Ⅰ.腹主动脉瘤动物模型的建立及改进

目的:确定建立腹主动脉瘤动物模型时弹力蛋白酶最短灌注时间和腹主动脉最佳游离长度.方法:80例大鼠随机均分为1组生理盐水对照组和7组弹力蛋白酶实验组.灌注时间分别为10、20、30、60和120min,游离长度分别为0.5和1.0cm.术后14d观察各组大鼠腹主动脉直径扩张率及动脉壁的组织学变化.结果:≥30min组腹主动脉直径平均扩张率均>100%,与10、20min及对照组有显著差异(P<0.05);而30min组与60、120min组无明显差异(P>0.05).≥30min各组的大鼠腹主动脉中弹力蛋白均严重受损,且与游离腹主动脉长度无关.结论:在弹力蛋白酶诱导的大鼠腹主动脉瘤模型中,弹力蛋白酶灌注时间可由120min降至30min,游离腹主动脉长度可从1.0cm缩至0.5cm,不影响腹主动脉瘤的形成.     

腹主动脉瘤发病机理的实验研究I．腹主动脉瘤动物模型的建立及改进

目的：确定建立腹主动脉瘤动物模型时弹力蛋白酶最短灌注时间和腹主动脉最佳游离长度。方法：80例大鼠随机均分为1组生理盐水对照组和7组弹力蛋白酶实验组。灌注时间分别为10、20、30、60和120min，游离长度分别为0．5和1．0cm。术后14d观察各组大鼠腹主动脉直径扩张率及动脉壁的组织学变化。结果：≥30min组腹主动脉直径平均扩张率均＞100％，与10、20min及对照组有显差异(P＜0．05)；而30m5n组与60、120m5n组无明显差异(P＞0．05)。≥30min各组的大鼠腹主动脉中弹力蛋白均严重受损，目与游离腹主动脉长度无关。结论：在弹力蛋白酶诱导的大鼠腹主动脉瘤模型中，弹力蛋白酶灌注时间可由120m5n降至30min，游离腹主动脉长度可从1．0cm缩至0．5cm，不影响腹主动脉瘤的形成。     

腹主动脉瘤发病机理的实验研究 Ⅱ.基质金属蛋白酶-9在大鼠腹主动脉瘤模型中的动态表达

目的 :检测MMP 9在大鼠正常动脉及动脉瘤模型组织中的动态表达 ,以探讨其在腹主动脉瘤发病机制中的作用。方法 :Wistar大鼠 5 4只 ,随机均分为 1组正常对照组、4组灌注对照组和 4组实验组。实验组腹主动脉灌注弹力蛋白酶 (2 5U ml) 2ml,灌注对照组灌注生理盐水 2ml,分别于术前、术后即刻、2d、7d、14d测量腹主动脉直径 ,并采用免疫组织化学和分子原位杂交技术动态检测腹主动脉组织中MMP 9的表达。结果 :正常及灌注对照组腹主动脉组织中均未发现MMP 9,而实验组弹力蛋白酶灌注后2～ 14dMMP 9均有不同程度升高 ,第 7d达到高峰 ,第 14d有所回落。结论 :MMP 9分泌的增加可能与炎症反应有关 ,且为腹主动脉瘤形成中不可或缺的一步。     

大鼠腹主动脉瘤发生与骨桥蛋白及核因子-κB表达的关系

目的 构建大鼠腹主动脉瘤模型并观察大鼠腹主动脉瘤中骨桥蛋白(OPN)及核因子-κB(NF-κB)的表达,探讨大鼠腹主动脉瘤发生的分子机制.方法 将30只大鼠分为3组,每组10只,用酶灌注法灌注30 min构建大鼠腹主动脉瘤模型;测量动脉直径;苏木素-伊红(HE)染色及特殊染色检测主动脉的结构改变及炎性细胞浸润;免疫组织化学技术、Western blot法检测动脉组织中OPN、NF-κB及基质金属蛋白酶-2(MMP-2)的表达.结果 成功构建大鼠腹主动脉瘤模型;腹主动脉瘤组术后直径扩张率明显高于对照组(P＜0.01),并且中层弹力蛋白明显减少,炎性细胞浸润程度显著增高;免疫组织化学结果显示OPN、NF-κB及MMP-2在腹主动脉瘤组中的表达均明显增加(P＜0.05).Western blot结果同样显示OPN、NF-κB及MMP-2在腹主动脉瘤组中的表达均明显增加(P＜0.01),OPN、NF-κB及MMP-2呈正相关.结论 在大鼠腹主动脉瘤模型中,OPN可能通过NF-κB途径上调MMP-2的表达,进而加速细胞外基质的降解,最终导致主动脉瘤的发生发展.     

基质金属蛋白酶-2在实验性大鼠腹主动脉瘤模型中的动态表达

目的:检测基质金属蛋白酶-2(MMP-2)在大鼠正常动脉及动脉瘤模型组织中的动态表达,以探讨其在腹主动脉瘤发病机制中的作用。方法:Wistar大鼠54只,随机分为9组,每组6只。1组为正常对照组;4组生理盐水对照组;4组实验组。实验组经腹主动脉灌注弹力蛋白酶(25U/ml)2ml,持续2h;对照组经腹主动脉灌注生理盐水2ml;分别于术前、术后即刻、第2天、第7天、第14天测量腹主动脉直径,并采用免疫组织化学和分子原位杂交技术动态检测腹主动脉组织中MMP-2的表达。结果:正常腹主动脉组织中仅含微量MMP-2,弹力蛋白酶灌注后第2～14天MMP-2均有不同程度升高,且与纤维反应相关。结论:MMP-2的分泌与纤维反应有关,并对腹主动脉瘤的形成起重要作用。     

iNOS抑制剂对大鼠腹主动脉瘤平滑肌凋亡的抑制作用

目的:建立腹主动脉瘤动物模型,阐述iNOS抑制剂对大鼠腹主动脉瘤平滑肌凋亡的作用,为临床治疗小腹主动脉瘤寻找新的理论依据。方法:通过弹力蛋白酶(25 U/mL)灌注大鼠腹主动脉建立SD大鼠腹主动脉瘤动物模型,阴性对照组予以生理盐水灌注腹主动脉(27只),术后阴性对照组(27只)和阳性对照(27)组均予以腹腔内注射生理盐水,实验组术后腹腔内注射iNOS抑制剂药物盐酸氨基胍(200 mg/kg),术后第2、7、14天分别取大鼠动脉血检测血清中NO的含量,腹主动脉瘤标本行iNOS免疫组化、TUNEL染色检测动脉瘤平滑肌细胞的凋亡情况。结果:应用弹力蛋白酶灌注大鼠腹主动脉建立腹主动脉瘤灌注模型成功率高,阳性对照组成瘤率分别为10%、60%、80%,治疗组分别为:0、10%、20%,阴性对照组无动脉瘤形成,治疗组和阴性对照组低于阳性对照组(P0.05),阳性对照组中NO含量从第2天开始逐渐升高,7 d达到高峰并维持在较高水平,治疗组血清中的NO含量比其他两组低(P0.05);iNOS在阳性对照组中强表达,在其它两组轻度表达;TUNEL结果显示,阳性对照组中可见大量凋亡细胞,自7 d后呈明显增大趋势,至观察结束(2周)逐渐增高,阳性对照组比阴性治疗组和阴性对照组要高(P0.05)。结论:iNOS抑制显著降低血清中NO含量,减轻中膜平滑肌细胞的凋亡,从而抑制了腹主动脉瘤的形成。为临床应用iNOS抑制剂治疗和控制AAA的发展提供了理论依据。     

影像学技术在腹主动脉瘤诊治的应用进展

<正>腹主动脉的直径扩张至正常动脉的1.5倍时可定义为腹主动脉瘤[1]。临床工作中若肾下腹主动脉的直径3 cm时可诊断为腹主动脉瘤[2];由于女性的主动脉直径一般较男性小,因此对女性而言指标可略小些[3]。依据不同的标准,腹主动脉瘤可有不同的分类。依据腹主动脉的直径,可分为小腹主动脉瘤(直径5.5 cm)和大腹主动脉瘤(直径≥5.5 cm),而后者常需要手术干预[4];依据其是否有相关的症状表现如动脉瘤相关的腹痛及背部疼痛,可分为症状型和非症状型腹主动脉瘤,其中症状型腹主动脉瘤较为少见,占5%～22%[5],通常是破裂     

改良腹主动脉瘤大鼠模型的制作方法

目的 介绍一种改良腹主动脉腔内灌注猪胰蛋白酶（PPE）制作腹主动脉瘤（AAA）大鼠模型的方法。方法 将20只SD大鼠随机为两组,分别是改良腹主动脉腔内灌注PPE组和传统腹主动脉腔内灌注PPE组,每组10只。通过超声测量腹主动脉直径,比较两组大鼠的手术相关指标,大鼠存活率,术后7、14d的AAA成瘤率和腹主动脉扩张率。通过弹性纤维染色和免疫组织化学染色（IHC）染色法观察腹主动脉弹性纤维情况和炎性细胞浸润情况。结果 改良腹主动脉腔内灌注PPE组的手术时间明显短于传统腹主动脉腔内灌注PPE组,每只大鼠的PPE用量明显少于传统腹主动脉腔内灌注PPE组,差异均有统计学意义（P﹤0.01）。术后14 d,两组的大鼠存活率比较,差异无统计学意义（P﹥0.05）。术后7 d,改良腹主动脉腔内灌注PPE组的腹主动脉扩张率、AAA成瘤率均高于传统腹主动脉腔内灌注PPE组,差异均有统计学意义（P﹤0.05）;术后14 d,改良腹主动脉腔内灌注PPE组的腹主动脉扩张率明显高于传统腹主动脉腔内灌注PPE组,差异有统计学意义（P﹤0.01）,但两组的AAA成瘤率比较,差异无统计学意义（P﹥0.05）。改良腹主动...     

腺病毒介导TIMP-2基因转染抑制大鼠腹主动脉细胞外基质降解的实验研究

目的利用大鼠腹主动脉瘤模型，在腹主动脉局部灌注携载基质金属蛋白酶组织抑制剂-2（TIMP-2）基因的腺病毒溶液，应用形态学及组织病理学手段评价其对血管壁基质降解的影响。方法建立大鼠腹主动脉瘤弹力蛋白酶灌注模型，将通过基因重组技术构建成功的腺病毒质粒AdTIMP-2灌注至主动脉局部。2周后处死大鼠，取动脉标本行多聚甲醛灌注固定，常规石蜡包埋，对标本进行大体观察、组织病理学常规及特殊染色观察。结果灌注后14d AdCMV组和PBS组腹主动脉直径分别为（3．52±0．11）mm和（3．43±0．09）mm，明显大于AdTIMP-2组的（2．33±0．06）mm，P〈0．05；腹主动脉直径增加百分比AdTIMP-2组为（48±4）％，明显低于AdCMV组的（120±6）％和PBS组的（118±5）％，P〈0．05；AdTIMP-2组的8只大鼠均未见腹主动脉瘤形成，而AdCMV组和PBS组8只大鼠均见主动脉形成瘤样扩张；AdTIMP-2组中层弹力纤维及胶原纤维保存较完整，破坏较轻，在动脉外膜可见炎症细胞浸润。结论腺病毒介导的TIMP-2基因转染可以恢复由蛋白溶解酶引起的细胞外基质降解，阻止动脉瘤的形成，为治疗腹主动脉瘤提供了新的策略。     

腹主动脉瘤药物干预的研究进展

正腹主动脉瘤(abdominal aortic aneurysm,AAA)是指腹主动脉局限性、永久性的扩张,其直径超过正常直径的1.5倍。目前针对直径≥5.5 cm或瘤体扩张率≥1.0 cm/年的AAA主要采取外科手术治疗;而对于直径5.5 cm且增长速率不快的小AAA,除了密切监测外尚无有效的治疗方式。因而,针对AAA的发病及进展机制展开研究,探索药物干预小AAA的可行性,降低瘤体扩张速率,减小破     

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.     

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.     

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.     

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.