难复型寰枢椎脱位的手术治疗

目的探讨后路寰枢椎弓根钉棒系统在难复型寰枢椎脱位的临床应用。方法 18例难复型寰枢椎脱位患者,采用后路寰枢椎弓根钉棒系统,进行寰枢椎部分撑开后提拉复位,固定及植骨融合,其中单纯固定融合14例,加行颈椎管成压术者4例。结果本组平均手术时间2.8(1.8～3.6)h,平均出血量380(150～680)ml,均无术中、术后并发症,无脊髓损伤症状加重。18例患者获得6月～3年随访,获得良好寰枢椎骨性融合,钉棒系统内固定牢固,无松动;寰枢椎保持复位位置;术后脊髓功能(JOA17分法)改善率82.3%,其中优12例,良4例,有效2例。结论经后路寰枢椎弓根钉棒系统,对寰枢椎进行部分撑开后提拉复位,一次完成难复型寰枢椎脱位的复位、固定和融合,是治疗难复型寰枢椎脱位较理想的手术方法。     

寰枢椎弓根钉联合枢椎椎板钉固定融合治疗寰枢关节不稳

[目的]探讨经寰枢椎弓根钉联合枢椎椎板钉固定融合治疗寰枢关节不稳或脱位的疗效.[方法]2003年2月～2009年2月收治的寰枢关节不稳或脱位病例7例,男4例,女3例;年龄10～61岁,平均41岁.术前颈椎矢状位CT提示枢椎椎动脉孔高跨3例;C2、3分隔不全,枢椎椎弓根狭小4例.其中4例有脊髓病或脊髓损伤的症状、体征.分别行颈后路经双侧寰椎侧块、一侧枢椎椎弓根钉、一侧楸椎椎板钉寰枢固定4例;经一侧枢椎椎弓根钉、一侧枢椎椎板钉与枕骨行枕颈固定3例.取自体髂骨植骨融合.[结果]手术中无脊髓和椎动脉损伤的病例.本组7例得到随访,随访1～3年,平均13个月,均获得骨性融合,无钉板断裂病例.3例脊髓功能改善明显,1例略有改善.[结论]寰楸椎不稳或脱位,术前枢椎CT提示楸椎椎弓根发育异常,无法采取螺钉固定时,可通过枢椎椎板置钉,实施寰枢融合或枕颈融合术,此技术操作简便,风险小,疗效可靠.     

寰枢椎脱位后路螺钉固定方法的临床选择

目的 探讨寰枢椎脱位后路钉棒固定术中寰椎螺钉和枢椎螺钉固定方法 的临床选择.方法 对2002 年11 月至2011 年12 月广州军区广州总医院收治的228 例可复性和23 例难复性寰枢椎脱位患者,术前进行置钉可行性和复位可能性评估,针对性地选择寰椎和枢椎的后路螺钉固定方法,进行寰枢椎后路钉棒固定治疗.结果 251 例患者均行钉棒固定并获得满意复位.寰椎螺钉固定采用椎弓根螺钉403 枚、部分经椎弓根螺钉77 枚、侧块螺钉22 枚;枢椎螺钉固定采用椎弓根螺钉437 枚、椎板螺钉56 枚、侧块螺钉9 枚.术中未发生椎动脉、脊髓损伤.237 例患者获得随访,随访时间4～38 个月,平均随访时间13 个月.230 例患者获骨性融合;6例为纤维愈合,动力位片（均随访2 年以上）未见复发脱位;另1 例为假关节未融合并双侧枢椎椎弓根螺钉松动,行后路翻修手术治愈.结论 根据寰枢椎脱位的复位难易程度和个体解剖特点灵活选择寰椎和枢椎不同的后路螺钉固定方法,扩大了寰枢椎后路钉棒固定技术的适用范围,提高了手术安全性和成功率.     

寰枢椎椎弓根钉固定融合治疗寰枢椎失稳

目的探讨经后路寰枢椎椎弓根钉固定融合技术治疗寰枢椎失稳的手术方法、疗效。方法采用后路寰枢椎椎弓根螺钉系统,固定、融合治疗32例寰枢椎失稳患者,术中在C型臂X线机辅助下行C1、C2置钉,复位固定,取自体髂骨行椎板间植骨。术后颈托固定3个月。结果 32例128枚螺钉成功置入,复位满意,术中未发生椎动脉和脊髓损伤。患者全部获327个月定期随访,螺钉位置良好,钉棒无松动、断裂,术后36个月均获植骨融合。术前JOA评分（8.6±2.8）分;术后3个月JOA评分（14.9±1.8）分,恢复率76%92%,平均83%。结论经后路寰枢椎椎弓根钉固定融合技术具有直视下置钉、短节段固定、固定牢靠、植骨融合率高等特点,有利于稳定寰枢关节及脊髓功能的恢复,是一种较为理想的治疗寰枢椎失稳的内固定术式。     

寰枢椎椎弓根螺钉固定技术治疗陈旧性难复性寰枢椎前脱位

目的 探讨陈旧性难复性寰枢椎前脱位后路椎弓根植骨融合内固定的手术方法和疗效.方法 对2004年8月～2007年7月收治的16例因陈旧性齿状突骨折导致的难复性寰枢椎前脱位患者,采用寰枢椎经椎弓根螺钉固定术行后路植骨融合.观察术后寰枢椎复位及植骨融合效果.结果 所有患者均得到随访,随访时间11个月～3.8年,平均2.2年,寰枢椎脱位复位程度均达90%以上,所有患者椎间植骨均融合,无内固定断裂、移位.结论 后路寰枢椎经椎弓根螺钉固定术是治疗陈旧性难复性寰枢椎脱位的有效方法.     

寰枢椎椎弓根螺钉内固定术治疗儿童寰枢椎脱位的初步报告

目的:探讨寰枢椎椎弓根螺钉内固定手术治疗儿童寰枢椎脱位的可操作性和近期疗效。方法:2005年9月~2011年3月对16例儿童寰枢椎脱位患者采用寰枢椎椎弓根螺钉内固定术治疗,男9例,女7例;年龄5～13岁,平均9.1岁。均有枕颈部疼痛、颈部僵硬;3例有高位颈脊髓病表现,ASIA分级:D级2例,C级1例。术前均行颈椎正侧位及过伸过屈位X线片、CT和MRI检查,均诊断为寰枢椎脱位,其中寰椎横韧带断裂1例,寰枢椎骨折脱位1例,先天性齿状突畸形12例,寰枢椎固定旋转半脱位2例;颈脊髓受压5例。寰椎后弓(椎弓根)高度2.5~3.8mm,平均3.0mm;寰齿前间隙6~14mm,平均9mm。术前常规行牵引1~2周复位,完全复位7例,部分复位5例,不能复位4例。术中采用"寰椎椎弓根显露置钉法",在直视下行C1、C2置钉,复位固定,植骨融合。随访患者症状和神经功能改善情况,定期行颈椎X线片及CT复查,了解内固定及植骨融合情况。结果:16例均行双侧寰枢椎椎弓根螺钉内固定,手术过程顺利,64枚螺钉均成功置入,复位固定满意,无术中、术后神经和血管并发症。术中出血150~650ml,平均300ml;手术时间100~190min,平均130min。12例随访12~72个月,平均28.5个月,术后3~6个月寰枢椎均骨性融合;末次随访时,颈枕症状明显改善,3例术前有脊髓功能损害者均好转,2例术前ASIA分级D级者恢复到E级,1例术前ASIA分级C级者恢复到D级;未发现螺钉松动、断钉和寰枢椎再移位现象,未发现曲轴现象。结论:采用"寰椎椎弓根显露置钉法"行寰椎椎弓根螺钉内固定可操作性强,置钉安全性高;寰枢椎椎弓根螺钉内固定治疗儿童寰枢椎脱位的近期疗效满意。     

寰枢椎椎弓根钉内固定治疗寰枢椎不稳

目的探讨寰枢椎椎弓根钉内固定治疗寰枢椎不稳的方法与临床疗效。方法自2007年12月~2010年6月采用寰枢椎椎弓根钉内固定治疗C1、2不稳21例,其中AndersonⅡ型齿状突骨折14例(陈旧性骨折11例,新鲜骨折3例),Ⅲ型陈旧性齿状突骨折1例,先天性游离齿状突并寰枢椎不稳6例。结果 21例共置入螺钉82枚,其中有1例6岁儿童在寰椎后弓上2个挂钩。随访时间12～40个月,平均27个月,术后JOA评分14～17分,平均14.8分。无感染,未发生与螺钉相关的神经血管并发症,无内固定松动或断钉现象,21例植骨者术后随访均已达到骨性融合。结论寰枢椎椎弓根钉内固定技术是治疗寰枢椎不稳的有效方法;难复性脱位患者先行前路松解术再经后路手术可获得良好的复位与融合;小儿亦可行该术式。     

寰枢椎椎弓根钉棒固定融合治疗上颈椎不稳

目的探讨经寰椎和枢椎椎弓根钉棒固定融合治疗上颈椎不稳的临床疗效。方法对17例上颈椎损伤致上颈椎不稳患者进行后路经寰椎和枢椎椎弓根钉棒系统复位内固定,使寰枢椎复合体得到稳定,在寰枢椎后弓间植骨融合。结果无术中、术后并发症,有神经症状者得到改善。患者均获随访,时间6～25个月,所有患者后伸活动无障碍,左右旋转功能略受限。X线示螺钉位置良好。无钉棒断裂,螺钉松动,脱落等现象。均在3～4个月获得骨性融合。结论利用寰椎和枢椎椎弓根螺钉通过钉棒连接能显著增强寰枢椎间生物力学稳定性,也能达到一定程度的复位,适用于上颈椎损伤稳定性重建的治疗。     

多种寰枢椎后路钉棒固定技术的临床组合应用

目的评价3种寰椎后路螺钉固定方法和2种枢椎后路螺钉固定方法构成的钉棒组合治疗上颈椎不稳的可行性和临床效果。方法在气管插管全麻下对132例患者施行了寰枢椎后路钉棒固定技术,寰椎进行椎弓根螺钉、部分经椎弓根螺钉或侧块螺钉固定;枢椎进行椎弓根螺钉或交叉椎板螺钉固定。结果全组病例获钉棒固定,其中寰椎螺钉固定采用椎弓根螺钉224枚,部分经椎弓根螺钉36枚,侧块螺钉4枚;枢椎螺钉固定采用椎弓根螺钉240枚,椎板螺钉24枚。术中未发生椎动脉、脊髓损伤。120例患者术后获得随访3～22个月,平均8个月,临床症状得到不同程度的改善;X线片、CT复查螺钉位置良好,无松动、断钉,植骨3～6个月后均达到满意融合。结论寰椎和枢椎螺钉可进行多重组合,为上颈椎后路提供灵活多变的短节段固定,增加了钉棒固定技术的临床适用范围。     

寰枢椎椎弓根钉内固定与融合术治疗寰枢椎不稳

目的观察采用寰枢椎椎弓根钉内固定与融合术治疗寰枢椎不稳的效果。方法对21例寰枢椎不稳行寰枢椎椎弓根钉内固定与融合术。结果本组平均随访23个月,神经症状得到不同程度的改善;螺钉位置良好,6个月后患者均获植骨融合;术后8个月JOA评分(13.9±2.1)分。结论寰枢椎椎弓根钉内固定治疗寰枢椎不稳是寰枢椎后路固定较好的手术方式。     

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.