椎弓根融合器添加磷酸钙骨水泥后的生物力学效果

目的:评价磷酸钙骨水泥(calcium phosphate cement,CPC)强化和修复椎弓根融合器的生物力学效果。方法:8具成人新鲜腰椎骨L1-L4共32个椎体,随机选取其中20个,分为3组(A,B,C),每组10个。A组(对照组):随机选择10个椎体双侧椎弓根放置直径为6.5 mm的椎弓根融合器,不穿透椎体前侧骨皮质。在材料实验机上进行椎弓根融合器最大轴向拔出力(Fmax)实验,拔出速率为5 mm/min。B组(修复组):对照组拔出椎弓根融合器后再向椎弓根融合器中空部分注入配制好CPC 3-5 ml,室温(28℃)1 h后再行前述最大轴向拔出力(Fmax)实验。C组(强化组):另选10个椎体直接向椎弓根融合器中空部分注入配制好CPC和拧入椎弓根融合器,再行拔出实验。沿椎弓根融合器方向锯开标本,观察CPC在椎体中分布范围。另外10个椎体作椎弓根融合器的递增负荷的周期抗屈实验。结果:正常对照组椎弓根融合器Fmax为(843.1±132.2)N,修复组为(1456.2±239.9)N,强化组为(1499.5±241.2)N;向椎弓根融合器中空部分注入CPC,未见CPC溢出椎弓根外或椎管内。周期抗屈实验中,添加CPC可使椎弓根融合器耐受更大的负荷或在同等负荷下仅产生较小的位移。CPC骨水泥强化和修复椎弓根融合器后轴向拔出力明显高于强化前,差异具有显著性意义(P<0.05)。结论:沿椎弓根融合器中空部分注入CPC可显著增加椎弓根螺钉的稳定性,并能减少CPC向椎弓根外或椎管内溢出。在活体中即使不添加CPC也有利于骨细胞长入椎弓根融合器侧孔,同样可以增加螺钉的稳定性。适用于螺钉松动和拔出的修复固定。     

聚甲基丙烯酸甲酯强化对骨质疏松椎弓根螺钉固定的生物力学作用

目的探讨聚甲基丙烯酸甲酯 (polymethylmethacrylate,PMMA)骨水泥强化椎弓根螺钉的方法和评价 PMMA强化骨质疏松椎弓根螺钉后的生物力学性质。方法 6具新鲜老年女性胸腰段骨质疏松脊柱标本 (T10～ L5),使用双能 X线骨密度吸收仪测试每个椎体的骨密度,随机取 16个椎体 (32侧椎弓根 ),一侧椎弓根拧入 CCD螺钉,测量最大旋入力偶矩后拔出螺钉作为正常对照组,用 PMMA骨水泥强化椎弓根螺钉作为修复固定组,行螺钉拔出试验;另一侧经导孔直接强化椎弓根螺钉后拔出作为强化固定组,记录三组螺钉的最大轴向拔出力。结果椎体平均骨密度为 (0.445± 0.019)g/cm2;螺钉最大旋入力偶矩为（ 0.525± 0.104） Nm;正常对照组螺钉最大轴向拔出力为 (271.5± 57.3)N;修复固定组为 (765.9± 130.7)N;强化固定组为 (845.7± 105.0)N。 PMMA骨水泥强化或修复骨质疏松椎弓根螺钉后最大抗压力明显高于强化前,差异有非常显著性意义 (P< 0.01)。结论 PMMA骨水泥强化骨质疏松椎弓根螺钉能显著增加螺钉在椎体内的稳固性。     

磷酸钙骨水泥强化椎弓根螺钉固定的生物力学研究

目的:评价磷酸钙骨水泥(calciumphosphatecement,CPC)对椎弓根螺钉固定的强化作用。方法:在两组男性尸体椎骨的一侧直接置入椎弓根螺钉作为对照(对照侧),另一侧填入CPC后再置入螺钉作强化固定(强化侧),15min和12h后测定椎弓根螺钉的最大轴向拔出力(Fmax),然后用CPC重新固定12h后拔松的椎弓根螺钉并测得其Fmax。结果:强化侧Fmax和对照侧比较,15min后提高了55%,12h后提高了83%;重新固定后,两侧Fmax较固定前分别提高了54.2%和63.6%,差别有显著性意义(Wilcoxon's检验,P<0.01)。结论:磷酸钙骨水泥能强化椎弓根螺钉的固定。     

经椎弓根螺钉内固定翻修术的生物力学研究

目的探讨不同直径与长度螺钉翻修及骨水泥强化后椎弓根固定的强度,评价其生物力学效果.方法采用10具新鲜成人尸体T10～L5节段共80个椎体标本.首先置入5.5mm/45mm椎弓根螺钉作为对照组.再将脊椎标本随机平分为Ⅰ、Ⅱ两大组.Ⅰ组中40个椎体各随机选择一侧椎弓根应用6.25mm/45mm螺钉翻修(Ⅰ a组),另一侧椎弓根应用7.0mm/45mm螺钉翻修(Ⅰ b组);Ⅱ组中40个椎体各随机选择一侧椎弓根应用6.25mm/55mm螺钉翻修(Ⅱa组),另一侧椎弓根应用7.0mm/55mm螺钉翻修(Ⅱb组).再随机选择56个椎弓根分别行细小螺钉及粗大螺钉骨水泥强化固定翻修(Ⅲa组、Ⅲb组).在858Mini-MTS生物力学实验机上测试最大拔出力及最大扭力矩,并进行统计分析.结果①6.25mm/45mm螺钉翻修5.5mm/45mm螺钉置入后的椎弓根,其拔出力及扭力矩无明显增加(P＞0.05);应用7.0mm/45mm、6.25mm/55mm及7.0mm/55mm螺钉翻修,把持力及扭力矩均明显增加(P＜0.05).②骨水泥强化固定后,螺钉把持力远大于单纯螺钉翻修组,且与螺钉粗细无关.③在对照组及螺钉翻修组,螺钉把持力与扭力矩间有明显相关性,相关系数r=.86.结论①椎弓根螺钉翻修时,单纯螺钉直径增加1.5mm或直径增加0.75mm、长度增加l0mm以及骨水泥强化均可达到翻修固定的生物力学要求,以骨水泥强化固定更为明显.②增加螺钉直径与长度的翻修中,把持力与扭力矩是一致的;而应用骨水泥强化固定时,螺钉把持力主要取决于骨水泥本身及添加物-骨界面结合强度.     

直入式注入PMMA骨水泥强化椎弓根钉内固定生物力学研究

【摘要】 目的 分析直入式骨水泥注入椎体强化方法在体外提高螺钉稳定性的效果。方法采用新鲜尸体脊柱标本共24个椎体,一侧椎弓根采用直入式注入PMMA骨水泥强化椎弓根钉固定作(试验组),另一侧椎弓根采用常规椎弓根螺钉固定(对照组),两侧进行最大轴向拔出力试验、最大旋出力矩试验、周期抗屈试验生物力学测试,比较两组测试结果。结果〓骨水泥强化组中螺钉的稳定性均显著强于单纯常规椎弓根螺钉组(P < 0.05)。结论〓应用PMMA行椎体强化椎弓根钉固定有利于增强对椎弓根钉的把持力,可有效防止椎弓根钉的松动及脱落,具有良好的临床效果。     

重度骨质疏松条件下椎弓根螺钉内固定的可靠性研究

目的评价重度骨质疏松条件下椎弓根螺钉的稳定性,为椎弓根内固定在合并有重度骨质疏松症的患者中的选用提供力学理论基础。方法采用新鲜尸体脊柱标本,检测骨密度后,根据诊断标准,选用正常骨质的2具尸体标本、重度骨质疏松的4具尸体标本,分离T12~L5节段成单个椎体以备后用;然后在骨质正常椎体置入椎弓根螺钉12枚作对照组;在重度骨质疏松水平,分单纯置入椎弓根螺钉(pedicle screw,PS)、经磷酸钙骨水泥(calcium phosphate cement,CPC)强化钉道后置入椎弓根螺钉、经聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)强化钉道后置入椎弓根螺钉三种方法置钉,依次为PS组、CPC/PS组和PMMA/PS组,进行螺钉轴向拔出实验,测最大拔出力、刚度和能量吸收值,对所测指标进行组间对比分析。结果重度疏松条件下,PS组、CPC/PS组和PMMA/PS各组最大拔出力、刚度、能量吸收值均显著低于对照组(P0.005);但是,PMMA/PS组三项指标均显著高于PS组、CPC/PS组(P0.001);PS组、CPC/PS组之间比较仅最大拔出力存在显著性差异(P0.05),刚度与能量吸收值差异无统计学意义(P0.05)。结论重度骨质疏松条件下,椎弓根螺钉固定强度明显下降,不宜单纯应用普通椎弓根螺钉行脊柱内固定治疗,采用普通骨水泥强化钉道后置钉可以提高椎弓根螺钉稳定性。     

CPC提高椎体钉固定强度的体外实验研究

目的探讨磷酸钙骨水泥(calcium phosphate cement,CPC)强化骨质疏松椎体钉后穿透单侧椎体皮质固定的可行性。方法选用新鲜成人尸体胸腰段骨质疏松标本24个,实验组为骨水泥(PMMA)和磷酸钙骨水泥灌注后椎体钉穿透单侧椎体皮质固定;对照组为无骨水泥强化,螺钉穿透双侧椎体皮质固定。应用螺钉拔出实验,记录螺钉最大拔出力并观察椎体破坏形态。结果三组拉出力值PMMA组(811.19±188.58N)、CPC组(541.89±101.44N)、对照组(374.21±77.66N)差异有显著性,P<0.01。分别增加122%±56%和50%±37%。对照组(8例)螺钉拔出破坏时均为螺钉抽出,在8例PMMA强化椎体中所有椎体均有不同程度骨折。而在8例CPC强化椎体中仅1例发生椎体骨折。结论应用CPC强化骨质疏松椎体钉简化手术步骤、增加手术安全性是可行的。     

geneX骨水泥强化骨质疏松椎体椎弓根钉的生物力学研究

目的评估骨质疏松情况下geneX骨水泥强化椎弓根钉的固定强度。方法应用微量注射泵对30个新鲜小牛腰椎标本注射稀盐酸建立骨质疏松椎体模型。60个椎弓根分为四组:geneX骨水泥组,硫酸钙骨水泥(CSC)组,聚甲基丙烯酸甲酯骨水泥(PMMA)组,对照组。随机选择一侧注射2.5 ml骨水泥,然后置入螺钉;另一侧行正常螺钉固定对照,应用材料试验机进行轴向拔出力测试,记录各组的轴向最大拔出力和能量吸收值并进行比较。结果 geneX组与CSC组两组拔出力及能量吸收值比较,差异无统计学意义(P>0.05),两组均显著低于PMMA组(P<0.05),两组均显著高于对照组(P<0.05)。结论 geneX骨水泥强化椎弓根钉可显著提高椎弓根固定强度,geneX骨水泥可用作椎弓根强化螺钉的填充材料。     

强化膨胀式椎弓根螺钉翻修作用的生物力学评价

目的测试骨水泥强化膨胀式椎弓根螺钉(augmentation expansive pedicle screwfixa-tion with polymethyl methacrylate,AEPS),未强化的膨胀式椎弓根螺钉(expansive pedicle screw,EPS),CDH椎弓根螺钉翻修后的最大轴向拔出力,评价AEPS螺钉的翻修效应。方法24个新鲜小牛腰椎随机分成三组,AEPS组、EPS组、CDH组,每组8个椎体,三组椎体的椎弓根处均预先植入直径6.5mm CDH螺钉,拔出螺钉造成螺钉松动脱出的脊柱模型,然后分别植入AEPS、EPS、CDH螺钉,再次拔出螺钉,记录翻修后最大轴向拔出力。结果AEPS、EPS、CDH螺钉翻修后的最大拔出力分别为(2723.3±565.4)、(2216.3±475.6)和(1321.4±346.7)N,AEPS和EPS螺钉最大拔出力均显著高于CDH螺钉(P<0.05),AEPS轴向拔出力高于EPS螺钉,但差异无统计学意义(P>0.05)。结论AEPS与EPS螺钉具有相当的翻修作用。     

磷酸钙骨水泥加强骨质疏松性肱骨近端骨折内固定的生物力学研究

目的 通过比较注射型磷酸钙骨水泥(CPC)和聚甲基丙烯酸甲酯(PMMA)骨水泥在加强骨质疏松性肱骨近端骨折内固定中的生物力学表现,探讨注射型CPC替代PMMA骨水泥作为肱骨近端骨缺损填充材料的可行性. 方法选择42个甲醛浸泡的老年女性尸体肱骨标本,制作成肱骨近端三部分骨折合并骨缺损模型.模型随机分三组:CPC填充组、PMMA骨水泥填充组和空白对照组,分别对三组标本进行压缩、拉伸及松质骨螺钉轴向拔出试验,测量极限压缩载荷、极限拉伸载荷及松质骨螺钉初始松动加载力等相关数据. 结果 CPC组和PMMA组的最大压缩载荷、拉伸载荷和螺钉松动强度均显著高于空白对照组,差异有统计学意义(P<0.05);而CPC组和PMMA组之间差异无统计学意义(P>0.05). 结论注射型CPC能够获得与PMMA骨水泥近似的力学强度,可以认为是能够较好替代PMMA骨水泥的生物材料.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.     

Anesthésie générale chez l’enfant : quid des pratiques en 2010 ?

Introduction

The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France.

Material and methods

One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated.

Results

There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N₂O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7–8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL).

Discussion

This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.     

Intérêt d’une rééducation précoce pour les patients neurologiques

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.     

Risiko Schlaganfall — Öffentlichkeitsarbeit und Aufklärung dringend erforderlich

Zusammenfassung Das wesentliche — und zugleich noch wenig ausgeschöpfte — Potenzial der Schlaganfallmedizin liegt in der langfristigen Prophylaxe. Durch Beeinflussung von Lifestylefaktoren wie Ernährungsgewohnheiten, Zigarettenkonsum und körperlichem Training durch entsprechende Aufklärung ließe sich ein erheblicher Teil an zerebralen Ereignissen vermeiden. Ein weiterer in Deutschland noch zu wenig beachteter Faktor ist die konsequente Blutdruckeinstellung. Breitgestreute Aufklärung könnte außerdem potenziellen Patienten helfen, bereits auftretende Warnsymptome wie die transiente ischämische Attacke richtig einzuschätzen, um eine rechtzeitige Behandlung zu ermöglichen.