大豆异黄酮减缓去卵巢大鼠骨量丢失的实验研究

目的研究大豆异黄酮对雌激素缺失状态下大鼠骨量丢失及骨转换的影响。方法 12月龄雌性SD大鼠40只随机分为4组,除假手术组大鼠行卵巢切除假手术外,其余均切除卵巢建立雌激素缺失模型。分组设计为:实验组[大豆异黄酮类40 mg／(kg．d)]及元素钙250 mg／(kg·d), 假手术组[蒸馏水)、实验对照组[元素钙250 mg／(kg·d)]及雌激素组[雌二醇30μg／100(g· 3d)及元素钙250mg／(kg·d)],除雌二醇皮下注射给予外,其余灌胃给予。28 d实验期满后处死大鼠,取股骨测定骨密度、股骨钙含量、股骨形态计量学相关指标,并测定血清碱性磷酸酶 (AKP)活性及血清骨钙素(OC)水平。结果实验组股骨骨密度、股骨钙含量稍高于假手术组和实验对照组,但未呈显著性差异(P>0．05);实验组骨小梁面积与假手术组无显著差异(P> 0．05);各组动物AKP活性无显著差异(P>0．05):实验组和雌激素组OC水平显著高于假手术组 (P<0．01)。结论大豆异黄酮具有弱雌激素样作用,可能通过促进成骨形成而减少雌激素缺失状态下的骨丢失,维持骨健康,预防绝经后骨质疏松。     

降钙素对卵巢切除大鼠骨转换的影响

尽管降钙素已在临床用于防治骨质疏松症，但其对骨转换的影响并未阐明，为此本实验以骨组织形态计量学为手段，观察了降钙素对卵巢切除大鼠小梁骨体积和骨转换的影响。实验分三组：卵巢切除后用降钙素组、卵巢切除后用生理盐水组和假手术组。取胫骨干骺端作不脱钙骨切片，行骨组织计量学测定。结果表明，与假手术组相比，卵巢切除后用生理盐水组其小梁骨体积明显下降，破骨细胞表面积、成骨细胞表面积、类骨质表面积、矿化表面积、矿化沉积率和骨形成率均明显升高。相反，卵巢切除后用降钙素组其小梁骨体积恢复正常，骨转换指标也接近假手术组。说明降钙素不仅抑制卵巢切除大鼠骨吸收，而且抑制其骨形成，使骨转换降低，从而预防卵巢切除大鼠骨丢失。     

尼尔雌醇抑制切除卵巢大鼠骨转换

<正> 对4月龄雌性 SD 大鼠切除双侧卵巢造成绝经后骨质疏松动物模型,采用骨计量学等方法观察国产长效口服雌三醇衍生物——尼尔雌醇(Nilestriol)对骨代谢的影响。一、材料和方法4月龄雌性 SD 大鼠40只,平均体重250g,随机分为3组:(1)卵巢切除组(OVX 组)13只,开腹后切除双侧卵巢;(2)假手术组(Sham 组)12只,开腹后关腹;(3)尼尔雌醇组(CEE_3组)15只,切除双侧卵巢并于术后第一天起给予 CEE_3(上海第十二制药厂生产)0.15mg/100g     

维生素K3对去卵巢大鼠骨质疏松预防作用的实验研究

绝经后骨质疏松的防治以药物为主要手段．近年来一些实验初步表明，维生素K可通过促进骨矿化和抑制骨吸收等作用减少绝经后骨量丢失．且无明显副作用。本实验进一步探讨维生素K3对击卵巢大鼠骨质疏松的预防作用，并将其效果与尼尔雌醇(CEE8)进行比较。结果显示，维生素K3组椎体和股骨端骨密度显著高于()VX组(P＜0．001)．光镜下骨小粱较0VX组增宽、致密，透射电镜下维生素K2组骨细胞呈功能活跃状态．胶原纤维排列较()VX组致密，分布亦均匀。CEE3组各项结果优于维生素K3组，VTK3 CEE3组优于单一用药组。以上结果表明．维生素K。可在一定程度上预防去卵巢大鼠骨质疏松，效果逊于尼尔雌醇，二者联合用药效果优于单用药。     

骨膦抗去势雌鼠骨质疏松研究

切除８月龄雌性大鼠双侧卵巢后，皮下注射骨膦１２周，与单纯卵巢切除组（ＯＶＸ组）、假手术组（ｓｈａｍ组）及口服尼尔雌醇组（Ｅ３组）比较，用骨生物力学、骨密度测量、骨形态计量学等方法对骨膦的药效进行综合评价。结果表明，与ｓｈａｍ组比较，ＯＶＸ组骨灰重、骨干重、骨钙含量及骨密度、抗弯力、骨小梁体积密度、宽度均明显降低，而成骨细胞指数和破骨细胞指数、尿羟脯氨酸则明显增高。骨膦和Ｅ３对上述指标有显著改善作用。     

补肾方药对骨质疏松防治的实验研究

目的 探讨补肾方药对骨质疏松的防治作用及其机理。方法 本研究选用3种模型，即地塞米松和卵巢切除所诱发的骨质疏松模型，自然衰老的大鼠骨质疏松模型，并给予中药治疗。测定大鼠骨密度、骨代谢相关生化指标及骨形态计量学指标及基因表达分析。结果 补肾方药可显提高地塞米松所致骨质疏松大鼠的骨密度、血清骨钙素水平，降低尿钙排泄，同时，促进骨组织中I型胶原和LMP－1 mRNA表达，补肾方药还提高小肠黏膜CaBp-D9K基因表达，从而使小肠黏膜钙结合蛋白（CaBp)的合成增加，促进小肠对钙的吸收；补肾方药可提高卵巢切除所诱发的骨质疏松大鼠的骨密度，促进骨组织中I型胶原mRNA及小肠黏膜中VDR mRNA的表达，提高卵巢切除大鼠血清雌激素的水平，同时，提高骨组织中雌激素受体α和β（ERα，ERβ）的表达，增加雌激素对骨代谢的调节作用；补肾方药改善老年骨质疏松大鼠骨代谢，降低尿钙排泄，通过提高骨转换，主要是促进骨形成防止骨量丢失。结论 补肾方药通过多环节、多途径，调节骨质疏松大鼠的骨形成与骨吸收，使其达到骨形成与骨吸收相偶联，而防治骨质疏松。     

槲皮素对去卵巢大鼠骨量丢失的保护作用

目的探讨槲皮素在去卵巢大鼠骨质疏松防治中的作用及其可能的作用机理。方法60只3月龄健康雌性Wistar大鼠被分为6组:假手术组(S组);模型对照组(OVX组);低剂量槲皮素(50mgkg·d)、中剂量槲皮素(100mgkg·d)和高剂量槲皮素(200mgkg·d)组(分别称L、M、H组);尼尔雌醇(1.5mgkg·w)组(E组)。术后第2d开始每天灌胃给药,S和OVX组则灌胃生理盐水。3个月后处死大鼠,留取血清测定碱性磷酸酶(ALP)、酸性磷酸酶(ACP)活性和雌二醇(E2)水平;分离子宫测定其重量;分离右股骨测定其生物力学性能;分离左股骨测定其骨密度。结果槲皮素对大鼠体重、子宫重量、ALP活性和E2均无明显影响,能抑制ACP活性,提高大鼠股骨骨密度,对其生物力学性能无明显影响,其作用与尼尔雌醇相似。结论槲皮素能预防去卵巢大鼠骨质疏松的发生,在体内无明显促进子宫增长的活性,其可能通过抑制骨吸收起作用,而对成骨代谢无明显影响,有望用于临床防治绝经后骨质疏松症。     

复方仙贞汤对去卵巢大鼠模型骨密度和骨形态的影响

目的 研究复方仙贞汤对去卵巢大鼠的骨密度和骨形态的影响。方法 3月龄的雌性SD大鼠，普通饲料喂养1周后，随机分为假手术组（Sham）、模型组（OVX）、尼尔雌醇阳性药物对照组、复方仙贞汤小剂量组、复方仙贞汤中剂量组、复方仙贞汤大剂量组。除假手术组，其余都经背部切开后切除双侧卵巢，制造去卵巢模型（OVX），假手术组则背部切开后切除部分脂肪组织再分层缝合。造模完成后，假手术组及模型组用生理盐水灌胃，阳性药物组用尼尔雌醇混悬液灌胃，复方仙贞汤小、中、大剂量组分别给以6．5g／kg、13g／kg、26g／kg大鼠体重（按生药计算）的复方仙贞汤药液，每日固定上午九点灌胃1次。全部动物共持续喂养3个月后处死，测定股骨的骨密度和胫骨骨体积、胫骨类骨表面，类骨质宽、骨吸收表面。结果 复方仙贞汤组和尼尔雌醇组均较模型组的骨密度显著性增高（P〈0．01），而且复方仙贞汤中剂量组与尼尔雌醇阳性对照组接近。与模型组比较，中药组和尼尔雌醇组的骨体积显著上升（P〈0．01），而类骨表面、类骨质宽和骨吸收表面却显著下降（分别P〈0．01）。结论 复方仙贞汤能提高去卵巢大鼠的骨密度和骨体积，减少类骨质宽、类骨质表面、骨吸收表面，提示复方仙贞汤能起到和尼尔雌醇相似的作用，即降低绝经后骨质疏松的高转换率，从而减慢骨质的丢失。     

去卵巢大鼠骨组成成分的改变

目的观察切除双侧卵巢后大鼠骨组成成分的改变。方法将27只健康4月龄雌性SD大鼠随机分成3组：正常对照组，假去卵巢组和去卵巢组；于切除卵巢后80d，同时将各组动物处死，测其骨矿盐含量，用ICP测其骨元素含量。结果切除双侧卵巢的大鼠骨无机质含量、无机质/cm^3、无机质占骨干重％等均显著减少（P〈0．01），而有机质占骨干重％、有机质，无机质的比值显著升高（P〈0．01）；骨元素Ca、S、Mg、Mn显著减少（P〈0．01）；Zn减少（P〈0．05），C0有减少趋势（P〉0．05）。骨磷显著增加（P〈0．05）。结论切除卵巢后引起骨组成成分特征性的改变。     

大黄酸-雌酮对去卵巢大鼠骨质量的保护作用

目的 观察新型雌激素衍生物-大黄酸-雌酮对去卵巢大鼠骨质量的保护作用及其对子宫的雌激素样作用,以评价大黄酸-哌嗪雌酚酮的抗骨质疏松活性.方法 6月龄Wistar雌性未孕大鼠48只,分为假手术组、去卵巢模型组、雌酚酮组、大黄酸-雌酮高、中、低3个剂量组,除假手术组外其余各组均行双侧卵巢切除,给药24 w后,测定大鼠全身及脊柱骨密度、骨矿盐含量、股骨生物力学及骨羟脯氨酸、骨钙含量和观察大鼠股骨远端和子宫的形态学变化.结果 大黄酸-雌酮3个剂量组大鼠全身及脊柱骨密度、骨矿物含量、最大压缩载荷、最大压缩应力、骨羟脯氨酸含量及股骨远端骺板下小梁骨体积均明显高于模型组(P<0.05或P<0.01);除骨体积少于雌酚酮组外,其余指标与雌酚酮组无明显差异;3组子宫重量、直径和内膜厚度明显小于雌酚酮组和假手术组,与模型组无明显差异.结论 大黄酸-雌酮在本实验剂量范围内与雌酚酮一样能显著改善去卵巢大鼠骨质量,而对子宫的刺激作用远远低于雌酚酮.     

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.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

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.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

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.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

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.