自体心包片下腔静脉重建

目的 探讨自体心包片腔静脉成形(APPC)或下腔静脉重建(RIVC)的治疗方法、适应症、临床价值和注意事项。方法 自1986年5月至1998年6月我们完成了APPC治疗下腔静脉(IVC)—肝静脉(HV)狭窄39例和自体心包管代血管IVC移植(VTIVC)治疗IVC闭塞或缺损3例，同时施行直视根治术切除梗阻病灶。结果 手术死亡2例(死亡率4．76％)，1例死于肝肾综合征，另1例死于呼吸道出血性窒息。40例痊愈出院(治愈率95.24％)。术后随访13—96个月，37例典型症状体征消失，B超和IVC造影证实IVC-HV通畅良好者37例，术后1．5年显示IVC狭窄1例，2例于术后2—4个月发现IVC血栓形成。结论 APPC是治疗IVC-HV狭窄或闭塞的直接有效的外科疗法，常使病人迅速康复。     

Budd-Chiari综合征与直视根治术

Budd-Chiari综合征行直视根治术观察其病变并作分析。方法:在常温下血管阻断或置管转流下,经右胸作下腔静脉(IVC)切开行膜切除、血栓摘除、癌栓摘除、自体心包片腔静脉成形、心包管代血管移植等手术共70例。结果:手术死亡3例,术后67例随访5～84个月(平均45个月),B超和IVC造影显示IVC-HV通畅者64例,术后4个月IVC血栓形成1例,术后1～1.5年示IVC狭窄2例。结论:Budd-Chiari综合征用直视根治术是一种较理想的疗法。     

活体肝移植治疗布加综合征并下腔静脉狭窄

目的 报道笔者利用尸体下腔静脉（IVC）替代受体肝后IVC施行成人间活体肝移植（LDLT）治疗布加综合征（BCS）并IVC狭窄的经验。方法 1例35岁男性BCS并肝后IVC狭窄的患者，曾接受内科治疗，并于9个月前经放射介入置入金属扩张器，但症状无缓解。最终患者被施行了成人间LDLT，术中采用了尸体IVC替代受体肝后IVC进行重建。结果 患者术后过程平稳，效果满意。结论 笔者认为采用LDLT及利用尸肝IVC重建受者肝后IVC治疗BCS并肝后IVC狭窄的术式可推荐作为一种新的术式。     

肝癌合并下腔静脉癌栓的外科治疗

目的总结7例肝癌合并下腔静脉（inferior vena cava,IVC）癌栓患者的手术方法及治疗经验。方法自2003年7月至2005年5月,我们为7例肝癌合并IVC癌栓的患者实施了肝癌切除及右心房和（或）IVC切开取栓手术。所有患者均采用全肝血流阻断来控制IVC血流。根据癌栓上极位置的不同,分别采用5种不同术式：（1）静脉转流,心脏停搏,右心房及下腔静脉切开取栓1例;（2）静脉转流,心脏不停搏,心包内高位阻断下腔静脉,右心房和（或）下腔静脉切开取栓2例;（3）经腹部切口切开膈肌,心包内高位阻断下腔静脉,下腔静脉切开取栓1例;（4）经腹部切口,经膈肌腔静脉裂孔小切口,心包外高位阻断肝上下腔静脉,下腔静脉切开取栓1例;（5）经腹部切口,肝上阻断下腔静脉,下腔静脉切开取栓2例。结果所有手术均获成功,术后并发症包括胸腔积液2例,右膈下积液1例,切口感染1例。7例患者的生存时间为2周～26个月,平均9．8个月。已死亡的6例患者术后生存时间分别为13、9、11、2、17个月和2周,尚生存的1例患者已无瘤生存26个月。结论对合适病例实施肝癌切除和IVC切开取栓手术是安全可行的。手术治疗可以避免右心流人道阻塞和肺动脉栓塞造成的猝死,并有可能获得相对提高的生存时间和生活质量。     

布加氏综合征的介入治疗(143例经验总结)

目的　总结介入方法治疗布加氏综合征 143例的临床经验。　方法　男 92例 ,女 5 1例。年龄 6岁～ 6 5岁 ,平均 34 8岁。共 6种病理类型 :①下腔静脉 (InferiorVenaCava ,IVC)完全阻塞 71例 ;②IVC狭窄 36例 ;③IVC膜性阻塞伴小孔 2 9例 ;④肝静脉 (HV)膜性阻塞 3例 ;⑤近期IVC血栓形成 4例 ;⑥以上IVC病例中同时合并HV阻塞 14例。治疗方法包括 :(1)经股静脉行IVC破膜扩张或狭窄扩张 77例 ;(2 )经股静脉行IVC破膜扩张或狭窄扩张后IVC支架置入术 6 2例 ;(3)经皮经HV破膜扩张 3例 ;(4)经股静脉行IVC置管溶栓 4例 ;(5 )介入治疗后附加降低门脉高压手术 16例。　结果　介入治疗成功率90 2 % (12 9/ 143) ,IVC压力下降范围 (3～ 2 9)cmH2 O ,平均 12 1cmH2 O。发生并发症 8例 ,肺栓塞、支架迁移及支架术后HV阻塞各 2例 ,心包填塞和血胸各 1例。死亡 5例 ,2例死于肺栓塞 ,3例IVC支架术后二期附加肠腔侧侧分流术后死于肝昏迷 ,围手术期死亡率 3 5 % (5 / 143)。单纯IVC扩张病例复发率10 4% ,IVC扩张加支架置入术病例复发率 1 6 % ,其余各组尚无复发者。　结论　①IVC或HV局限性病变且无继发新鲜血栓者 ,应首选行破膜扩张术。②IVC破膜扩张后出现弹性回缩或复发者应行IVC支架术。③IVC病变合并HV闭塞者 ,IVC介     

Budd—Chiari综合征与直视根治术

目的：Ｂｕｄｄ－Ｃｈｉａｒｉ综合征行直视根治术观察其病变并作分析。方法：在常温下血管阻断或置管转流下，经右胸作下腔静脉（ＩＶＣ）切开行膜切除、血栓摘除、癌栓摘除、自体心包片腔静脉成形、心包管代血管移植等手术共７０例。结果：手术死亡３例，术后６７例随访５￣８４个月（平均４５个月），Ｂ超和ＩＶＣ造影显示ＩＶＣ－ＨＶ通畅者６４例，术后４个月ＩＶＣ血栓形成１例，术后１￣１．５年示ＩＶＣ狭窄２例。结论：Ｂｕ     

直视下Budd-Chiari综合征根治术术式选择

目的：探讨Ｂｕｄｄ－Ｃｈａｉｒｉ综合征（ＢＣＳ）４种根治术的适应证及其优缺点。方法：１９９３年１１月～２０００年１２月对１１４例ＢＣＳ病人行直视下根治术,其中单纯隔膜切除２０例,下腔静脉病变段切开、心包片成形３９例,下腔静脉病变段切除、人工血管原位移植４２例,肝静脉主干闭塞段及其上方的下腔静脉闭塞段切除、肝静脉流出道扩大成形、肝静脉开口至下腔静脉的右房入口处人工血管原位移植术１３例。结果：全组无手术死亡。住院期间４例死于并发症。随访６～８４个月,复发５例,２例无效,均为心包片扩大成形术后。结论：４种根治术有各自不同的适应证。合理的术式选择是取得良好远期疗效的关键。     

经皮腔内血管成形术治疗布加综合征

笔者采用经皮腔内血管成形术（PTA）治疗13例布加综合征（BCS）。男9例、女4例，平均39．9岁。其中下腔静脉（IVC）膜性阻塞10例，采用PTA单纯治疗；IVC节段性狭窄3例，采用PTA后置入自膨式金属内支架。术后IVC压力由术前3．77土0．79kPa即刻降至1．70士0．19kPa，IVC-右房压力阶差由2．58士0．73kPa降至0．18士0．12kPa。对其中12例随访3～44个月（平均18个月），主要临床症状和体征完全消失，仅首例膜性闭塞者PTA后44个月IVC发生再闭塞。笔者对介入治疗的临床价值、病例的选择、内支架的适应症等进行了讨论。认为膜性阻塞应首选PTA；对于节段性狭窄合理的治疗方法是PTA后置入内支架可有效阻止再狭窄的发生。     

下腔静脉型布加综合征合并下腔静脉血栓形成的治疗及随访分析

目的探讨下腔静脉（inferior vena cava,IVC）型布加综合征（Budd-Chiari syndrome,BCS）合并IVC血栓形成的治疗方法、疗效及预后。方法回顾性分析2004年4月至2012年6月期间因膜性或短段闭塞性IVC型BCS合并IVC血栓形成于郑州大学第一附属医院行介入治疗的128例患者的临床资料,比较行小球囊预开通治疗及可回收支架治疗患者的疗效。结果 128例患者中,9例行搅拌溶栓治疗（搅拌溶栓组）,56例行小球囊预开通治疗（预开通组）,63例行可回收支架治疗（可回收支架组）。除可回收支架组有1例患者于术中发生支架断裂、行外科手术外,其余127例患者的介入手术均成功。术后可回收支架组发生支架移位2例,余2组无并发症发生。预开通组与可回收支架组的尿激酶用量、溶栓时间、住院时间以及总并发症发生率比较差异均无统计学意义（P〉0.05）,但可回收支架组的住院费用高于预开通组（P〈0.01）。术后128例患者均获访,随访时间18-66个月,平均44.2个月。随访期间,搅拌溶栓组有1例、预开通组有6例、可回收支架组有6例患者发生原闭塞处的再次狭窄闭塞,预开通组与可回收支架组的再次狭窄闭塞率比较差异无统计学意义（P〉0.05）。复发患者经再次扩张治疗后未再发生管腔狭窄和血栓形成。结论搅拌溶栓技术治疗IVC型BCS合并IVC新鲜血栓形成安全而有效;小球囊预开通技术及可回收支架技术治疗IVC型BCS合并IVC陈旧性血栓形成的效果满意,且前者更经济。     

腔静脉-腔静脉转流术治疗布-加综合征

目的 探讨布－加综合征更为有效的手术方式。方法 采用腔静脉－腔静脉人工血管转流术对３２例节段闭塞型布－加综合征病人进行手术治疗。结果 围手术期死亡２例,病死率６％。对３０现人术后随访６～３０个月,随访率９４％,效果优者２６例（８１％）,病人临床病状、腹水、胸腹壁曲张静脉及下肢肿胀消失,肝右肋下不能触及;良好者３例（１０％）,胸腹壁曲张静脉基本消失,肝脏缩小;１例效果欠佳。结论 本术式与腔静脉－右心     

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.