腹腔镜肝切除术20例临床分析

目的 探讨腹腔镜下肝切除术的可行性及相关技术问题如术中出血的控制、肝实质离断方法和肝断面的处理方法等.方法 自2011年6月至2014年4月共施完全腹腔镜肝切除术20例,对其临床资料进行回顾性分析.结果 20例患者中肝血管瘤10例,肝细胞性肝癌9例,乙状结肠癌肝转移1例.2例位于肝脏第Ⅱ和第Ⅲ段,8例位于第Ⅲ段,7例位于第Ⅵ段,第Ⅳb、Ⅴ、Ⅶ段各1例.平均肿瘤直径（4.7±1.9） cm.肝肿瘤局部切除6例,肝左外叶切除7例,肝右后叶切除2例,肝段切除5例.单独使用超声刀离断肝组织8例,超声刀联合Habib4X射频止血凝固器离断肝组织6例,超声刀联合Endo GIA离断肝组织6例.平均手术时间（196±57） min,术中出血量（380±459）ml,术后出现中等量腹水1例、胆漏1例,顽固性胸腔积液1例,均经保守治疗治愈.术后平均住院时间（9.2±3.5）d.10例恶性肿瘤患者术后随访1～35个月,5例出现肝内复发.结论 在严格掌握手术适应证的前提下,腹腔镜肝切除术是安全可行的;根据肝脏质地的不同,选择不同离断肝实质的器械,可减少术中出血.     

可吸引电凝棒在腹腔镜肝切除术中的应用(附10例报道)

目的探讨可吸引电凝棒在腹腔镜肝切除术中的应用价值。方法回顾性分析2017年1–7月期间桂林医学院第二附属医院收治且采用可吸引电凝棒行完全腹腔镜下肝(段或叶)切除手术的10例原发性肝癌患者的临床资料。结果 10例患者均顺利完成腹腔镜肝切除手术,无中转开腹。手术时间(110±45)min,术中出血量(300±50)mL,肠蠕动恢复时间(2±1)d,住院时间(8±2)d。术后无出血、胆汁漏等发生。术后随访1~5个月、(3±2)个月,10例患者均健在,未见肿瘤复发。结论本研究有限病例的初步研究结果提示,应用可吸引电凝棒行腹腔镜肝切除术安全、有效及便捷,结合超声刀进行断肝可有效减少术中出血量。     

腹腔镜肝切除术6例报告

2002年4月～2004年6月腹腔镜下超声刀结合氩气刀完成肝切除6例,其中原发性肝癌2例,肝海绵状血管瘤4例.手术时间0.5～4.0 h,平均1.8 h.术中出血量80～320 ml,平均220 ml.术后住院5～7 d,平均5.7 d.超声刀结合氩气刀是腹腔镜肝切除术的理想手术工具.     

腹腔镜下冷循环射频消融联合脾切除术贲门周围血管离断治疗肝癌合并门静脉高压症的研究

目的研究腹腔镜下冷循环射频消融联合脾切除术贲门周围血管离断术治疗肝癌合并门静脉高压的临床疗效。方法原发性肝癌合并门静脉高压症病人80例,根据治疗方法不同分为两组,消融组46例,接受腹腔镜下冷循环射频消融联合脾切除术贲门周围血管离断术;肝切除组34例,接受腹腔镜下肝部分切除联合脾切除术贲门周围血管离断术。收集两组病人手术时间、术中出血量、住院时间,比较两组病人并发症发生率。结果消融组病人的手术时间(251.7±45.1)分钟、术中出血量(223.0±108.0)ml,住院时间(11.5±3.1)天,肝切除组分别为(287.5±61.5)分钟、(276.6±126.0)ml和(13.8±3.7)天,两组比较差异有统计学意义(P0.05),消融组疼痛并发症发生率少于肝切除组,差异有统计学意义(P0.05)。结论腹腔镜下冷循环射频消融与贲门周围血管离断配合治疗肝癌合并门静脉高压临床疗效良好,病人预后较好。     

腹腔镜手术治疗肝癌128例的疗效评析

目的 探讨腹腔镜手术治疗肝癌的临床价值.方法 回顾性分析2007年3月至2009年10月第三军医大学西南医院采用腹腔镜手术治疗128例肝癌患者的临床资料.其中原发性肝癌116例,转移性肝癌12例.行腹腔镜肝切除术107例,单纯腹腔镜下RFA治疗15例,腹腔镜下门静脉右支结扎降期治疗6例.结果 107例行腹腔镜肝切除术患者中7例中转开腹手术,5例中转手助式腹腔镜肝切除术.规则性肝切除88例,包括左外叶切除21例、左半肝切除15例、超左半肝切除2例、中肝切除1例、右半肝切除11例、右后叶切除9例、单肝段切除29例;两个以上部位联合切除4例;非规则性肝切除15例.肝切除术的平均手术时间(228±92)min,术中平均出血量(393±213)ml,无手术死亡,16例术后出现并发症,术后平均住院时间(8±4)d.126例患者随访1～42个月,12例行腹腔镜肝切除术者于术后3～16个月死亡,术后平均生存时间(118±7)周,平均无瘤生存时间(105±7)周.行腹腔镜下BFA治疗的2例患者分别于术后9个月及11个月死亡;行腹腔镜下门静脉结扎的2例患者于术后行二期根治性切除.结论 腹腔镜手术治疗肝癌安全可行,具有创伤小、恢复快的优点.     

腹腔镜肝切除术治疗中央型肝癌的安全性及有效性分析

目的分析探讨腹腔镜肝切除手术治疗中央型肝癌的安全性及有效性。方法选择2018年1月至2019年1月中南大学湘雅二医院肝胆外科应用腹腔镜技术治疗的45例中央型肝癌患者的临床资料。其中肝细胞癌36例,胆管细胞癌6例,混合型肝癌3例。肿瘤最大径3～11 cm,平均(5.6±2.9)cm。记录患者的手术时间、术中出血量、住院时间、并发症、术后1年复发率等指标。结果 44例成功实施全腹腔镜手术切除,1例患者因术中出血量大于800 ml中转开腹。手术时间180～280 min,平均(240±30)min;术中出血量100～500 ml,平均(300±200)ml;术后住院时间6～14,平均(7.6±2.6)d;围手术期内无死亡病例;术后1年复发率为8.9%(4/45)。结论腹腔镜肝切除术治疗中央型肝癌是安全有效的。     

腹腔镜肝切除术27例报告

目的探讨腹腔镜肝切除术的可行性。方法采用腹腔镜多功能手术解剖器(LPMOD)刮吸断肝技术行完全腹腔镜下肝切除术27例。包括规则性肝切除13例(其中Ⅱ、Ⅲ段切除3例,Ⅴ段切除1例,Ⅵ段切除7例,Ⅴ、Ⅵ段切除1例,Ⅴ、Ⅵ、Ⅶ、Ⅷ段切除1例),局部切除14例。结果全部顺利完成手术,无中转开腹。手术时间35~360 min,(178.0±78.4)min,术中出血35~1200 ml,(451.7±332.6)ml,术后住院时间2~14 d,(8.4±3.0)d,无严重并发症发生。术后病理:肝海绵状血管瘤15例,肝局灶性增生2例,肝细胞性肝癌伴肝硬化6例,肝胆管结石伴胆管增生2例,肝(血肿)纤维化1例,肝血管平滑肌脂肪瘤1例。27例术后随访1~26个月,(7.9±7.4)月,复查肝B超或CT,无血管瘤复发、肝癌复发及穿刺口种植、肝内胆管结石残留。结论在经过选择的病例中,采用LPMOD行腹腔镜肝切除术是可行的。     

腹腔镜下双极射频Habib 4X辅助肝切除治疗原发性肝癌86例

目的探讨腹腔镜下双极射频Habib 4X辅助肝切除治疗原发性肝癌的安全性和可靠性。方法 2010年10月~2016年10月我科对86例肝癌行腹腔镜下双极射频Habib 4X辅助肝切除,规则性肝切除时沿分界线,不规则肝切除时在距离肿瘤边缘1~2 cm处采用Habib 4X消融后行肝切除术。结果 85例顺利完成腹腔镜下肝切除术,其中14例行解剖性左半肝切除术,31例行左肝外叶切除术,40例行不规则肝切除术;1例中转开腹。所有患者均未阻断第一肝门。手术时间80~330 min,(151±62)min;出血量10~400 ml,(105±83)ml,术中均未输注血制品。围手术期无死亡,无肝断面出血、胆漏、肝功能衰竭等术后严重并发症发生。术后住院5~22 d,(11±4)d。85例随访1~72个月,中位随访时间30个月,术后1年内复发7例(8.2%),随访期间死亡14例(16.5%)。结论腹腔镜下Habib 4X辅助肝切除治疗原发性肝癌安全、可行,值得临床推广。     

手助腹腔镜肝血管瘤切除术

目的探讨手助腹腔镜下肝血管瘤切除的可行性及方法。方法经Lapdisc系统辅助腹腔镜完成8例肝血管瘤切除。术中切除步骤:(1)置入Lapdisc,游离肝脏;(2)解剖第一肝门,准备阻断;(3)阻断肝门,超声刀离断肝实质;(4)标本取出,创面处理。结果所有患者经Lapdisc辅助腹腔镜下顺利切除病灶,无中转开腹手术,手术时间(196·3±81·2)min,出血量(307·5±224·7)ml,住院时间(7·9±2·9)d。无胆漏、腹腔出血及感染等并发症。结论手助腹腔镜下肝血管瘤切除是安全可行的。     

微波止血分离器在降低肝门板的肝癌切除术中的应用

目的探讨微波止血分离器在降低肝门板的肝癌切除手术中的临床应用价值。方法回顾分析2010年至2012年70例应用微波止血分离器进行的降低肝门板的肝癌切除手术资料,采用微波止血分离器(HeSetor)进行肝门板解剖及断肝,术中仅阻断切除侧肝门;与同期40例常规手术对照组资料进行比较,该组采用常规Pringle阻断肝门及钳夹断肝。结果两组手术均顺利完成。HeSetor结合降低肝门板组手术时间平均(115.4±42.3)min;术中出血量平均(120.0±105.2)ml,术中均无输血;术后肝功能生化检查平均在(6.3±2.7)d恢复;术后并发症发生率为15.7%(11/70),其中胸腔积液5例(7.1%),腹水6例(8.6%);术后平均住院(6.4±3.5)d。常规手术对照组手术时间平均(169.1±86.5)min;术中出血量平均(360.5±153.1)ml,术中3例输血(7.5%);术后肝功能生化检查平均在(9.1±5.6)d恢复;术后并发症发生率为30.0%(12/40),其中胸腔积液5例(15.0%),腹水5例(15.0%),胆瘘2例(7.5%);术后平均住院(11.1±6.3)d。两组间以上指标比较,P值均小于0.05。结论应用微波止血分离器进行的降低肝门板的肝癌切除手术是一种安全可靠的肝切除方法,术中出血少,容易掌握,术后恢复快,值得临床推广应用。     

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.