胰源性门静脉高压症21例诊治经验

目的:探讨胰源性门静脉高压症的诊断方法和治疗措施.方法:回顾分析我院自1995年3月至2006年6月收治的胰源性门静脉高症症21例,均有胰腺炎病史,其中3例合并假性囊肿,1例合并胰尾部癌.10例有上消化道大出血.结果:16例行手术治疗.手术指征:胃底静脉重度曲张或伴有食道静脉曲张,既往有上消化道大出血史,以及门静脉主干有血栓形成.手术方法:脾切除是基本方法,胰周纤维化明显者联合胰体尾切除;假性囊肿行囊肿-空肠Roux-en-v式吻合;胰尾癌行胰体尾切除;有食管静脉曲张者附加贲门食管周围血管离断术;门静脉主干有血栓者行肠系膜上静脉-下腔静脉H型分流术.5例行非手术治疗.结论:胰源性门静脉高压症临床较为少见,其诊断和治疗有不同于肝硬化性门静脉高压症的特点,手术治疗效果良好.对于胃底静脉曲张较轻、无出血史者可非手术治疗,随着胰腺原发病的控制和血栓再通,胃底静脉曲张也可好转或停止发展.     

胰外瘘防治的探讨

目的　胰外瘘 ( PF)系胰腺炎症、外伤及手术后严重并发症 ,兹探讨其防治。方法　总结治疗组 13例。因重症胰腺炎 ( SAP)坏死清除引流 4例 ;外伤单纯引流 3例 ,胰十二指肠切除 ( PD) 1例 ;十二指肠降段癌及胰头炎性肿块各 1例均行PD;假性囊肿左半胰切除 1例 ;十二指肠首段癌首段及部分降段切除 1例 ;原因不明 1例。 PF发生于术后 1～ 5 d,胰液量 10 0～ 10 0 0 m l,淀粉酶多数 >10 0 0 IU。影像学有关检查。 11例非手术治疗 ;2例手术 ,分别为瘘管空肠 Y吻合及瘘管胃吻合、脾及胰尾切除和胰空肠 Y吻合。预防组 12例 ,术前影像学检查。壶腹 (周 )癌 PD9例 (保幽 5、空肠造瘘 4 ) ,均行胰管空肠吻合并安支撑 ;胰尾癌左半胰切除 1例 ;慢性胰腺炎左半胰切除近端空肠 Y吻合 1例 ;胰管结石伴胆囊炎胆囊切除、胆总管引流、胰管切开取石 T管引流经胃窦部引出 1例。结果　非手术治疗 10例 5 d～ 9个月 PF愈合 ,1例死于原发病 SAP;2例手术治愈。预防组未发生 PF。结论　大多数 PF可非手术治愈。手术指征按 PF时间长短、引流量、有无壶腹及主胰管梗阻或狭窄等综合地掌握 ;术式按病情针对性地选择。 PF预防是多方面的 :SAP严格手术指征和时机 ;胰伤按伤情轻重、有无邻近脏器损伤、特别是有无主胰管受伤而采用适当术式     

胰源性门静脉高压症7例诊治分析

目的:探讨胰源性门静脉高压症的临床诊断和治疗方法。
方法:回顾分析收治的7例胰源性门静脉高压症患者的临床资料。6例有慢性胰腺炎病史，其中4例合并假性囊肿，1例为胰体尾部癌。术前肝功能检查均正常。5例出现上消化道出血，胃镜检查发现胃底静脉曲张。
结果:7例均行手术治疗，单纯脾切除2例，胰周坏死组织清除+脾切除+门奇静脉断流术1例，胰尾囊肿切除+脾切除术1例，假性囊肿内引流+脾切除术2例，胰体尾切除+脾切除术1例。术后随访胃底静脉曲张消失，均未再发生出血。
结论:胰源性门静脉高压症手术治疗效果令人满意，对有症状的患者，在治疗胰腺疾病的同时应附加脾切除术。

     

胰性腹水的内镜治疗(英)

胰性腹水多由于假性胰腺囊肿破裂所致,当然也可因胰管直接破裂引起,尚见于腹部钝性伤以及酒精性慢性胰腺炎病人.传统的治疗方法有高价静脉营养、腹腔穿刺和生长抑素药物,手术治疗有胰腺切除或囊肿空肠吻合术,而半数以上病人最终需要手术,死亡率约15%～25%,作者应用经内镜(ERCP)放置胰管支撑物治疗了4例胰性腹水病人,计男性3例、女性1例,年龄37～58岁,3例有慢性酗酒史,1例为克隆病回肠结肠炎和硬化性胆管炎病人.高价静脉营养补充和利尿剂均无效,3例还同时使用了生长抑素.CT扫描均显示大量腹水和2例假性囊肿,腹水中总蛋白量     

胰管结石伴发慢性胰腺炎急性发作临床诊治探讨

目的 探讨胰管结石伴发慢性胰腺炎急性发作的临床治疗方案.方法 回顾性分析南华大学附属南华医院1998年1月至2006年9月收治的11例胰管结石伴发慢性胰腺炎急性发作病人的临床资料,11例均接受手术治疗,其中胰头部胰管切开加十二指肠乳头成形及胆总管切开T管引流术2例,胰管切开取石并胰管空肠Roux-en-Y吻合术5例,胰体尾切除加胰断端面胰管空肠Roux-en-Y吻合2例.单纯胰尾切除2例.结果 术后疼痛治愈率54.54%(6/11),好转率45.45%(5/11),胰漏(瘘)或出血27.27%(3/11).9例平均随访时间(39.2±36.2)个月,均无并发症出现.结论 胰管结石伴发慢性胰腺炎急性发作者早期宜非手术治疗,3个月后接受适宜的外科手术治疗,效果肯定.并发症发生率较低,术式根据结石部位、主胰管是否通畅决定.     

慢性胰腺炎78例诊断和外科治疗

目的探讨慢性胰腺炎的临床诊断,评价慢性胰腺炎的手术疗效。方法回顾性临床资料分析。结果慢性胰腺炎的临床诊断正确率78.2%(61/78),误诊17例,其中真性囊肿误诊为假性囊肿8例,胰腺壶腹部癌误诊为慢性胰腺炎6例。手术方法包括胰十二指肠切除术12例,胰体尾或囊肿切除术27例,胰腺囊肿空肠Roux-en-Y吻合术8例,胰管空肠Roux-en-Y吻合术2例,胰腺囊肿外引流4例,胰床引流3例,胰腺活组织学检查22例。疗效:手术后腹痛缓解率65.6%(40/61),腹痛缓解明显42.6%(26/61),腹痛缓解不明显23.0%(14/61);腹痛不缓解率32.8%(20/61);手术死亡率1.64%(1/61)。结论病理组织学诊断是慢性胰腺炎诊断的金标准;慢性胰腺炎可发生局限性癌变;慢性胰腺炎临床表现复杂,外科治疗应采用个体化原则。     

胰头肿块型慢性胰腺炎的临床分析

目的探讨胰头肿块型慢性胰腺炎的诊治方法。方法对我院近10年38例胰头肿块型慢性胰腺炎的临床资料进行回顾性分析。结果本组病例主要症状为上腹部疼痛(100%)、黄疸(47.4%)和体重明显下降(42.1%),B超检查阳性率94.1%,CT、ERCP和MRCP阳性率均为100%。症状较轻,或因并存严重并发症的8例和病理切片排除恶性病变的5例行内科综合治疗,症状严重行胰头十二指肠切除16例,胆管空肠吻合5例、胰管空肠吻合1例,囊肿空肠吻合3例。结论本病诊断主要依靠影像学检查。症状较轻,可行内科治疗。症状严重,发生胆胰管梗阻或不能排除恶性病变者应行胰头十二指肠切除手术为主。     

Clinical analysis of chronic pancreatitis with mass

目的 探讨胰头肿块型慢性胰腺炎的诊治方法.方法 对我院近10年38例胰头肿块型慢性胰腺炎的临床资料进行回顾性分析.结果 本组病例主要症状为上腹部疼痛(100％)、黄疸(47.4％)和体重明显下降(42.1％),B超检查阳性率94.1％,CT、ERCP和MRCP阳性率均为100％.症状较轻,或因并存严重并发症的8例和病理切片排除恶性病变的5例行内科综合治疗,症状严重行胰头十二指肠切除16例,胆管空肠吻合5例、胰管空肠吻合1例,囊肿空肠吻合3例.结论 本病诊断主要依靠影像学检查.症状较轻,可行内科治疗.症状严重,发生胆胰管梗阻或不能排除恶性病变者应行胰头十二指肠切除手术为主.     

胰头肿块型慢性胰腺炎手术治疗体会

目的探讨胰头肿块型慢性胰腺炎的手术治疗效果。方法回顾性分析1999年1月至2013年12月间经手术治疗的18例胰头肿块型慢性胰腺炎患者的临床资料。其中4例合并胰管结石,5例合并胰腺囊肿。10例行胰十二指肠切除术,5例行胰管空肠Roux-Y吻合术,2例行胰腺囊肿空肠Roux-Y吻合术,1例行胆总管空肠Roux-Y吻合术,其中1例同时行胰肠吻合和胃空肠吻合术。比较不同术式对腹部疼痛的缓解率。结果 17例完成手术,1例损伤肠系膜上静脉大出血术中死亡。术后出现胸腔积液2例,切口裂开1例。获随访13例,其中行胰十二指肠切除术8例(61.5%),疼痛完全消失;胰肠或胆肠吻合4例(30.8%),疼痛部分缓解;胰肠吻合和胃肠吻合1例(7.7%),疼痛无缓解,反复住院治疗未痊愈。结论外科手术是胰头肿块型慢性胰腺炎的有效治疗方式,胰十二指肠切除术效果显著。     

胰腺假性囊肿43例诊治体会

目的探讨胰腺假性囊肿的外科手术治疗方式。方法回顾性分析43例胰腺假性囊肿患者的临床资料,其中行单纯囊肿外引流术8例(18.6%),单纯囊肿切除10例(23.3%),囊肿切除、胰尾部+脾切除术3例(7.0%),囊肿空肠Roux-en-Y吻合19例(44.2%),囊肿胃吻合3例(7.0%)。结果术后发生并发症6例:1例囊肿胃吻合患者术后出现消化道出血,2例单纯囊肿外引流患者发生胰漏,1例囊肿空肠吻合者术后发生逆行感染,切口感染2例。随访37例,复发急性胰腺炎1例。结论胰腺假性囊肿在经保守治疗度过急性期后,应根据病情选择合适的术式治疗。     

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.