泡沫敷料预防高危风险患者压疮的Meta分析

目的评价使用泡沫敷料联合常规护理预防高危风险患者压疮的有效性。方法检索国内外数据库建库至2013年12月关于泡沫敷料用于预防高危风险患者压疮的随机对照试验(RCT)和类实验研究,文献的筛选与资料提取均由2名评价员独立进行,分歧通过协商或第三方解决。纳入文献的质量依据Jadad量表评价,提取资料用Revman5.0软件进行数据处理和分析。结果共纳入7篇文献,1 611例患者。所纳入研究的偏倚风险较低。Meta分析结果显示:对于存在压疮高危风险患者预防性使用泡沫敷料联合常规护理能有效降低压疮发生率(RR=0.22,95%CI=0.10~0.49,P0.05),但研究间存在一定程度的异质性,可能与预防部位、研究人群、泡沫敷料的来源不同有关。结论预防性使用泡沫敷料联合常规护理能更有效减少高危风险患者压疮的发生,但是由于纳入7篇研究存在一定程度的异质性,泡沫敷料的有效性、具体的使用方法和经济效益还需大样本多中心的RCT研究进一步验证。     

WB-MRI与骨扫描诊断恶性肿瘤骨转移：Meta分析

目的采用Meta分析评价WB-MRI与99 Tcm-亚甲基二磷酸盐骨扫描诊断恶性肿瘤骨转移的价值。方法检索PubMed、EMbase、Web of Science、Cochrane图书馆、中国期刊全文数据库、中国科技期刊数据库(维普)、万方数字化期刊全文数据库中关于比较WB-MRI和骨扫描诊断恶性肿瘤骨转移能力的中英文文献,采用诊断性试验质量评价方法评价纳入文献质量,以Meta-Disc 1.4软件进行Meta分析。结果共纳入9篇文献、447例患者。WB-MRI诊断恶性肿瘤骨转移的合并敏感度和特异度分别为0.91(95%CI 0.86~0.95)和0.95(95%CI 0.92~0.97),SROC曲线下面积为0.9797;骨扫描诊断恶性肿瘤骨转移的合并敏感度和特异度分别为0.80(95%CI 0.73~0.85)和0.89(95%CI 0.85~0.93),SROC曲线下面积为0.9183。结论与99 Tcm-亚甲基二磷酸盐骨扫描相比,WB-MRI诊断恶性肿瘤骨转移敏感度和特异度更高。     

循环肿瘤细胞对胰腺癌诊断价值的Meta分析

目的:通过Meta分析系统评价外周循环肿瘤细胞(CTCs)在胰腺癌患者中的诊断中的价值。方法:计算机检索多个国内外数据库,收集已发表关于CTCs在胰腺癌患者与非胰腺癌人群中检测的研究,检索起止时间均为建库至2016年8月31日。按照纳入标准筛选文献、提取资料和质量评价后,采用Metadisc1.4和Stata12.0软件对纳入研究进行Meta分析。结果:共纳入19篇文献,包含693例胰腺癌患者和406例非胰腺癌对照。采用随机效应模型进行统计量,得到CTCs检测对胰腺癌检出的合并敏感性为0.67(95%CI=0.63~0.60),合并特异性为0.94(95%CI=0.91~0.96),合并诊断优势比DOR为50.47(95%CI=20.13~126.55),合并诊断阳性似然比和阴性似然比分别为11.15(95%CI=5.42~22.95)、0.36(95%CI=0.28~0.45);总受试者工作特征曲线下面积为0.93,Q*值为0.03,诊断性试验Deek漏斗图显示存在发表偏倚。结论:目前CTCs尚不足以单独作为胰腺癌早期诊断指标,但可作为胰腺癌诊断方法的重要补充。     

循环miR-21对胰腺癌诊断价值的Meta分析

目的:通过Meta分析系统评价血液中miR-21对胰腺癌的诊断价值。方法:检索多个国内外数据库,收集2017年5月以前公开发表的关于miR-21用于胰腺癌诊断的研究数据,按照纳入标准筛选文献、提取资料和质量评价,然后采用Metadisc 1.4和Stata 14.0软件对纳入研究进行Meta分析。结果:共纳入8篇文献,累计261例胰腺癌患者和242例对照。Meta分析结果显示,循环miR-21诊断胰腺癌的合并敏感度为0.76(95%CI=0.71~0.81),合并特异度为0.76(95%CI=0.70~0.81),合并阳性似然比为3.17(95%CI=2.24~4.47),合并阴性似然比为0.26(95%CI=0.15~0.45),合并诊断比值比为13.17(95%CI=6.78~25.58)。综合受试者工作特征曲线下面积(AUC)为0.8518。亚组分析显示,血清和血浆亚组的AUC均为0.8513;健康人群对照亚组的诊断准确性优于健康人群+胰腺良性疾患对照亚组(AUC:0.876 vs.0.72,P0.05)。诊断性试验Deek漏斗图显示不存在发表偏倚,敏感性分析显示Meta分析结果并未过分依赖于某个研究,结论稳定。结论:循环miR-21用于胰腺癌诊断具有一定的价值。     

血清前列腺健康指数在前列腺癌诊断中预测活检结果价值的Meta分析

目的:系统评价血清前列腺健康指数(PHI)在前列腺癌(PCa)诊断中预测前列腺穿刺活检的临床价值。方法:检索PubMed(1966~2014年)、中国学术期刊全文数据库(CNKI,1982~2014年),维普期刊资源整合服务平台(1989~2014年)、Cochrane图书馆(1999~2014年)等数据库,检索年限均从建库至2014年2月,收集数据库中血清PHI在PCa诊断中预测活检结果的相关文献;制定相关文献的纳入、排除标准及检索策略,并对纳入文献进行数据提取和质量评价;采用MetaDise 1.4软件进行Meta分析。结果:共检索到相关文献64篇,排除52篇,符合纳入标准的12篇文献进行Meta分析,其中PCa病例组为1 430例,正常或前列腺增生对照组为2 159例。各研究之间存在异质性。按照随机效应模型计算,血清PHI检测在PCa诊断中预测前列腺穿刺活检结果的合并敏感性、特异性、阳性似然比、阴性似然比、诊断比值比、汇总受试者工作特征曲线下面积SROC、Q*指数分别为:55.1%(95%CI:0.525~0.577)、71.5%(95%CI:0.695~0.734)、2.379(95%CI:1.922~2.943)、0.515(95%CI:0.428~0.619)、5.268(95%CI:3.870~7.170)、0.757 8、0.699 9。结论:血清PHI检测在PCa诊断方面能够起到一定的辅助诊断作用,可以成为一种新型的可预测前列腺穿刺活检结果的检测方法。     

湿润烧伤膏治疗压疮有效性的系统评价

目的系统评价湿润烧伤膏治疗压疮的有效性。方法计算机检索PubMed、EMbase、Cochrane数据库、中国生物医学文献数据库(CBM)、维普资讯中文科技期刊数据库(VIP),均从建库检索至2010年5月,并筛选已获文献的参考文献,纳入比较湿润烧伤膏治疗与常规治疗压疮的随机对照试验(RCT)。由2名评价员独立进行质量评价和数据提取,采用RevMan 5.0.2软件进行Meta分析。结果共纳入11个RCT,合计703例患者。Meta分析结果显示,相对于常规治疗湿润烧伤膏可显著提高压疮的治愈率(OR=9.06,95%CI为6.21~13.21;P<0.01)和缩短治愈时间(MD=-8.11,95%CI为-12.39~-3.83;P<0.01)。结论现有证据表明湿润烧伤膏治疗压疮有效,但由于纳入研究的方法学质量较低,上述结论在临床使用时应谨慎考虑。     

三维子宫输卵管超声造影评估输卵管通畅性：Meta分析

目的采用Meta分析评价三维子宫输卵管超声造影(3D HyCoSy)评价输卵管通畅性的价值。方法检索1994—2013年国内外公开发表的有关3DHyCoSy的中外文文献,按照诊断性试验的纳入和排除标准筛选符合要求的文献,提取纳入研究的相关信息进行Meta分析。结果共纳入11项独立研究,其中3DHyCoSy诊断输卵管通畅性的敏感度范围为0.67~1.00,特异度为0.77~1.00,合并敏感度和特异度分别为0.95(95%CI 0.93~0.96)、0.92(95%CI0.89~0.94),合并阳性和阴性似然比分别为9.28(95%CI 5.91~14.58)、0.08(95%CI 0.05~0.13),SROC曲线下面积为0.98。结论 3DHyCoSy用于评价输卵管通畅性具有高度临床价值。     

MicroRNA-1对急性心肌梗死诊断价值的系统评价与Meta分析

目的系统评价microRNA-1(miRNA-1)在急性心肌梗死(acute myocardial infarction,AMI)患者诊断中的临床价值。方法计算机检索PubMed、EMBASE、Cochrane Library、中国知网数据库、万方数据库、维普数据库有关miRNA-1诊断AMI的文献。检索时间为建库至2018年8月。文献质量评价采用诊断性研究质量评价(QUADA-2)标准。采用MetaDisc1.4软件进行系统评价。评价指标为合并灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比以及受试者工作特征(summary receiver operator characteristic,SROC)曲线下面积。结果共纳入12篇文献,根据miRNA-1待检测人群的不同,分健康组(7篇)和非AMI疾病组(5篇)进行亚组分析,结果显示:AMI与健康人群比较,miRNA-1诊断AMI的合并灵敏度为0.78(95%CI 0.73~0.82),特异度为0.88(95%CI0.83~0.91),SROC曲线下面积为0.911 2;AMI与非AMI疾患者群比较,合并灵敏度为0.59(95%CI 0.54~0.64),特异度为0.74(95%CI 0.68~0.79),SROC曲线下面积为0.743 2。结论 MiRNA-1对诊断AMI具有一定的价值,可帮助鉴别AMI与伴随有其他系统疾病的患者,可与其它生物标志物联合诊断AMI。     

糖皮质激素治疗重症急性胰腺炎的疗效及其并发症临床荟萃分析

目的采用荟萃分析法评价糖皮质激素(GC)治疗重症急性胰腺炎(SAP)的疗效及安全性。方法检索Cochrane Library、Pub Med、Embase、中国生物医学数据库、CNKI、万方数据库、维普中文科技期刊数据库,查找2005年1月1日到2016年7月1日有关GC治疗SAP的临床随机对照试验,通过纳入和排除标准筛选文献,对纳入的研究进行分析并提取试验数据。采用R软件进行数据分析。结果研究共纳入18篇符合要求的文献,纳入的病例总数为1 601例,其中实验组773例,对照组828例。Meta分析的结果表明:实验组患者腹痛缓解时间及血淀粉酶恢复时间明显低于对照组,合并标准均数差(SMD)分别为-2.59(95%CI:-3.28~1.90)和-1.45(95%CI:-1.80~-1.10);实验组并发症的发生率、中转手术治疗率及病死率均显著低于对照组,OR值分别为0.15(95%CI:0.09~0.26)、0.30(95%CI:0.13~0.74)和0.15(95%CI:0.08~0.28)。结论 SAP的患者早期、短程使用GC是获益的,但仍需大样本、多中心、前瞻性随机对照研究来进一步证实。     

3种压疮评估工具的临床效度测定

目的 测定Braden、Norton、Waterlow 3种压疮评估工具在新疆患者中使用的临床效度.方法 运用3种评估工具对随机抽取的500例住院患者进行压疮评估和皮肤完整性检查.计算各评估工具的灵敏度(Se)、特异度(Sp).结果 压疮发生率为2.8%;对于全部人群,Braden量表的临床效度较好(Se=0.8571,Sp=0.7160);对于汉族患者.Braden量表的临床效度较高(Se=0.8750,Sp=0.7438);对于少数民族患者,Waterlow量表具有较高的临床效度(Se=0.8333,Sp=0.7366).结论 临床初步评估压疮时,建议首选Braden量表,对于少数民族患者,辅以Waterlow量表.     

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.     

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.     

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.     

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.