卵巢切除联合应用激素对绵羊股骨近端BMD及微观结构的影响

目的评价去势手术联合应用激素对绵羊股骨近端骨密度(bone mineral density,BMD)及微观结构的影响。方法将10只健康成年绵羊随机分为假手术组(n=5)和实验组(n=5)。假手术组仅显露双侧卵巢;实验组行双侧卵巢切除术(ovariectomy,OVX),术后1月开始肌肉注射甲基强的松龙10个月。测量术前和术后1年两组绵羊股骨近端的BMD。术后1年,处死所有绵羊并制作股骨近端骨组织标本,通过micro-CT技术对微观结构进行三维重建及空间参数的测量分析,通过组织学观察评价绵羊腰椎微观结构的病理改变。结果术前两组BMD之间的差异无统计学意义,假手术组手术前后的BMD无显著变化;术后1年实验组BMD显著下降,且术后1年实验组中BMD显著低于假手术组。实验组的骨体积分数、骨小梁厚度和骨小梁数目均显著低于假手术组;实验组的骨表面积体积比和骨小梁间隙均显著高于假手术组。Micro-CT重建及组织学观察发现:与假手术组相比,实验组中骨小梁数量明显减少,排列稀疏、骨小梁多处断裂,失去正常的髓腔结构。术后1年实验组中的骨组织微观结构显著差于假手术组。结论去势手术联合应用激素的方法可以显著降低绵羊股骨近端的BMD、显著破坏绵羊股骨近端的微观结构,降低局部的骨质条件。卵巢切除联合应用激素的方法可用于建立髋部骨质疏松动物模型。     

卵巢切除联合应用激素对绵羊股骨近端 BMD 及微观结构的影响简

目的评价去势手术联合应用激素对绵羊股骨近端骨密度（bonemineraldensity，BMD）及微观结构的影响。方法将10只健康成年绵羊随机分为假手术组（n=5）和实验组（n=5）。假手术组仅显露双侧卵巢；实验组行双侧卵巢切除术（ovariectomy，OVX），术后1月开始肌肉注射甲基强的松龙10个月。测量术前和术后1年两组绵羊股骨近端的BMD。术后1年，处死所有绵羊并制作股骨近端骨组织标本，通过micro—CT技术对微观结构进行三维重建及空间参数的测量分析，通过组织学观察评价绵羊腰椎微观结构的病理改变。结果术前两组BMD之间的差异无统计学意义，假手术组手术前后的BMD无显著变化；术后1年实验组BMD显著下降，且术后1年实验组中BMD显著低于假手术组。实验组的骨体积分数、骨小梁厚度和骨小梁数目均显著低于假手术组；实验组的骨表面积体积比和骨小梁间隙均显著高于假手术组。Micro．CT重建及组织学观察发现：与假手术组相比，实验组中骨小梁数量明显减少，排列稀疏、骨小梁多处断裂，失去正常的髓腔结构。术后1年实验组中的骨组织微观结构显著差于假手术组。结论去势手术联合应用激素的方法可以显著降低绵羊股骨近端的BMD、显著破坏绵羊股骨近端的微观结构，降低局部的骨质条件。卵巢切除联合应用激素的方法可用于建立髋部骨质疏松动物模型。     

去势手术联合激素注射对绵羊腰椎生物 力学性能的作用

目的评价去势手术联合激素注射对绵羊腰椎生物力学性能的作用。方法健康成年绵羊 10只,随机分为假手术组（n =5 )和实验组（n = 5 )。假手术组仅显露双侧卵巢;实验组行双侧卵巢切 除术(ovariectomy, OVX),且术后1月开始肌肉注射甲基强的松龙（0.45 mg/kg/d ) 10月。测量术前 和术后1年绵羊腰椎的骨密度（BMD),通过压缩实验和轴向拔出实验来评价术后1年椎体的生物力 学性能。结果术后1年实验组绵羊腰椎的BMD显著下降（P<0. 05 ),平均下降T5.1%。实验组的 最大压缩应力和能量吸收值均显著低于假手术组,差异均具有统计学意义（P<0. 05 );实验组的最大 轴向拔除力和能量吸收值均显著低于假手术组,差异均具有统计学意义（P<0.05 )。结论去势手 术联合激素注射的方法可以显著降低绵羊腰椎的BMD,显著降低绵羊腰椎自身的生物力学强度和对 椎弓根螺钉的把持力。该方法可用于建立适合脊柱及内固定稳定性研究的骨质疏松动物脊柱模型。     

骨质疏松绵羊模型松质骨及皮质骨的微观结构及力学性能变化的研究

目的观察去势手术对绵羊皮质骨和松质骨的骨密度、骨小梁结构及力学性能的影响。方法20只雌性成年绵羊（4±1.5）随机分为去势4个月组（OVX-4months）（4只）、去势12个月组（OVX-12months）（8只）和假手术（Sham）组（8只）。OVX组行双侧卵巢切除术,假手术组仅显露双侧卵巢,术中测定腰椎骨密度。分别与术后4、12个月处死动物,测定股骨颈、股骨干及股骨髁的骨密度,并行MicroCT分析及生物力学测试。结果去势12个月后（OVX-12months）组腰椎、股骨颈及股骨髁的骨密度较对照组显著降低,而皮质骨骨密度无明显降低。其松质骨的相对骨体积（BV/TV）、骨小梁厚度（Tb.Th）、骨小梁数目（Tb.N）较对照组显著降低,表面积体积比（BS/BV）、骨小梁间隙（Tb.Sp）则较对照显著增高。生物力学测试表明,去势12个月后,腰椎松质骨的最大压缩应力分别较Sham组和OVX-12months组下降82.5%和85.9%,力学强度显著下降,而皮质骨的力学强度无显著变化。结论去势12个月后,绵羊腰椎、股骨部的松质骨BMD及骨小梁空间结构参数明显降低,力学强度也显著下降,可以作为骨质疏松的大动物模型。而皮质骨的骨密度和力学强度下降不明显,需要更长的去势时间。     

激素诱导去势后绵羊骨质疏松动物模型的椎体微观结构观察及力学性能研究

目的运用去势+糖皮质激素的方法,建立绵羊骨质疏松椎体模型,并通过Micro-CT观察其微观结构变化与其生物力学之间的关系。方法采用完全随机的设计方法,选用3±0.5岁绵羊24只,随机分配至3个处理组:A组(去势组),B组(去势+激素组),C组(假手术组),每组8只绵羊。观察时间为经过相应处理后9,12月。在每个时间点,处死一定数量的绵羊,然后检测各组在各时间点上椎体的骨密度(BMD);生物力学性能变化:测试最大轴向拔出力(Fmax)和最大抗压强度及其能量吸收值.同时切取部分椎体行Micro-CT检查,对各组各个时间点绵羊腰椎骨小梁微观结构进行观察。结果随着时间的延长,A,B组较C组均出现BMD及生物力学性能下降,显微CT观察见骨小梁空间结构呈骨质疏松样变化,且在同一时间点B组较A组向骨质疏松样变化更显著。结论运用去势+糖皮质激素的方法,可快速的建立绵羊骨质疏松动物模型,且经激素诱导9个月及12个月的去势绵羊均是较为理想的骨质疏松动物模型。     

局部注射缓释型bBMP对去势绵羊椎体骨骼影响的研究

目的探索能够在短期内有效提高骨质疏松椎体骨强度的局部治疗方法。方法采用卵巢切除法（OVX）对6只成年雌性绵羊去势，低钙饲养1年后，经双能X线吸收骨密度测量仪检测后确定建立骨质疏松模型。采用拉丁方设计方案，通过经椎弓根注射途径，分别在每只动物的L4～L6注射三种药物：实验组A注射20mgbBMP／FS，对照组B注射20mg bBMP，对照组C单纯注射FS。L3椎体设为空白对照组D。术后3个月，采用骨密度测量仪和MicroCT对绵羊腰椎骨密度及骨小梁微观结构进行分析比较。通过轴向加压实验对腰椎标本进行生物力学测定，对椎体力学性能进行评估。结果绵羊去势1年后，腰椎骨密度平均下降20．6％，动物模型成功建立。接受实验处理3个月后，实验组A骨密度（1．334g／cm^2）明显高于对照组B、C及D组骨密度（1．139g／cm^2，1．163g／cm^2和1．177g／cm^2）。MicroCT分析表明：实验组骨小梁的密度、连接率均显著高于对照组。生物力学研究表明实验组A最大压缩应力、最大压缩应变、能量吸收值及骨质弹性模量均明显高于对照组B、C及D组。结论bBMP复合纤维蛋白胶可以促进骨小梁的改建，改善骨小梁的三维结构，增加椎体的骨密度及骨强量，可以作为局部治疗脊柱骨质疏松的新型方法之一。     

甲状旁腺素联合雌二醇对大鼠骨质疏松的影响

目的探讨甲状旁腺素联合雌二醇对骨质疏松的影响及其作用机制,为临床用药提供理论依据。方法选取100只雌性SD大鼠随机分为5组:假手术组、去势组、甲状旁腺素组、雌二醇组、联合用药组,每组20只。首先构建去卵巢大鼠骨质疏松性动物模型,然后分别进行骨组织骨密度(bone mineral density,BMD)测定、骨代谢相关生化指标检测、骨代谢标志物检测、骨形态结构变化观察。结果去势组腰椎和股骨BMD、股骨最大载荷和刚度及血清Ca、P水平均较假手术组显著降低(P0. 05),而联合用药组上述指标均较去势组显著增高(P0. 05)。去势组血清ALP、COL-I、OC、OPG水平均较假手术组显著增高(P0. 05),而联合用药组上述指标均较去势组显著降低(P0. 05)。去势组骨小梁少见,细小稀疏,小梁间断裂分离,排列疏松紊乱;而联合用药组骨组织结构较完整,骨小梁形态结构较规整,数量多,致密均匀,连续性好呈网状。结论甲状旁腺素联合雌二醇可调节维持骨质疏松性骨代谢,增加骨密度,改善生物力学性能和骨组织病理形态学,促进骨形成,抑制骨吸收,具有骨保护作用。     

PM2.5对去势后雌性SD大鼠骨微结构micro-CT的影响

目的探讨不同浓度的PM_(2.5)暴露对去势SD雌性大鼠骨微结构的影响。方法用不同浓度(35、70、150μg/m3)的PM_(2.5)对SD大鼠进行气道滴注,随机分为低剂量组、中剂量组和高剂量组,滴注后5个月末行去势手术;滴注后9个月末取股骨、胫骨、腰椎,运用显微计算机断层扫描术(micro-CT)分别检测三者骨微结构。结果与对照组相比,PM_(2.5)暴露组胫骨、股骨、腰椎的骨小梁骨密度(Tb.BMD)减小、骨体积分数(BV/TV)减小、结构模型指数(SMI)增大、骨小梁厚度(Tb.Th)减小、骨小梁数量(Tb.N)减少、骨小梁分离度(Tb.Sp)增加; PM_(2.5)暴露组中,胫骨骨小梁的BV/TV、Tb.Th、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05),股骨骨小梁的Tb.BMD、BV/TV、SMI、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05),腰椎骨小梁的SMI、Tb.Th、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05)。从micro-CT三维重建图结果看,与对照组比较,PM_(2.5)暴露组胫骨骨髓腔内明显空虚,骨小梁缺如;股骨Ward三角区骨小梁数量稀疏、间隙变大;腰椎骨小梁结构的完整性被破坏,杆状结构增多。结论表明PM_(2.5)暴露可使去势后雌性SD大鼠胫骨、股骨、腰椎骨小梁结构遭到破坏,数量减少,由片状结构转为杆状结构,由此可见PM_(2.5)暴露可加重绝经后骨量丢失。     

甲状旁腺素联合降钙素对大鼠骨质疏松的治疗作用

目的探讨甲状旁腺素联合降钙素对大鼠骨质疏松的影响及其作用机制,为临床治疗提供理论依据。方法 100只雌性SD大鼠随机分为5组:假手术组、去势组、甲状旁腺素组、降钙素组、联合用药组,每组20只,构建去卵巢大鼠骨质疏松动物模型。骨组织骨密度(bone mineral density,BMD)和骨矿物质含量(bone mineral content,BMC)测定,血清E2检测,骨代谢相关生化指标和标志物检测,观察骨形态结构变化。结果去势组较假手术组腰椎和股骨BMD和BMC、股骨最大负荷及血清E2、Ca、P、骨保护素水平均显著降低(P0. 05),而联合用药组上述指标较去势组均显著增高(P0. 05)。去势组血清碱性磷酸酶、OC、RANK水平较假手术组均显著升高(P0. 05),而联合用药组上述指标较去势组均显著降低(P0. 05)。去势组骨小梁明显减少,排列稀疏错乱,并出现大片断裂现象,大量纤维组织,骨细胞少见;联合用药组骨小梁较多且致密,形态结构较规整,骨细胞排列较整齐,骨连续性好,骨密质较厚且均匀。结论甲状旁腺素联合降钙素通过提高雌激素水平,调节维持骨代谢,提高骨密度和矿物含量,改善生物力学性能,改善骨组织病理形态学,起到抗骨质疏松疗效和骨保护作用。     

探究短期去势法对12月龄雌性大鼠骨质的影响

目的初步研究使用切除卵巢法作用于12月龄SD雌性大鼠一个月对其骨质的相关影响。方法将6只12月龄SD雌性大鼠分为2组(实验组3只,假手术组3只),对实验组的大鼠进行切除双侧卵巢操作;对照组的大鼠进行假手术操作,即行腹部切口切除与卵巢重量相同的脂肪组织。术后一个月,分别取出实验组和假手术组大鼠的第3腰椎和左侧股骨,随后进行Micro-CT检测,以了解其骨密度(BMD)、骨小梁相关情况。结果实验组对比假手术组12月龄SD雌性大鼠左侧股骨的皮质骨BMD、松质骨BMD及其总体BMD均有所下降,但无统计学意义(P0.05);实验组对比假手术组12月龄SD雌性大鼠腰3椎体的皮质骨BMD有所下降(P0.05),而腰3椎体的松质骨BMD以及其总体BMD稍有上升(P0.05)。实验组腰3椎体和左侧股骨骨小梁BMD较假手术组下降,但亦无统计学差异(P0.05)。术后一个月无SD雌性大鼠死亡情况。结论对12月龄SD雌性大鼠使用切除卵巢法并饲养观察时间只为一个月难以构造成骨质疏松动物模型。     

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.