mg/kg, 制备急性肾损伤小鼠肾纤维化模型;第4天时分别腹腔注射JMJD3抑制剂GSKJ4 10 mg/kg和等容量PBS, 间隔3 d注射1次, 共注射6次。CON组和CON-A组分别在相应时点腹腔注射等容量PBS和GSKJ4 10 mg/kg。每组取6只小鼠, 于第1次注射顺铂后第3天, 采集眼眶血检测血清Cr和BUN的浓度, 然后处死取肾组织, 行HE和PAS染色, 光镜下进行观察并行肾损伤评分。第1次注射顺铂后第28天处死6只小鼠, 取肾组织, 行天狼星红和Masson染色, 测定肾纤维化面积;采用免疫荧光法测定纤维连接蛋白、Ⅰ型胶原蛋白和α-平滑肌肌动蛋白(α-SMA)表达水平, 免疫组化法行F...     

深黄被孢霉高产花生四烯酸菌株的微波诱变育种

为获得生长活力较强、产ARA能力强的菌株,以干菌重、微生物油脂产量和花生四烯酸(ARA)产量为评价指标,采用两轮微波诱变的方法,利用单因素试验确定微波累计加热时间,并采用气相色谱分析ARA含量.试验结果表明:微波频率为高档,累计加热时间为35 s,其致死率为78.3%.经过两轮微波诱变及菌种筛选,获得一株高产菌株W35s2-153,其生物量为30.85 g/L,总油脂含量为15.5 g/L,ARA质量浓度为2.61 g/L,ARA产量比原始对照菌株提高3.18倍,并且遗传性能稳定.     

甲状旁腺素相关肽诱导的局部骨吸收及高钙血症动物模型特点

目的研究甲状旁腺素相关肽(PTHrP)诱导的局部骨吸收及高钙血症动物模型特点。方法于小鼠颅骨注射PTHrP9μg/10μL,每日2次。注射前、注射1d、注射3d、注射5d的不同时间内检测血钙水平;注射3d及5d的不同时间内取材,行X线检查和组织学检查。结果注射PTHrP3d后出现高钙血症(>2.0mmol/L),维持3～6h,10h后下降犤(1.50±0.10)mmol/L犦,正常水平为(1.11±0.09)mmol/L;注射PTHrP5d后3h再次上升犤(2.05±0.34)mmol/L犦,10h后下降犤(1.50±0.16)mmol/L犦。骨吸收在注射3d后的24h明显犤(6.839±1.974)mm2犦,注射5d后更为明显犤(22.751±7.090)mm2犦。结论PTHrP诱导的局部骨吸收动物模型最短取材时间以注射3d后的24h为宜,血钙水平的变化呈波动性变化。     

微波消融家犬肺组织的实验研究

目的探讨微波消融犬肺组织的可行性,为临床应用提供实验依据。方法以微波功率20 W、40 W、60 W及辐射时间600 s的不同参数组合作用于15只家犬肺组织,测量微波消融灶的大小,术后1 h内取肺组织送病理学检查。结果微波消融术中1只家犬因心脏损伤死亡,余均对微波消融耐受良好。不同功率消融范围不同,40 W消融范围最大,20 W次之,60 W消融灶最小。消融灶的形态椭圆形,近球形。消融灶病理呈特征性表现,从内到外为中心碳化区、中间凝固区及周边反应区。结论微波消融肺组织创伤小,安全可行;40 W能形成（3.12±0.08）cm2的消融面积,适合于活体犬肺组织的微波输出功率。     

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.