两种长度的颈椎椎弓根螺钉与侧块螺钉拔出试验比较

目的:比较两种长度的颈椎椎弓根螺钉和侧块螺钉的抗拔出力,探讨颈椎经椎弓根短螺钉固定的可行性。方法:5具C3~C5共15节新鲜颈椎标本,用长度为28mm和20mm的皮质骨螺钉分别置入椎弓根,并用20mm的螺钉行侧块双皮质固定,螺钉进入侧块深度约14mm。行拔出试验,比较螺钉的最大轴向拔出力。结果:椎弓根长螺钉的最大拔出力为650N,椎弓根短螺钉为585N,两者比较无显著性差异(P>0.01);侧块螺钉的最大拔出力为360N,与椎弓根短螺钉比较有显著性差异(P<0.0001)。结论:颈椎椎弓根短螺钉固定可提供足够的稳定性,其安全性相对较高。     

胸椎经"椎弓根-肋骨间"螺钉与椎弓根螺钉固定的抗拔出力比较

目的比较胸椎经"椎弓根-肋骨间"螺钉与椎弓根螺钉固定的抗拔出力.方法5例新鲜尸体脊柱(T6～T10)标本,自椎间盘、小关节及上位椎体下肋椎关节处分解为单椎体(附带双侧肋骨)25个.根据配对随机分组的原则,随机选取椎体一侧作椎弓根螺钉固定组,另一侧则为配对的"椎弓根-肋骨间"螺钉固定组,共组成25个配对组.同组中"椎弓根-肋骨间"螺钉长度较椎弓根螺钉长10mm,直径与椎弓根螺钉相同.将25组的50个螺钉分别进行拔出测试(5mm/min的速度垂直方向拔出).结果"椎弓根-肋骨间"螺钉的抗拔出力为423.1±198.7N;椎弓根螺钉的抗拔出力为783.3±199.5N.前者的抗拔出力显著小于后者(P＜0.01).结论"椎弓根-肋骨间"螺钉的力学性能不及椎弓根螺钉,建议仅将前者作为后者的一种补充,特别是在无法完成椎弓根螺钉置入的部分胸椎节段.     

锥形与柱形椎弓根螺钉的生物力学研究

目的 比较锥形与柱形椎弓根螺钉在下胸段及腰段的生物力学差异性及影响因素。方法 将6具成人新鲜T_9～L_5脊柱标本分解为 54个椎体标本。随机选取一侧按标准方法放置特制试验用直径5.5mm锥形螺钉,然后在MTS力学试验机上先后测量其最大扭矩及最大拔出力。在对侧以同样的方法进行5.5mm柱形螺钉的实验。结果在下胸段,锥形螺钉的最大扭矩(1.445 ±0.66)N·m显著性大于柱形的最大扭矩(1.073±10.42)N·m(P=0.021),而在腰段锥形(1.017±0.43)N·m和柱形(1.28±0.50)N·m螺钉的最大扭矩没有明显差异(P=0.416)。无论在下胸段还是腰段,锥形螺钉与柱形螺钉的最大拔出力均无显著性差异。从下胸段到腰段,螺钉的最大拔出力逐步增加。柱形椎弓根螺钉的最大扭矩与最大拔出力呈正相关(r=0.629)锥形螺钉的最大扭矩与最大轴向拔出力的相关性不显著(r=0.179)。结论 相同直径的锥形与柱形螺钉的最大拔出力相近,且锥形螺钉在其直径与椎弓根内径相近时具有较高的扭矩。螺钉的最大扭矩与最大拔出力的相关关系要视螺钉的类型而定。     

经骶1-2侧块螺钉固定的最大拔出力测定

【摘要】 目的：测量经骶1-2侧块螺钉固定的最大拔出力,初步探讨该内固定方法的有效性。方法：8具甲醛溶液固定湿润成人骶骨标本,采用双能X线吸收测定仪（dual-energy X-ray absorptiometry, DEXA）测定S1椎体骨密度。在同一骶骨标本上随机置入3种骶骨螺钉：经骶1-2侧块螺钉（A组）、S1椎弓根螺钉（B组）、S1前外骶骨翼螺钉（C组）。将标本固定于858型MTS材料试验机上,对螺钉施加轴向拔出力,根据3种骶骨螺钉轴向拔出实验的数据绘制力（N）-位移（mm）曲线,取曲线的顶点作为最大拔出力数值。应用SPSS 16.0统计软件对3组骶骨螺钉的最大拔出力数值行方差分析。结果：8具骶骨标本S1椎体骨密度为0.43～0.74g/cm3,平均0.641±0.275g/cm3。3种骶骨螺钉固定的螺钉即刻平均最大拔出力：A组为379.62±73.10N,B组为829.12±170.74N,C组为230.62±98.52N,3组之间两两比较差异有统计学意义（P＜0.05）。结论：经骶1-2侧块螺钉固定的最大拔出力低于S1椎弓根螺钉固定,但高于S1前外骶骨翼螺钉固定,当S1椎弓根螺钉固定不能施行时,骶1-2侧块螺钉固定可作为一种有效的选择。     

聚甲基丙烯酸甲酯强化对骨质疏松椎弓根螺钉固定的生物力学作用

目的探讨聚甲基丙烯酸甲酯 (polymethylmethacrylate,PMMA)骨水泥强化椎弓根螺钉的方法和评价 PMMA强化骨质疏松椎弓根螺钉后的生物力学性质。方法 6具新鲜老年女性胸腰段骨质疏松脊柱标本 (T10～ L5),使用双能 X线骨密度吸收仪测试每个椎体的骨密度,随机取 16个椎体 (32侧椎弓根 ),一侧椎弓根拧入 CCD螺钉,测量最大旋入力偶矩后拔出螺钉作为正常对照组,用 PMMA骨水泥强化椎弓根螺钉作为修复固定组,行螺钉拔出试验;另一侧经导孔直接强化椎弓根螺钉后拔出作为强化固定组,记录三组螺钉的最大轴向拔出力。结果椎体平均骨密度为 (0.445± 0.019)g/cm2;螺钉最大旋入力偶矩为（ 0.525± 0.104） Nm;正常对照组螺钉最大轴向拔出力为 (271.5± 57.3)N;修复固定组为 (765.9± 130.7)N;强化固定组为 (845.7± 105.0)N。 PMMA骨水泥强化或修复骨质疏松椎弓根螺钉后最大抗压力明显高于强化前,差异有非常显著性意义 (P< 0.01)。结论 PMMA骨水泥强化骨质疏松椎弓根螺钉能显著增加螺钉在椎体内的稳固性。     

新型寰椎内径锥形螺钉的设计与拔出力的测试

目的比较两种设计的寰椎椎弓根钉的最大拔出力,为临床选择寰椎推弓根钉类型提供生物力学依据。方法设计制作两种寰椎椎弓根钉,根据螺纹部分分为皮质骨螺钉(A型螺钉)、内径锥形螺钉(B型螺钉),利用24节新鲜猪寰椎标本,置入两种类型的椎弓根钉,进行拔出试验,测定每种螺钉的最大拔出力,进行统计学分析比较。结果同一长度,不同设计的螺钉抗拔出力接近,均无显著性差异;同一直径两种设计的螺钉,28 mm比26 mm的抗拔出力略大,但均无显著性差异。结论新型寰椎内径锥形螺钉(3.0 mm)抗拔力高,螺钉根部强度好,抗弯曲、断裂性能好,可提供足够的即刻稳定性,是寰椎椎弓根固定的理想螺钉类型。     

寰椎侧块螺钉与寰椎椎弓根螺钉的解剖与生物力学对比研究

目的对寰椎侧块螺钉和寰椎椎弓根螺钉进行解剖和生物力学研究,为临床选择寰椎螺钉的固定方式提供依据。方法利用12例新鲜标本的寰椎进行单皮质和双皮质的椎弓根螺钉或侧块螺钉固定,测试比较其螺钉拔出强度和钉道长度。结果寰椎椎弓根螺钉的最大进钉长度为29·79mm±1·68mm,其中10·15mm在寰椎后弓内,19·65mm在寰椎侧块内。寰椎侧块螺钉的最大进钉长度为24·88mm±0·41mm,其进钉点与寰椎后弓后缘的平均距离为9·93mm±1·35mm。双皮质寰椎椎弓根螺钉的拔出力量最大,平均1757·0N±318·7N;单皮质寰椎椎弓根螺钉(1192·5N±172·6N)与双皮质寰椎侧块螺钉(1243·8N±350·0N)无明显差异,单皮质寰椎侧块螺钉最小(794·5N±314·8N)。结论在同时适用寰椎椎弓根螺钉和寰椎侧块螺钉固定的患者,宜首先选择寰椎椎弓根螺钉固定,次选寰椎侧块螺钉固定。     

可注射硫酸钙MIIGX3与医用骨水泥对椎弓根钉固定作用的比较研究

[目的]用可注射硫酸钙M IIGX3(m in im ally invasive in jectab le graft X3,以下简称M IIGX3)及医用骨水泥分别强化猪腰椎椎弓根钉内固定,测定椎弓根钉最大轴向拔出力,比较两种材料对椎弓根钉固定强度的影响。[方法]8个新鲜猪腰椎作为实验对象,在同一椎体双侧椎弓根制作钉道,一侧在固定螺钉前加用M IIGX3(M IIGX3组),另一侧加用骨水泥(骨水泥组)。24 h后行轴向拔出力测试。[结果]最大轴向拔出力,M IIGX3组1915±375 N,骨水泥组3625±775 N,二者配对t检验有显著差异(P<0.01)。[结论]骨水泥对椎弓根钉的固定作用大于M IIGX3。当存在脊柱滑脱需较大提拉力量或椎弓根钉需承受较大拔出力的节段,使用骨水泥进行强化更为合适。     

可注射硫酸钙在椎弓根螺钉固定中的生物力学研究

目的:探讨可注射硫酸钙在椎弓根螺钉固定中的作用。方法:取16个新鲜猪腰椎标本,随机分为两组,每组8个。第1组在双侧椎弓根丝锥攻丝,一侧钉道内填充可注射硫酸钙MIIGX3(minimally invasive injectable graftX3)(1A组),另一侧作为自身对照(1B组),拧入椎弓根钉后1h行拔出实验。第2组同样双侧攻丝,一侧填充MIIGX3(2A组),另一侧自身对照(2B组),拧入椎弓根钉后24h行拔出实验。比较填充MIIGX3与不填充以及填充1h与填充24h的最大轴向拔出力有无差别。结果:1A组最大轴向拔出力为1837.5±251.7N,1B组为1003.8±85.0N,2A组为1895.0±252.5N,2B组为1027.5±97.8N。对4组数据作析因设计的方差分析,填充MIIGX3与不填充比较,即1A组与1B和2A组与2B组比较,存在显著性差异(P<0.001);填充1h与填充24h比较,即1Avs2A,无显著性差异(P>0.05)。结论:MIIGX3对椎弓根钉的固定有明显的增强作用,且填充1h与填充24h固定强度无差异。     

胸椎椎弓根螺钉固定失败经椎弓根外入路补救的力学测试

目的 比较胸椎椎弓根螺钉椎弓根入路，椎弓根外入路置钉以及置钉失败后椎弓根入路，椎弓根外入路补救置钉的抗拔出力。方法 4具书本脊柱标本（T6-11）分解为单椎体（附双侧肋骨）24个。根据配对随机分组的原则进行标本分组，测试各组的抗拔出力，将椎弓根入路置钉组成的抗拔出力结果作为对照组数据。结果 椎弓根入路补救组抗拔出力和椎弓根入路组，椎弓根外入路组差异无显著性（P〉0.05）。结论椎弓根螺钉穿破内侧壁导致的胸椎椎弓根螺钉固定失败，可选择椎弓根外入路的方式进行补救。     

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.