经椎体前路移位健侧颈7神经根修复臂丛上中干根性撕脱伤

目的探讨健侧颈7神经根经椎体前路移位，修复臂丛上、中干根性撕脱伤的最短通路及其安全性，并分析其应用指征和临床疗效。方法将颈部双侧前斜角肌切断，经椎体前、食管后间隙构制健侧颈，神经根移位通路，将颈7神经根自锁骨后股束交界处切断，近端游离至椎间孔，通过皮神经桥接或直接缝合修复患侧颈5、6神经根或上干前后股。2005年12月-2007年5月，对8例臂丛上、中干根性撕脱伤伴下干部分损伤，或合并副、膈神经损伤的患者进行修复。结果术后1周内，8例患者在咳嗽、进食时健侧手指有轻度麻木感，2～3周后症状逐步消失；体感诱发电位（豁口）在术后3个月时均能引出，7个月时能引出支配肌复合肌肉动作电位（CMAP）；术后12个月肩、肘功能部分恢复。结论切断双侧前斜角肌不仅可以缩短移植神经的长度，且健侧颈7神经根翻转通路更通畅、安全。直接修复或短段皮神经移植极大地缩短了神经再生的距离，利于患肢肩、肘功能的恢复。术后早期禁食可以减轻食道的组织创伤反应，利于颈7神经根缝合口的愈合。     

健侧颈7神经移位与下干直接缝合的可行性研究

目的观察健侧颈7神经经椎体前通路移位与患侧下干直接缝合的可行性,为提高健侧颈7神经移位重建臂丛神经根性撕脱伤患者的屈指功能,寻找一种新术式.方法10具福尔马林固定的尸体标本,设定左侧为臂丛神经损伤侧,右侧为健侧.将健侧通过颈7神经根的前后股向远端进行干支分离,使其长度增加后再切断.经椎体前通路将健侧颈7向患侧颈部牵拉,测量其远端过颈7椎体中线的距离.患侧经锁骨上、下切口显露臂丛神经,将下干向近端游离至颈8、胸1神经根,在前斜角肌的外缘切断之.然后沿下干向远端游离至上臂中段.在患侧肩关节前屈、内收位,将下干经锁骨后向对侧颈部牵连,测量其过颈7椎体中线的距离.临床选择7例全臂丛神经撕脱伤患者,行健侧颈7神经经椎体前通路与患侧下干直接缝合.结果颈7神经根与前股和后股长度之和分别为(6.8±0.7)cm、(6.3±1.0)cm,前后股过颈7椎体中线的长度分别为(2.8±0.67)cm、(2.3±0.98)cm;患侧下干过颈7椎体中线的距离为(1.0±0.3)cm.临床应用7例均成功将健侧颈7与患侧下干直接缝合.结论健侧颈7神经经椎体前通路可直接与患侧下干进行缝合.     

健侧C7神经根经椎体前通路移位修复臂丛神经损伤疗效的初步观察

目的：观察经椎体前通路行健侧C7神经根移位修复臂丛神经损伤的临床效果。方法：将健侧C7神经根在干股交界处切断，近端游离至椎间孔处，经前斜角肌的深面翻转至椎体前食管后间隙，经4-6股皮神经桥接，修复患侧上干或上干后股。2002年3月-2003年8月，共完成21例手术，其中14例术后随访1年以上。14例中男12例，女2例；年龄17-41岁，平均31岁。手术时间：伤后2～6个月，平均4个月。全臂丛神经撕脱伤5例，上中干撕脱伴下干不全损伤8例，上中干锐器伤1例。结果：14例患者术后随访12～19个月，平均16个月。健侧C7神经根修复患侧上干或C5、C6神经根或上干前后股的10例，9例肩外展及屈肘肌肌力≥3级，1例无效；健侧C7神经根修复患侧上干后股或C5神经根的3例，肩外展肌肌力均≥3级；健侧C7神经根修复C6神经根1例，肱二头肌肌力为0级。结论：健侧C7神经根经椎体前通路移位修复臂丛神经上干的同时重建肩外展及屈肘功能或修复上干后股重建肩外展功能，可取得良好疗效。     

健侧C7神经经椎体前食管后移位治疗臂丛神经损伤

目的探讨健侧C7神经移位经椎体前食管后通路修复臂丛神经根性撕脱伤的可行性和优点。方法施行健侧C7神经移位经椎体前食管后通路修复臂丛神经上干或下干。将健侧C7神经前后股在进入外、后侧束之前切断，向上游离至近椎间孔处，尽量延长其长度。切断患侧锁骨，充分游离下干，必要时切断下干后股。健侧C7神经翻转后可达患侧胸锁乳突肌内侧间隙。在此间隙内7例健侧C7神经断端距患侧臂丛上千或C5，6神经距离为4．0～7．5cm，平均6．0cm，移植一段神经桥接予以修复。11例健侧C7神经与臂丛下干或C8、T1神经直接缝合。结果临床治疗18例，8例患者术后随访时间短未统计在内。10例患者术后随访12～33个月，4例修复上干者，其中3例肩外展肌肌力M3，肩外展45°，屈肘肌力M3，肘关节屈曲30°。6例修复下干者，尚无屈指动作恢复。结论健侧C7神经移位经椎体前食管后通路修复臂丛神经根性撕脱伤是可行的，其优点是缩短了健侧C7神经到靶器官的距离，减少一个神经缝合口，提高了神经功能恢复的质量。     

健侧颈7神经经椎体前路移位直接修复臂丛根部撕脱伤

目的 探讨健侧C7神经经椎体前路移位、一期直接修复臂丛根部撕脱伤的临床疗效.方法 对臂丛根性撕脱伤伤后1～3个月行健侧C7神经经椎体前路移位直接修复术16例.在健侧C7神经前、后股汇入外侧束、后束平面后作显微解剖分离以切取健侧C7的最大长度.健侧C7神经均可顺利经前斜角肌内侧隧道-椎体前路引至患侧,一期与患侧C8、T1-下干直接缝合10例,与患侧C5、6-上千直接缝合4例,与患侧C6、C8神经根直接缝合2例.结果 健侧C7根干前、后股切取长度分别为(7.71±1.16)和(6.97±1.18)cm.一期直接修复c8、T1-下干组经6～18个月随访8例,术后6个月尺、正中神经Tinel征阳性平面至肘关节.有2例术后9个月胸大肌胸肋部收缩(M3),术后12～18个月,手掌、手指与前臂内侧均有触痛觉恢复,尺侧腕屈肌和示、中、环、小指屈肌收缩(M3).结论 健侧颈7神经经椎体前路移位、一期直接修复C8、T1-下干的手术设计具有可操作性,是治疗臂丛根部撕脱伤的有效方法.     

健侧C7神经根移位经椎体前通路的应用解剖及临床研究

目的　通过尸体解剖及临床手术 ,找到健侧C7神经移位修复臂丛损伤的最佳桥接神经通路。方法　对 8具成人颈段尸体标本 ,显露双侧臂丛神经 ,将右侧C7神经在干股交界处切断并游离至椎孔处 ,经前斜角肌的深面翻转至椎体前 ,测量C7神经根至对侧臂丛上干前后股的距离。临床选择 13例臂丛神经撕脱伤患者 ,术中测量健侧C7神经根经椎体前及颈前皮下通路修复患侧臂丛上干或前后股的距离 ,并对其手术入路进行观测。结果　尸体标本测量C7神经根经椎体前通路至对侧臂丛上干前后股的距离平均为 ( 7.9± 2 .6)cm , x±s,下同。临床测量健侧C7神经根经椎体前通路及颈前皮下通路至对侧臂丛上干或前后股的距离分别为 ( 9.4± 1.2 )cm及 ( 18.2± 3 .2 )cm。两组相比差异有显著意义 (P<0 .0 1)。临床应用 13例全部取得成功 ,无并发症出现。结论　经椎体前通路是健侧C7神经移位修复臂丛损伤的最佳桥接神经通路之一。     

同侧颈7神经根选择性束组移位术的临床应用

目的　证实同侧选择性颈 7神经根移位术治疗臂丛上干撕脱伤的科学性、可行性与实用性。方法　 1996年 3月至 1997年 2月 ,运用同侧颈 7神经根选择性束组移位术治疗臂丛根性撕脱伤 8例。其中 ,上干撕脱伤 7例 ,上干根性撕脱伤合并颈 7神经根部分损伤 1例。选择颈 7神经根前股或前股前外侧份行移位术 ,直接与上干前股作显微缝合。 5例术后随访 6个月 ,3例因时间短未统计在内。结果　 8例移位后同侧颈 7神经根支配的肌肉均未见明显的功能障碍。颈7神经根前股外侧份移位至上干前股的 5例 ,4例术后 4个月肱二头肌已恢复屈肘动作 ,疗效显著。 1例合并颈7神经根部分损伤患者的功能恢复欠佳。结论　同侧选择性颈 7神经根纤维束组移位 ,提供了治疗臂丛根性撕脱伤新的动力神经源 ,为一种切实可行的新手术方法     

双干臂丛变异一例报道

健侧Ｃ7移位术的手术关键是如何识别Ｃ7神经根。Ｃ7神经根形成独立中干 ,因此与Ｃ5,6合成的上干 ,Ｃ8Ｔ1合成的下干 ,在解剖上有明显的区别较易识别。 2 0 0 1年 ,我们在术中遇到 1例臂丛的解剖学变异 ,险将下干误认为Ｃ7或中干。现将有关变异情况报道如下 ,供同道们参考。　　患者　男 ,3 4岁。左全臂丛根性撕脱伤 ,行健侧Ｃ7移位术。按臂丛探查作手术切口 ,解剖健侧臂丛 ,在斜角肌间隙轻轻牵开前斜角肌 ,暴露出正常的Ｃ5,6及上干 ,Ｃ7神经根及中干 ,经初步解剖Ｃ7神经根可基本确定。此时切断前斜角肌 ,显露位于第一肋表面的锁骨下动脉和Ｃ…     

健侧颈_7椎体前路移位直接修复下干联合股薄肌移植治疗臂丛根部撕脱伤

目的 探讨健侧颈7神经椎体前路移位直接修复下干联合功能性股薄肌移植重建术治疗全臂丛根部撕脱伤的手术设计及其临床疗效.方法 12例全臂丛根性撕脱伤患者,于伤后1～3个月行臂丛神经根干部探查,一期健侧颈,经椎体前路移位直接修复患侧C_8T_1-下干,同时行膈神经移位修复肩胛上神经9例.于一期术后4-8个月分别行二期吻合血管的股薄肌移植(以副神经斜方肌支为缝接神经)重建屈肘、伸指伸拇功能.结果 随访9～36个月.一期术后3个月12例患侧尺神经、正中神经Tinel征至上臂近段平面,术后6个月至肘关节与前臂近段平面,9个月至前臂远段与腕部.9例12个月Tinel征至手掌、手指部.7例术后9个月胸大肌胸肋部收缩,12个月肩内收可夹持物品;5例术后15-18个月手掌、手指与前臂内侧均有触痛觉恢复,尺侧腕屈肌和示、中、环、小指屈指肌收缩.3例术后24个月,拇指屈曲,1例鱼际肌出现收缩(M_1).二期股薄肌移植功能重建术后有7例于二期术后4～7个月移植肌肉收缩;9～12个月屈肘90°～120°(M_3),伸指伸拇M_3 .结论 健侧颈_7神经经椎体前路移位直接修复C_8T_1-下干术,联合二期股薄肌移植重建屈肘、伸指伸拇功能治疗全臂丛根部撕脱伤的手术设计具有可操作性,初步观察神经再生进程顺利,能恢复手腕、手指的屈曲与感觉功能,重建屈肘、伸指功能.     

健侧C_7神经根移位治疗臂丛神经根性撕脱伤的疗效观察

目的观察健侧C7神经根移位修复臂丛神经根性撕脱伤术后患侧肢体运动、感觉功能恢复情况,以及该术式对健侧肢体的影响。方法 2008年8月-2010年11月,采用健侧C7神经根移位修复全臂丛神经根性撕脱伤22例。患者均为男性;年龄14～47岁,平均33.3岁。术前临床检查及电生理检测均确诊为全臂丛神经根性撕脱伤。其中修复正中神经16例,桡神经3例,肌皮神经3例;一期手术2例,二期手术20例。观察手术前、后患侧肢体运动、感觉功能恢复情况。结果 21例患者获随访,随访时间7～25个月,平均18.4个月。健侧C7神经根修复正中神经:屈腕肌肌力达3级或以上10例,屈指肌肌力达3级或以上7例;感觉恢复达S3或以上11例。健侧C7神经根修复肌皮神经:屈肘肌肌力达3级或以上2例;前臂外侧皮肤感觉达3级2例。健侧C7神经根修复桡神经(失访1例)伸腕肌肌力达3级1例;感觉恢复达S3 1例。结论健侧C7神经根全干移位修复全臂丛神经根性撕脱伤效果较好,分期手术是提高疗效的重要因素。     

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.     

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.