跖跗关节复合体损伤的手术治疗

目的 评价跖跗关节复合体损伤的手术治疗效果.方法 2003年1月至2008年12月,共收治167例闭合性跖跗关节损伤患者,其中跖跗关节复合体损伤35例.通过X线及CT检查明确诊断,闭合或切开复位螺钉或钢板内固定,术后定期放射学检查随访,以美国足踝外科协会(AOFAS)中足评分系统进行功能评估.结果 本组有135例获得12～78个月随访,平均随访时间48个月.其中跖跗关节复合体损伤26例,术后AOFAS评分48～75分,平均67分;其中16例继发创伤性关节炎,12例因疼痛明显、行走受限二期行关节融合术;单纯跖跗关节损伤109例,术后AOFAS评分70～95分,平均82分,继发创伤性关节炎的17例中5例二期行关节融合术.单纯跖跗关节损伤闭合复位经皮螺钉内固定者术后AOFAS中足评分82～95分,平均87分,与跖跗关节复合体损伤者比较差异具有统计学意义(t=2.651,P<0.05).结论 跖跗关节复合体损伤的预后比单纯跖跗关节损伤的差,而准确诊断、实现复合体各个部分的解剖复位和可靠固定是取得良好治疗效果的关键.     

跨关节固定治疗跖跗关节损伤的临床疗效

目的探讨跨关节固定治疗跖跗关节损伤的临床疗效。方法应用可控加压骑缝钉联合自锁螺钉钢板治疗12例跖跗关节损伤患者。结果患者均获随访,时间8～16个月。切口均一期愈合。根据美国足踝外科协会(AOFAS)评分:优秀3例,良5例,一般4例。结论可控加压骑缝钉联合自锁镙钉钢板能灵活有效地治疗跖跗关节复合体损伤。     

桥接固定治疗跖跗关节损伤

目的 探讨使用桥接钢板或外固定支架固定治疗跖跗关节损伤的临床疗效. 方法 对2008年8月至2011年2月收治的26例跖跗关节损伤患者的病例资料进行回顾性研究,男19例,女7例;年龄19 ～56岁,平均34岁.损伤按Myerson三柱损伤分型:单柱损伤2例,两柱损伤8例,三柱损伤16例.采用桥接钢板固定10例,外固定支架固定16例.术后定期放射学检查随访,采用美国足踝外科协会(AOFAS)中足评分进行功能评价.比较术后6个月和18个月AOFAS评分. 结果 所有患者术后获18～ 49个月(平均27个月)随访.伤口均愈合良好,未见感染征象,未发现钢板、螺钉松动、脱出、断裂及异物反应等与内置物相关的并发症.12例患者继发创伤性关节炎,2例因疼痛明显、行走受限二期行关节融合术.所有患者术后6个月和18个月的平均AOFAS中足评分分别为(59.6±15.4)分和(76.8±11.5)分,差异有统计学意义(t=12.620,P=0.000). 结论 对于低能量跖跗关节损伤患者使用桥接钢板,避免贯穿跖跗关节固定,可以减少关节软骨继发损伤.对于高能量跖跗关节损伤患者应重视柱的粉碎骨折造成的短缩问题,使用桥接外固定支架,恢复柱长度的解剖复位和可靠固定是获得良好疗效的关键.     

切开复位双重加压螺钉固定治疗跖跗关节损伤

[目的]探讨切开复位双重加压螺钉固定治疗跖跗关节损伤的临床疗效.[方法]回顾性分析2007年9月～2010年10月间治疗的67例跖跗关节损伤患者,其中35例损伤患者采用切开复位双重加压螺钉或结合克氏针固定治疗,32例患者采用空心钉或结合克氏针固定治疗.男53例,女14例,年龄18 ～60岁,平均32岁.根据Myerson分型:A型15例,B型36例,C型16例.根据美国矫形足踝协会(AOFAS)中足评分标准评价比较两种方法的治疗效果.[结果]所有患者均获得随访,平均随访18个月(12～30个月).双重加压螺钉治疗组术后平均AO-FAS中足评分81.7分(56 ～98分),术后未发生感染、创伤性关节炎、螺钉断裂等并发症;空心钉治疗组术后平均AOFAS中足评分78.6分(45 ～96分),2例发生伤口感染,2例未获得解剖复位,二期行关节融合术.两种治疗方法AOFAS评分差异无统计学意义(t=1.056,P＞0.05).[结论]切开复位双重加压螺钉固定治疗跖跗关节损伤与空心螺钉治疗效果相似,由于双重加压螺钉能更好达到解剖复位和坚强固定,切开复位双重加压螺钉固定治疗跖跗关节损伤是一种疗效满意的方法.     

闭合复位经皮螺钉内固定治疗跖跗关节损伤

目的探讨应用闭合复位经皮螺钉内固定治疗跖跗关节损伤的临床疗效。方法自2003年1月～2005年6月应用闭合复位经皮螺钉内固定治疗跖跗关节损伤26例。按照Myerson分类:中间柱损伤13例,内侧、中间柱合并损伤7例,内侧、中间、外侧柱三柱损伤6例。结果本组切口均一期愈合,平均手术时间为40min(30～70min),切口长度平均为5mm;所有患者获平均11.4个月(6～17个月)随访,根据美国足踝骨科协会(AOFAS)评分平均为87分,患者术后平均5.3个月(3～11个月)恢复正常生活。结论闭合复位经皮螺钉内固定手术创伤小,软组织并发症低,能有效治疗跖跗关节复合体损伤;中间柱复位并沿Lisfranc韧带方向插入螺钉内固定是重建跖跗关节复合体稳定性的关键。     

开放性跖跗关节损伤的治疗

目的 探讨开放性跖跗关节损伤的治疗方法及疗效.方法 2009年4月至2010年4月收治14例开放性跖跗关节损伤患者,男10例,女4例;年龄21 ～67岁,平均45岁;根据Chiodo和Myerson提出的三柱分型,均为三柱损伤.合并内侧柱或外侧柱短缩的患者(各2例)辅以微型外固定支架固定;皮肤软组织缺损者(2例)缺损区清创后予负压封闭引流(VSD)敷料覆盖;合并皮肤脱套者(1例)打薄脱套皮肤后原位回植,并用VSD敷料覆盖;软组织条件改善后,均二期更换内固定或同时行软组织覆盖.术后采用美国足踝外科协会(AOFAS)中足评分系统评定疗效.结果 1例脱套伤患者出现部分回植皮肤坏死,于急诊术后第13天行清创、更换内固定及局部皮瓣转位修复术;2例皮肤软组织缺损者分别于术后第7、11天更换内固定及创面植皮覆盖.12例患者术后平均随访18个月(13 ～ 25个月),二期术后平均12周(10～ 16周)骨性愈合.末发生皮瓣坏死、感染、骨不连、骨髓炎等并发症,2例跖跗关节复合体损伤患者因创伤性关节炎致疼痛及功能严重受限,分别于术后12和14个月行跖跗关节融合术.所有患者末次随访AOFAS中足评分平均为72分(61～ 89分).结论 开放性跖跗关节损伤早期要对创面彻底清创,复位骨折脱位、恢复足部力线后临时固定,待软组织条件改善后择期更换内固定,可获得骨折脱位的稳定固定,是一种安全有效的治疗方法.     

微型钢板内固定治疗跖跗关节损伤21例

目的探讨切开复位微型钢板内固定治疗跖跗关节损伤的临床疗效。方法应用国产钛合金微型钢板内固定治疗跖跗关节损伤21例。结果切口均一期愈合,有2例切口边缘部分坏死,经换药后痊愈。患者均获随访,时间9～16（12.2&#177;3.6）个月。术后9～16个月拆除内固定。根据美国足踝外科协会AOFAS评分为73～95（86.5&#177;9.8）分,优10例,良9例,中2例。结论切开复位微型钢板内固定治疗跖跗关节损伤,可达到坚强稳定跖跗关节的效果,可以早期活动踝部诸关节,达到较理想的临床疗效。     

不同方法治疗跖跗关节损伤疗效分析

目的探讨不同方法治疗跖跗关节损伤的临床疗效。方法分别采用石膏固定、闭合复位经皮内固定、开放复位内固定和二期关节融合术治疗35例跖附关节损伤患者。结果患者均获随访,时间12～36(22±1.5)周,骨折愈合时间16～28(18±2)周。术后12周33例患者能穿平常鞋子在各种地面上行走,步态基本正常。按AOFAS评分:优11例,良18例,可5例,差1例。结论解剖复位、牢靠固定是治疗跖跗关节损伤的基本原则。重建跖跗关节复合体是稳定的关键,并且需要重视对跖跗关节的整体化治疗。     

微型接骨板跨关节内固定治疗跖跗关节损伤

目的总结微型接骨板跨关节桥式支撑内固定治疗跖跗关节损伤的临床效果。方法 2013年6月至2014年6月采用切开复位微型接骨板系统跨关节内固定治疗48例跖跗关节损伤的病例资料,通过随访,观察和记录损伤愈合时间及相关并发症,并利用美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)中足评分标准比较术前与末次随访时的得分。结果该组病例术后随访12~24个月,平均(16.46±3.55)个月;所有患者切口均一期愈合;术后X线片显示骨折脱位愈合时间16~20周,平均(17.21±1.79)周;末次随访时AOFAS评分由术前平均(46.90±8.05)分改善至(87.25±6.60)分,差异有统计学意义(P0.05);所有患者骨折均骨性愈合,无骨不连、骨坏死、畸形愈合、创伤性关节炎发生,无内固定材料折断,无疼痛、畸形、行走受限。结论微型接骨板跨关节桥式支撑内固定治疗跖跗关节骨折脱位疗效肯定,值得临床推广。     

跖跗关节融合术结合微型钢板内固定治疗陈旧性Lisfranc损伤

目的探讨微型钢板跖跗关节融合术治疗陈旧性Lisfranc损伤的手术疗效。方法笔者自2013-04—2014-09采用微型钢板跖跗关节融合术治疗14例(14足)陈旧性Lisfranc损伤,分别于术后1、3、6、12个月定期随访,记录关节融合时间及相关并发症,比较术前与末次随访时美国足踝外科协会(AOFAS)评分、疼痛视觉模拟评分(VAS)。结果 11例获得随访随访25~32个月,平均28.5个月。末次随访时,11例AOFAS评分由术前(46.6±15.0)分提高至(84.7±12.1)分,VAS评分由术前(6.2±1.4)分降低至(1.7±0.9)分,差异均有统计学意义(P0.05)。结论切开截骨矫形恢复中足力线、重建足弓,微型钢板固定融合跖跗关节是治疗陈旧性Lisfranc损伤安全、有效的方法。     

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.