芬太尼对大鼠海马锥体神经元GABAA受体的作用

目的探讨芬太尼对大鼠海马锥体神经元GABAA受体的作用。方法采用酶-机械法急性分离出生3-10 d SD大鼠的海马锥体神经元,用全细胞膜片钳技术记录锥体神经元GABAA受体介导的Cl-电流(GABA电流,IGABA),不同浓度的GABA和1 μmol/L GABAA受体特异性拮抗剂荷包牡丹碱诱发并确定IGABA;用不同浓度的芬太尼和1．0 μmol/L μ受体特异性拮抗剂CTAP评价芬太尼对30 μmol/L GABA诱发IGABA的影响。结果 GABA诱发内向电流(IGABA),其EC50为23．73μmol/L,荷包牡丹碱阻断IGABA;芬太尼剂量依赖性地抑制IGABA,其EC50为0．011 μmol/L,并缩短IGABA的脱敏感时间常数τdes;CTAP使芬太尼抑制GABA诱发IGABA的EC50升至0．414μmol/L;芬太尼不改变IGABA的翻转电位 ECl-(-3．0mV)。结论芬太尼可抑制大鼠海马锥体神经元GABAA受体的功能。     

异丙酚对大鼠海马CAl区锥体神经元GABAA受体的作用

目的：研究异丙酚（propofol,Pro）对急性分离大鼠海马CAl区锥体神经元γ-氨基丁酸A型（GABAA）受体的作用。方法：采用膜片钳全细胞记录技术。结果：（1-300）μmol/L Pro可以直接激发内向电流（Ipro），Ipro可被GABAA受体拮抗剂荷包牡丹碱（BIC）阻断；（0.01-30)μmol/L Pro能增强GABA诱发的内向电流（IGABA），洗脱后，电流恢复。结论：Pro既能直接激活GABAA受体，又能通过增强GABA的作用变构调控受体；海马区GABAA受体可能是Pro的重要药靶。     

咪达唑仑对大鼠背根神经节神经元GABAA受体激活电流的影响

目的 咪达唑仑对大鼠背根神经节(DRG)神经元GABAA受体激活电流的影响.方法 健康SD大鼠,体重200 ～ 250 g,4周龄,雌雄不拘,分离DRG神经元,采用全细胞膜片钳技术记录GABAA受体激活电流.采用无糖细胞外液进行药物配制.记录咪达唑仑(终浓度3.00 μmol/L,)与不同浓度(终浓度0.03、0.10、1.00、10.00、100.00、1000.00 μmol/L) GABA混合液作用下的GABAA受体激活电流、不同浓度(终浓度0.03、0.10、1.00、3.00、10.00、100.00 μmol/L)咪达唑仑作用下的GABAA受体激活电流、不同浓度(终浓度0.03、0.10、1.00、3.00、10.00、100.00 μmol/L)咪达唑仑与GABA(终浓度100.00 μmol/L)混合液作用下的GABAA受体激活电流和不同咪达唑仑预灌注时间(灌注即刻、20、40、60、120 s)时咪达唑仑(终浓度1.00 μmol/L)与GABA(终浓度100.00 μmol/L)混合液作用下的GABAA受体激活电流.计算咪达唑仑·给药前后电流的增强率.结果 对GABA敏感的神经元灌注咪达唑仑均未记录到可检测的膜电流变化;各浓度GABA下,咪达唑仑给药后GABAA受体激活电流均较给药前增强(P＜0.01);各浓度咪达唑仑给药后DRG神经元GABAA受体激活电流均较给药前增强,且随咪达唑仑浓度升高,对DRG神经元GABAA受体激活电流的增强率逐渐升高,咪达唑仑3.00 μmol/L时达峰值(P ＜0.05或0.01);随咪达唑仑预灌流时间延长,DRG神经元GABAA受体激活电流增强率逐渐升高,预灌流40 s时达峰值(β＜0.05或0.01).结论 咪达唑仑可增强DRG神经元GABAA受体激活电流,提示咪达唑仑可通过增强GABAA受体活性,从而增强GABA的作用,在脊髓水平产生镇痛作用.     

异丙酚对大鼠海马神经元NMDA受体通道电流的影响

目的 研究异丙酚对大鼠海马神经元N-甲基-D-天冬氨酸（NMDA）受体通道电流的影响。方法 体外培养新生Wistar大鼠海马神经元8—12d，采用全细胞膜片钳技术和压力喷射给药方式，钳制电压为-80mV，记录3、48μg∥ml异丙酚对100μmol／LNMDA诱发NMDA受体通道电流的影响；然后用7-氨基丁酸（GABA）受体拮抗剂荷包牡丹碱100μmol／L阻断GABA．受体，观察3、48μg／ml异丙酚对NMDA受体通道电流的影响。结果 3、48μg／ml异丙酚抑制自发兴奋性突触后电流并直接激动GABA．受体，使Cl．内流，产生外向超极化的GABA电流，从而间接抑制NMDA受体通道电流。用荷包牡丹碱100μmol／L阻断GABA．受体后，3、48μg∥ml异丙酚仍可抑制100μmol／LNMDA诱发的NMDA受体通道电流（P〈0．05）。结论 异丙酚通过激活GABA．受体影响NMDA受体通道电流，对NMDA受体通道也有直接抑制作用。     

γ-氨基丁酸受体和甘氨酸受体在大鼠丙泊酚麻醉中的作用

目的研究丙泊酚对大鼠海马CA1区电刺激诱发兴奋性突触后电流(EPSC)的影响,分析γ-氨基丁酸(GABA)受体和甘氨酸受体在丙泊酚麻醉中的作用。方法断头法分离wistar大鼠(13～19d)海马半脑,切出400μm厚度的海马脑片,全细胞膜片钳技术记录CA1区锥体神经元EPSC。80张脑片分为八组:脂肪乳剂组,50μmol/L丙泊酚组,100μmol/L丙泊酚组,200μmol/L丙泊酚组,SR95531组,士的宁组,SR95531 100μmol/L丙泊酚组,士的宁 100μmol/L丙泊酚组,每组10张。SR95531 100μmol/L丙泊酚组和士的宁 100μmol/L丙泊酚组先在循环液中加入10μmol/LSR95531或4μmol/L士的宁预孵脑片30min。八组均记录基础EPSC10min,然后加入不同药物,继续记录EPSC40min。膜钳制电压为-70mV。结果脂肪乳剂、SR95531和士的宁对EP-SC幅值无影响;丙泊酚呈剂量依赖性的抑制EPSC幅值,50、100、200μmol/L丙泊酚最大抑制EPSC幅值为14.4%、52.3%、67.8%;SR95531 100μmol/L丙泊酚组加入丙泊酚后,EPSC幅值基本无改变;士的宁 100μmol/L丙泊酚组加入丙泊酚后,EPSC幅值仍然下降,最大抑制程度为34.7%。结论丙泊酚主要通过增强GABAA受体功能使兴奋性突触活动降低,甘氨酸受体在其中起到协同和调节作用。     

异丙酚对皮质酮抑制体外培养大鼠海马神经前体细胞增殖的影响

目的 评价异丙酚对皮质酮抑制体外培养大鼠海马神经前体细胞增殖的影响及其与GABAA受体表达的关系。方法 体外培养大鼠海马神经前体细胞,第二代生长良好的细胞随机分为10组：空白对照组（Con组）、异丙酚0．5μmol/L组（P1组）、异丙酚2．5μmol/L组（P2组）、皮质酮100μmol/L组（Cort组）、荷包牡丹碱10μmol/L组（Bic组）、皮质酮和异丙酚0．5μmol/L组（CP1组）、皮质酮和异丙酚2．5μmol/L组（CP2组）、皮质酮、荷包牡丹碱和异丙酚0．5μmol/L组（BCP1组）、皮质酮、荷包牡丹碱和异丙酚2．5μmol/L组（BCP2组）、皮质酮和荷包牡丹碱组（BC组）。建立皮质酮抑制细胞增殖模型,利用噻唑蓝法和胸腺嘧啶核苷掺人法观察体外培养大鼠海马神经前体细胞的增殖。采用免疫细胞化学方法鉴定海马神经前体细胞GABAA受体的表达;采用ELISA法定量观察海马神经前体细胞表面GABAA受体表达。结果 异丙酚（0．5、2．5μmol/L）可以减轻皮质酮引起的大鼠海马神经前体细胞增殖的抑制作用,荷包牡丹碱可完全拮抗其作用。海马神经前体细胞有GABAA受体的表达,皮质酮100μmol/L可以使海马神经前体细胞GABAA受体表达下调（P＜0．05）,异丙酚可以阻断皮质酮的效应。结论 低浓度异丙酚可以减轻皮质酮引起的体外培养大鼠海马神经前体细胞增殖的抑制作用,可能与异丙酚激活GABAA受体有关。     

吗啡对大鼠海马锥体神经元L-型Ca2+通道电流的影响

目的观察吗啡对大鼠海马锥体神经元L-型Ca^2＋通道电流的影响。方法成年SD大鼠,体重230～270 g,麻醉后快速断头取脑,急性分离海马锥体神经元,12个海马（椎体神经元）随机分为2组（n=6）,吗啡组应用细胞贴附式膜片钳技术记录依次加入不同浓度吗啡[0（未加吗啡）、10^-8、10^-7、10^-6、10^-5mol/L]后海马锥体神经元L-型Ca^2＋通道电流及电导;纳洛酮组加入10^-5mol/L纳洛酮后30min,再依次加入上述不同浓度吗啡,记录此通道电流及电导。结果与未加吗啡比较,吗啡组10^-6、10^-5mol/L吗啡可抑制海马神经元L-型Ca^2＋通道电流,10^-5 mol/L的抑制作用更明显（P＜0．01）;预先加入纳洛酮可阻断吗啡对该通道电流的抑制作用（P＜0．01）;但L-型Ca^2＋通道电导无变化。结论通过作用于μ片受体,10^-6、10^-5 mol/L吗啡可抑制大鼠海马锥体神经元L-型Ca^2＋通道电流,10^-5mol/L的抑制作用更强。     

GABAA受体与全麻机制的研究进展

全麻作用的分子机制可能与神经细胞膜上离子通道的活性变化有关，其中γ-氨基丁酸A型受体（GABAA受体）及其门控的Cl^-通道复合物是近来研究的焦点。目前发现除氙气和氯胺酮外，临床浓度的全麻药物多可通过各种机制作用于GABAA受体而增强GABA能的突触抑制作用，在GABAA受体的不断亚单位上亦已发现存在多种全麻药物的特异性作用靶位。     

不同浓度褪黑激素对新生大鼠海马锥体神经元电压门控性Ca2+通道的影响

目的 探讨不同浓度褪黑激素对新生大鼠海马锥体神经元电压门控性ca2通道的影响.方法 原代培养新生Wistar大鼠(出生时问<12 h)海马锥体神经元7～12 d.配制褪黑激素溶液,终浓度依次为1 nmol/L、10 nmol/L、100 nmol/L、1 μmol/L、10μmol/L、100μmol/L和1 mmol/L.选择胞体清晰、光晕良好、轴突明显的锥体神经元,采用膜片钳全细胞记录模式观察Ca2+通道的基本电生理特点,记录不同浓度褪黑激素作用下Ca2+电流,分析Ca+2通道动力学特性,并计算Ca2+电流变化率.结果 不同浓度褪黑激素均可快速、可逆性地增强Ca2+电流,10 nmol/L和100 nmol/L褪黑激素使Ca2+电流激活曲线向超极化方向移动,其余浓度褪黑激素对Ca2+电流激活曲线的动力学特性无影响.与100 mol/L褪黑激素比较,其余浓度褪黑激素作用后Ca2+电流变化率降低(P<0.05或0.01);与Iμmol/L褪黑激素比较,10 μmol/L、100μmol/L和1 mmol/L褪黑激素作用后Ca2+电流变化率降低(P<0.05).结论 l nmol/L～1 mmol/L褪黑激素均可增强体外培养的新生大鼠海马锥体神经元Ca2+电流,100 nmol/L褪黑激素作用最强.     

鞘内预先注射荷包牡丹碱、烯丙基甘氨酸对氯胺酮抗伤害作用的影响

氯胺酮(Ket)是目前常用的静脉全麻药。其机理除了和非竞争性地拮抗NMDA受体有关以外，可能还和促进γ-氨基丁酸(GABA)的释放有关；在体实验证实，脑内GABAA受体参与了Ket的催眠作用。增强脊髓GABAA受体介导的抑制性突触传递是麻醉药产生抗伤害作用的重要机制之一。但脊髓GABAA受体和Ket抗伤害作用是否有关，尚不清楚。     

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.