腹腔镜辅助下结直肠癌手术的疗效分析

目的探讨腹腔镜辅助下结直肠癌手术的可行性、安全性、并发症及近期临床疗效。方法回顾性分析4年间1 1 2例腹腔镜下结直肠癌手术患者的临床资料,包括右半结肠切除2 3例,左半结肠切除7例,乙状结肠癌切除1 5例,D ixon术4 9例,M iles术1 8例。结果1 0 5例手术成功,7例因出血、肥胖及与邻近器官粘连而中转开腹手术,其中左半结肠2例,直肠癌4例。平均手术时间(1 6 1.2±4 8.6)m in,平均出血量7 8.5mL。术后早期并发症8例,无围手术期死亡。结肠癌标本近、远切缘长度分别为(1 4.5±3.2)cm和(1 1.0±2.6)cm,直肠癌标本近、远切缘长度分别为(15.3±2.7)cm和(2.8±1.6)cm。清扫淋巴结平均(8.2±4.6)枚,4 9例淋巴结转移。随访8~4 4个月,随访率9 5.5%。随访未发现戳孔肿瘤种植,局部复发7例(6.5%),远处转移6例(5.6%),总病死率7.5%(8/1 0 7)。结论腹腔镜下结直肠癌手术不仅安全可行,具有微创优势,并可达到与开腹同样的肿瘤根治性效果。     

直肠癌患者远端直肠系膜癌胚抗原检测及临床意义

目的从肿瘤免疫学角度探讨全直肠系膜切除术 (totalmesorectalexcision ,TME)治疗直肠癌的科学性。方法应用微粒子酶联免疫荧光检测法 ,对 2 6例直肠癌患者手术切除的直肠系膜的远端部分 (距癌灶下缘 3cm以下 )进行癌胚抗原 (carcinoembryonicantigen ,CEA)含量检测 ,同时测定其癌组织和正常结肠系膜的CEA含量。结果正常结肠系膜CEA含量为 (1 6± 1 0 )ng/g,2 5例患者 (96 2 % )的癌组织CEA呈高表达 (>10 0 0ng/g) ,该组的远端直肠系膜的CEA含量为 (6 2 5± 85 2 )ng/g,与正常结肠系膜相比差异有显著意义 (P <0 0 0 5 )。结论直肠癌患者远端直肠系膜的CEA含量明显高于正常 ,提示有远端直肠系膜播散的可能。因此中、下段直肠癌患者外科治疗时常规行TME是必要的     

直肠癌全直肠系膜切除经腹腔镜与开腹手术的临床对照研究

目的 :探讨经腹腔镜行全直肠系膜切除的可行性。方法 :36例直肠癌患者分别采用经腹腔镜或常规开腹手术行直肠癌根治术 ,比较两组围手术期的情况与切除标本 ,了解肿瘤切除的彻底性 ,肠旁淋巴结清扫数量的差异。结果 :两组切除标本的直肠系膜均完整 ;腹腔镜组与开腹组淋巴结数分别为 7 9± 0 7与 8 1± 0 9(P >0 0 5 ) ;直肠远切端均无癌细胞浸润 ;腹腔镜组失血 136± 2 1ml ,开腹组失血 35 7± 34ml,差异有高度显著性 (P <0 0 1) ,腹腔镜组手术后肠功能恢复早 (4 3± 5hvs 78± 12h ,P <0 0 5 ) ,围手术期并发症 2组无显著差别。结论 :在熟练掌握开腹全直肠系膜切除 (TME)的基础上经腹腔镜行TME是可行的 ,且患者创伤小、康复快 ,近期治疗效果与开腹手术无差别     

大切片CK20染色对中下段直肠癌远端转移的研究

目的 探讨中下段直肠癌远端壁内浸润和系膜转移的频率、类型,确定合适的病灶远端切除长度.方法 收集中山大学肿瘤医院2004年8月至2005年12月中下段直肠癌标本34例,山东省立医院2006年10月至2007年10月中下段直肠癌标本28例,分别用HE和CK20(cytokeratin,CK)染色,观察中下段直肠癌远端癌灶存在形式及分布规律.Logistic回归分析筛选与中下段直肠癌发生远端壁内浸润和系膜转移的临床病理因素.结果 直肠癌远端肠壁浸润形式为:黏膜下或肌肉间浸润发生率为16%(10/62),扩散距离0.5～1.0 cm.直肠癌远端系膜转移形式为:淋巴结转移、脉管转移、周围神经转移、孤立癌灶,发生率为24%(15/62),扩散距离0.5～4.0 cm.CK20染色观察3例患者存在远端系膜癌灶.Logistic单因素分析显示,血CEA水平、淋巴结转移、环周切缘癌浸润(circumferential margin involvement,CMI)和TNM分期与中下段直肠癌远端肠壁浸润和系膜转移有关.多因素分析显示,TNM分期是中下段直肠癌远端转移的独立影响因素(Wald=9.567,P=0.002).结论 TNM分期是影响中下段直肠癌远端壁内浸润和系膜转移的独立因素.直肠癌手术切除远端肠管长度达1.5 cm即可,但必须保证切除远端系膜长度不少于5 cm.     

远端胆管癌外科治疗的效果分析

目的　探讨远端胆管癌外科治疗的并发症、术后生存率及其相关因素。方法　回顾性分析我科 12年间外科治疗的 2 3例远端胆管癌患者的临床资料。结果　出现手术并发症的患者其术前症状持续的时间 ( 0 .5 0± 0 .18)个月显著短于无手术并发症的患者 ( 1.2 9± 0 .2 3 )个月 (P <0 .0 5 )。总体术后中位时间生存 18( 1～ 70 )个月 ,17例 ( 73 .9% )生存 1年以上 ,5例 ( 2 1.7% )生存 3年以上 ,2例 ( 8.7% )生存 5年或 5年以上。是否行根治性切除、手术时是否出现远处转移与术后生存率显著相关 (P <0 .0 5 )。结论　首发症状持续时间可能和外科治疗后并发症发生率有关。胰十二指肠切除是治疗远端胆管癌的有效手段。手术时出现远处转移者预后较差。     

后盆腔次全切除术治疗女性低位直肠癌273例

目的探讨在女性低位直肠癌患者中行后盆腔清除术时兼行保肛手术的可能性。方法自 195 4年 1月至 1999年 12月共收治女性直肠癌 10 2 7例 ,其中 718例为低位直肠癌 ,能行根治性切除者 5 70例 ,占 79 4% ,行后盆腔清除术者 2 73例占 47 9%。按不同时期分二组 ,Ⅰ组 195 4～ 1989年 ,低位直肠癌 36 6例 ,行后盆腔清除术者 2 0 6例 ,占 5 6 3% ,其中 2 2例行后盆腔清除低位前切除 (后盆腔次全切除 ,简称次全切除组 ) ,占 10 7%。Ⅱ组 1990～ 1999年 ,低位直肠癌 2 0 4例 ,行后盆腔清除术 6 7例 ,占 32 8% ,其中 2 6例行次全切除 ,占 38 8%。二组病例在病理学类型、组织学分类和病理分期上均无差异。结果总手术死亡率 3 3% ,二组之间无差异 ,分别为 3 4%和 3 0 %。 48例行清扫保肛手术者发生吻合口漏 4例 (8 3% ) ,均发生于Ⅰ组 ,故Ⅰ组吻合口漏发生率高达 18 2 %。全组术后局部复发 13例 ,占 4 8% ,其中Ⅰ组复发 9例 (4 4% ) ,Ⅱ组 4例 (6 0 % ) ,P >0 0 5。 13例均复发于盆腔 ,无吻合口复发。Ⅰ组 5年生存率 (5 3 2± 1 9) % ,Ⅱ组 (6 7 3± 1 6 ) % ,P <0 0 5。结论女性低位直肠癌患者在行后盆腔清除时 ,对合适的病例兼行保肛手术不但可行 ,而且不会增加局部复发率。Ⅱ组 5年生存率的提高则是我们     

经腹腔镜行全直肠系膜切除的可行性研究

目的探讨经腹腔镜行全直肠系膜切除治疗直肠癌的可行性。方法比较经腹腔镜与开腹两组标本的直肠系膜完整性和肠旁 3站淋巴结清扫数目的差异。结果①两组各 2 0例直肠癌切除标本的直肠系膜均完整无破损。②腹腔镜组与开腹组N1的淋巴结数分别为 8 5± 3 6与10 6± 6 2 (P =0 334 ) ;N2 的淋巴结数分别为 3 7± 2 2与 2 4± 2 1(P =0 32 8) ;N3 的淋巴结数分别为2 4± 1 7与 2 0± 1 8(P =0 5 90 )。③直肠远切端均无癌细胞浸润。结论经腹腔镜行全直肠系膜切除是可行的     

直肠癌远端壁内扩散的病理分析

５０例直肠癌切除标本，远端壁内扩散为２１例，其中１９例扩散距离〈１ｃｍ。其与癌的大体类型、大小、组织类类型和分化程度、肠壁浸润深度、淋巴结转移不同程度的关系。据此，考虚标本固定的因素，对中低位直肠远端切除长度进行了探讨。     

微淋巴管密度对直肠癌手术远端切除长度的临床意义

目的 研究低位直肠癌的微淋巴管密度(LVD)与直肠癌远端扩散(DIS)长度的关系,探讨LVD在低位直肠癌手术时对决定远端切除长度的价值.方法 92例低位直肠癌手术标本通过苏木精.伊红染色测定DIS,利用淋巴管内皮细胞透明质酸受体(LYVE-1)免疫组织化学法测定LVD,分析LVD与DIS及直肠癌其他临床病理学因素间的关系.结果 44例(47.8%)患者有DIS,为(0.31±0.09)cm;其中有23例(52.3%)淋巴管内癌栓.癌缘LVD明显高于癌内,DIS组明显高于无DIS组.相关分析显示,DIS组中,癌缘LVD与DIS呈正相关(r=0.755,P＜0.01);当癌缘LVD超过38时,DIS均超过1 cm.LYD还与浸润程度、淋巴结转移和淋巴浸润有关.结论 淋巴管内癌栓是直肠癌DIS的主要形式,LVD与DIS的相关关系有助于决定低位直肠癌手术中的远端切除长度.     

微淋巴管密度对直肠癌手术远端切除长度的临床意义

目的研究低位直肠癌的微淋巴管密度（LVD）与直肠癌远端扩散（DIS）长度的关系，探讨LVD在低位直肠癌手术时对决定远端切除长度的价值。方法92例低位直肠癌手术标本通过苏木精．伊红染色测定DIS，利用淋巴管内皮细胞透明质酸受体（LYVE-1）免疫组织化学法测定LVD，分析LVD与DIS及直肠癌其他临床病理学因素间的关系。结果44例（47．8％）患者有DIS，为（0．31±0．09）cm；其中有23例（52．3％）淋巴管内癌栓。癌缘LVD明显高于癌内，DIS组明显高于无DIS组。相关分析显示，DIS组中，癌缘LVD与DIS呈正相关（r=0．755，P〈0．01）；当癌缘LVD超过38时，DIS均超过1cm。LVD还与浸润程度、淋巴结转移和淋巴浸润有关。结论淋巴管内癌栓是直肠癌DIS的主要形式．LVD与DIS的相关关系有助于决定低位直肠癌手术中的远端切除长度。     

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.