不阻断下腔静脉的全肝血流阻断切肝术

目的探讨不阻断下腔静脉的全肝血流阻断切肝术的应用价值。方法对10例位于第二肝门区肿瘤施行第一肝门 左、中、右肝静脉阻断切肝术,保持下腔静脉血流畅通,部分病人同时行肝短静脉结扎。结果10例病人中原发性肝癌8例、转移性肝癌1例、肝巨大血管瘤1例。肿瘤直径5cm~18cm(13cm)。肿瘤侵犯2根主肝静脉8例,侵犯3根主肝静脉2例。行右三叶切除2例,右半肝切除1例,中肝叶切除4例,Ⅷ段切除1例,Ⅳ、Ⅶ、Ⅷ切除1例,左三叶切除1例。结扎肝静脉8根,血管带阻断9根,血管夹或心耳钳阻断5根。切断1根主肝静脉4例,切断2根主肝静脉6例。第一肝门阻断时间15m in~38m in(25.5m in),肝静脉阻断时间阻断时间15m in~25m in(19.7m in)。术中出血量100m l~6000m l(1180m l)。行肝静脉修补4例。结论不阻断下腔静脉的全肝血流阻断切肝术既能达到无血切肝的目的,又避免了下腔静脉阻断所引起全身血流动力学紊乱,是一种更合理的新技术。     

肝静脉阻断技术在肝切除术中的应用

目的 探讨肝静脉阻断技术在复杂肝脏肿瘤切除术中防止肝静脉破裂大出血及空气栓塞的作用。方法 对71例肝脏肿瘤手术切除病例施行了1根以上主肝静脉阻断。所有肿瘤均位于第二肝门并侵犯或压迫1根以上主肝静脉。肝静脉阻断方法采用绕线结扎、血管带阻断或血管夹及心耳钳夹闭法。结果 71例中无1例肝静脉分离破裂，行肝静脉结扎28例，血管带阻断26例，血管夹阻断17例；阻断右肝静脉34例，右肝静脉＋中肝静脉2例，左、中肝静脉共干24例，左、中肝静脉分干2例，左、中、右三干9例。施行半肝全血流阻断35例（右侧24例，左侧11例）。交替半肝全肝血流阻断4例，第一肝门阻断加部分肝静脉阻断23例。第一肝门阻断加全部肝静脉阻断（不阻断下腔静脉的全肝血流阻断）9例。71例肝肿瘤均顺利切除。结论 肝静脉阻断技术是一种安全、有效的血流阻断技术。不阻断下腔静脉的全肝血流阻断术既能控制术中出血，又能保证全身血流动力学稳定。     

肝静脉阻断技术在肝切除术中的应用(附105例报道)

目的探讨肝静脉阻断技术在复杂肝脏肿瘤切除术中防止肝静脉破裂大出血及空气栓塞的作用。方法对105例肝脏肿瘤手术切除患者施行了1根以上主肝静脉阻断。所有肿瘤均位于第二肝门并侵犯或压迫1根以上主肝静脉。肝静脉阻断方法采用绕线结扎、血管带阻断或血管夹及心耳钳夹闭法。结果105例中无一例肝静脉分离破裂。施行半肝全血流阻断41例（右侧27例，左侧14例），交替半肝全血流阻断4例，第一肝门阻断加部分肝静脉阻断45例，第一肝门阻断加全部肝静脉阻断（不阻断下腔静脉的全肝血流阻断）15例。其中46例同时行第三肝门分离。105例肿瘤顺利切除。结论肝静脉阻断技术是一种安全、有效的血流阻断技术。不阻断下腔静脉的全肝血流阻断术既能控制术中出血，又能保证全身血流动力学稳定。     

Pringle′s法联合肝静脉阻断技术在复杂肝切除术中的应用

目的: 探讨Pringle′s法联合肝静脉阻断技术在复杂肝切除术中的应用价值。方法: 对37例第二肝门区肿瘤施行Pringle′s法＋肝静脉阻断切肝术患者的临床资料进行回顾性分析。结果:37例患者中原发性肝癌27例，转移性肝癌2例，肝巨大血管瘤8例。肿瘤平均直径12.7cm（6～35cm）。肿瘤侵犯1根主肝静脉6例，侵犯2根主肝静脉20例，侵犯3根主肝静脉11例。行右三叶切除11例，右半肝切除5例，中肝叶切除9例，Ⅷ段切除4例，左三叶切除5例，尾状叶切除3例。平均第一肝门阻断时间29min（17～48min），平均肝静脉阻断时间21min（8～32min）。行肝静脉修补1例。平均术中出血量950mL（200～4 000mL）。全组术后发生并发症18例次，均经治疗后愈。无死亡病例。结论:Pringle′s法联合肝静脉阻断技术在复杂肝切除术中既能达到减少术中出血的目的，又能防止术中肝静脉破裂导致空气栓塞，还避免了下腔静脉阻断所引起全身血流动力学紊乱，是一种更安全、有效的血流阻断技术。     

全肝与选择性肝静脉阻断术在肝切除术中的应用比较

目的累及肝静脉或下腔静脉的肝肿瘤切除最严重的并发症是术中大出血,全肝血流阻断术（THVE）能有效控制术中大出血,但由于阻断下腔静脉,易引起全身血流动力学紊乱。选择性肝血流阻断术（SHVE）仅阻断入肝与出肝血流而保持下腔静脉通畅,不会引起全身血流动力学紊乱。本文就这两种肝血流阻断技术在肝切除术中的应用作一比较。方法2000年1月至2006年6月,共施行包括入肝与出肝血流同时阻断切肝术197例,其中THVE87例,SHVE110例。比较两组病人术前情况、肝切除范围、术中情况、术后并发症等指标。结果所有肿瘤均压迫或侵犯1根以上主肝静脉或下腔静脉,两组病人术前一般情况、肝切除范围、肿瘤病理类型无明显差别,术中出血量、肝热缺血时间、手术时间,THVE组明显高于SHVE组。THVE组有15例同时行下腔静脉癌栓取出术,4例肝静脉癌栓取出术,7例行下腔静脉壁修补术,SHVE组有7例同时行肝静脉取栓术,有1例因肿瘤侵犯下腔静脉壁而改行THVE。术后并发症THVE组明显高于SHVE组,前者有2例术后死于肝功能衰竭,SHVE组无1例死亡。术后ICU时间及住院时间THVE组明显高于SHVE组。结论THVE与SHVE均能有效控制术中肝静脉破裂大出血,THVE对伴有下腔静脉癌栓或静脉壁受侵犯的病人是唯一的选择方法,但THVE对全身血流动力学影响大,对未侵犯下腔静脉而仅侵犯肝静脉的病人更适合采用SHVE。     

间歇性肝门阻断下肝腔静脉结合部肝肿瘤的手术切除及疗效观察

目的 探讨肝腔静脉结合部肝肿瘤手术切除的方法和疗效。方法 在间歇性肝门阻断下行肝切除术，部分病例预置肝下下腔静脉（IVC）阻断带；切肝先易后难，最后处理肝静脉根部；全组68例患者术后随访观察患者生存期。结果 68例肝腔静脉结合部肝肿瘤均在间歇性肝门阻断下得到成功切除，全组无手术死亡，术中因皆得到妥善处理；切除的68例肝肿瘤中65例为原发性肝癌，术后1、2、3和4年生存率分别为64.11％、52.82%、44.90%和36.98%，其中肿瘤有包膜者术后生态率显著高于无包膜者。结论 肝腔静脉结合部肝肿瘤可在简单的间歇性地门阻断下获得安全切除，不必常规作复杂的全肝血流阻断；对该部位边界清楚的原发性肝癌应积极争取手术切除。     

肝三叶切除术11例报告

目的 评价肝三叶切除治疗肝巨大肿瘤的手术技术和经验。 方法 本组肝三叶切除术１１例术前肝功能均为Ｃｈｉｌｄ Ａ级，无肝硬化。瘤体最大横径为１２￣３５ｃｍ，行右三叶切除７例，左三叶切除４例。术中施行全肝血流阻断６例，阻断时间为６￣２２分钟，其中在全肝血流阻断下成功修复损伤的下腔静脉和主肝静脉各２例。 结果 术中输血４００￣１６００ｍｌ，无手术死亡。术后并发症：胆瘘和右侧胸腔积液各２例。切除肿瘤湿重量     

第二肝门区域肿瘤切除中两种肝血流阻断方法的比较

目的比较入肝血流加肝静脉血流阻断术与单纯第一肝门阻断术在第二肝门区域肿瘤切除中的作用。方法从2000年1月至2005年10月,共施行2100例肝脏肿瘤切除术,其中235例肿瘤紧贴或压迫1根以上主肝静脉,根据肝血流阻断方法的不同,将235例患者分为两组：选择性肝血流阻断组（SHVE组,125例）和第一肝门阻断组（Pringle组,110例）。分析两组患者的术中及术后情况。在SHVE组,完全SHVE（阻断第一肝门和所有主肝静脉）25例,部分SHVE（阻断第一肝门和部分主肝静脉）100例。肝静脉阻断方法有3种：丝线结扎肝静脉,止血带阻断和辛氏钳阻断。结果两组间年龄、性别、肿瘤大小、肝硬化发生率、HBsAg阳性率、术中热缺血时间和手术时间的差异均无统计学意义（P〉0．05）。SHVE组的术中失血量及输血量明显少于Pringle组（P〈0．05）。Pringle组有17例发生主肝静脉破裂,其中大出血14例,空气栓塞3例。而SHVE组无1例肝静脉破裂、大出血或空气栓塞发生。Pringle组术后再出血、再次手术和肝功能衰竭等并发症发生率高于SHVE组,ICU时间和住院时间长于SHVE组（P〈0．05）。结论SHVE较Pringle法能更有效地控制术中大出血,防止肝静脉破裂导致的大出血和空气栓塞,降低术后并发症和手术病死率。用辛氏钳阻断肝静脉较结扎法和止血带阻断法更安全和简便。     

肝尾状叶肿瘤手术76例临床总结

目的分析切除肝尾状叶肿瘤的手术技术及效果。方法自1994年4月至2004年8月，第二军医大学东方肝胆外科医院采用分离结扎切断肝短静脉，使肝后下腔静脉与肝脏完全分离，针对不同部位肿瘤采用不同入路，局部或联合肝叶切除尾状叶肿瘤76例。结果76例尾状叶肿瘤均顺利切除，57例采用解剖第三肝门法切除肿瘤，平均结扎肝短静脉5．2支，第一肝门阻断时间平均24．7min，术中平均出血655mL．未发生大出血及肝功能衰竭等严重并发症。仅5例行全肝血流阻断切肝。结论采用第三肝门解剖法切除肝尾状叶肿瘤能明显减少术中大出血的机会，合理选择切除肿瘤途径能提高肝尾状叶肿瘤的切除率，降低术后并发症发生率。     

全肝血流阻断在临床中的应用

目的　评价改良全肝血流阻断法在肝切除术中的安全性及应用价值。方法　回归分析近年 11例常规方法不能切除的中央型肝肿瘤病例 ,采用全肝血流阻断法 ,2例同时利用静脉 -静脉转流方法 ,1例利用体外循环静脉转流技术。结果　 1例术中不能耐受全肝血流阻断术中死亡 ,其余 10例顺利切除肿瘤 ,手术时间 32 7.3± 117.8min,3例术后出现右胸积液 ,1例心房纤颤。结论　全肝血流阻断方法对减少术中出血无优势 ,且术后并发症发生率高 ,宜仅选择性应用于肿瘤侵犯肝静脉主干、腔静脉或伴有腔静脉癌栓者     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.