超声引导下置管引流化疗后二期经椎间孔入路病灶清除固定治疗胸腰段结核

目的探讨超声引导下置管引流化疗后二期经椎间孔入路病灶清除固定治疗胸腰段结核的疗效。方法对13例胸腰段(T8~L5)结核合并单侧或双侧腰大肌脓肿患者采用超声引导下置管引流化疗后二期经椎间孔入路病灶清除固定治疗。术前脊髓神经功能ASIA分级:C级9例,D级4例。采用Birdwell分级评价椎间植骨融合情况,采用ASIA分级评定术后脊髓功能恢复情况。结果术中无大血管或脊髓损伤。术后随访13~40(23.5±10)个月,所有患者结核症状消失。无结核复发、切口感染、窦道形成或内固定失败等并发症,复查血沉结果正常。植骨融合良好,术后6~10个月复查X线片提示椎间植骨均获得骨性愈合。Birdwell分级:Ⅰ级11例,Ⅱ级2例;内固定位置正常。脊髓神经功能ASIA分级:C级5例,D级6例,E级为2例。5例胸腰段结核伴有后凸畸形者术前后凸Cobb角为32°~43°(38.5°±1.3°),末次随访时后凸Cobb角为6°~10°(7.3°±1.1°),较术前明显好转(P0.001)。结论超声引导下置管引流化疗后二期经椎间孔入路病灶清除固定治疗胸腰段结核病灶清除彻底,椎管减压可靠,复发率低,创伤小,不破坏后方韧带复合体,能够最大限度保留脊柱生物力学稳定性,临床疗效确切、可靠。     

同一切口经侧前方病灶清除并植骨联合后路内固定治疗胸椎结核

目的探讨后路同一切口经侧前方病灶清除并植骨联合后路内固定治疗胸椎结核的临床效果。方法对9例T5~12椎体结核患者经抗结核治疗3周后,行同一切口后路经侧前方病灶清除并髂骨植骨联合后路椎弓根钉固定术,观察脊柱稳定性及脊髓功能恢复情况。结果手术时间为185~230 min。9例均获随访,时间6~39个月,植骨部位均骨性愈合。Cobb角由术前24°~52°(37.4°±5.5°)矫正到术后7°~25°(21.5°±3.2°),随访期内无明显丢失。神经功能损伤的患者均有一定程度恢复。胸背部疼痛及不适明显缓解,结核无复发。结论采用同一切口侧前方病灶清除并植骨联合后路椎弓根钉内固定治疗胸段脊柱结核可彻底清除病灶,椎弓根钉置钉安全性高,适合大部分中下段胸椎结核的治疗,近、远期疗效均满意。     

经皮穿刺引流联合后路病灶清除椎间植骨内固定治疗胸腰段脊柱结核伴巨大脓肿

目的探讨经皮穿刺引流联合后路病灶清除椎间植骨内固定治疗胸腰段脊柱结核伴巨大脓肿的安全性及临床疗效。方法回顾自2007-05—2012-04诊治胸腰段脊柱结核伴巨大脓肿9例。所有患者先行CT引导下穿刺,灌洗引流1~2周后再行后路开放减压、病灶清除、植骨融合内固定术。观察比较手术前后血沉(ESR)、后凸角度、神经功能及植骨融合情况。结果 9例均获得随访18~56个月,平均35个月。手术时间120~260 min,平均165 min;术中失血量300~1 600 ml,平均650 ml。患者术后切口均一期愈合,无窦道形成。术后3个月ESR恢复正常,平均21 mm/h。术后后凸角度3°~16°,平均7°。末次随访时Frankel分级:C级1例,D级4例,E级4例。植骨融合时间3~6个月,平均4个月。结论对于胸腰段脊柱结核伴巨大脓肿者采用经皮穿刺引流联合后路病灶清除椎间植骨内固定是一种安全有效的治疗方法。     

单纯后路病灶清除植骨融合内固定术治疗脊柱结核

目的分析后路病灶清除植骨融合内固定术治疗脊柱结核的临床疗效。方法对60例脊柱结核患者进行常规四联抗结核化疗,手术方式为后路病灶清除植骨内固定。采用VAS评分、ODI和Frankel分级对患者进行术前术后评估。结果手术时间4~8(4.30±2.60)h。全部患者手术成功,未出现术后结核复发、内固定断裂等情况。患者均获得12个月随访。术后12个月,VAS评分由术前7.97分±0.69分改善至1.18分±0.83分(P0.05);ODI由术前43.58±2.08改善至9.63±1.66(P0.05)。术后6个月,Cobb角:胸椎由术前35.00°±2.83°改善至20.70°±2.26°(P0.05),胸腰段由术前20.75°±2.22°改善至5.42°±1.78°(P0.05),腰椎由术前的27.00°±1.41°改善至46.50°±1.29°(P0.05),术后12个月复查各角度均有部分丢失(P0.05)。Frankel分级:A级3例改善至B级1例,2例无改善;B级5例改善至C级1例、D级1例,3例无改善;C级7例改善至D级3例、E级2例,2例无改善;D级11例改善至E级8例,3例无改善;E级34例无加重。1例患者合并术后窦道形成,3个月后愈合。结论单纯后路手术能在有效清除病灶的基础上减少手术时间,降低术后并发症的发生率。     

前路内固定治疗胸腰椎结核伴后凸畸形与截瘫

目的：探讨前路植骨内固定治疗胸腰段脊柱结核伴后凸畸形与截瘫的疗效。方法：1996年～2002年4月采用前路病灶清除，植骨内固定治疗胸腰椎结核伴后凸畸形与截瘫62例，观察术后植骨融合、畸形矫正、截瘫恢复及结核病灶愈合情况。结果：平均随访2年2个月，56例患者获访，平均融合时间为3．6个月。骨性融合率100％。在胸段、胸腰段及腰段后凸畸形分别平均纠正29°、15°及9°，随访时无矫正度丢失；伴截瘫者11例，Frankel神经功能平均恢复2级；本组脊柱结核均治愈。结论：一期前路病灶清除植骨内固定，融合时间短，畸形矫正效果好，减压彻底，有利于截瘫恢复。     

病灶清除植骨内固定治疗胸腰椎结核

目的评价采用病灶清除植骨内固定术治疗胸腰椎结核的疗效。方法采用前路或前后路联合病灶清除植骨内固定术治疗16例胸腰椎结核患者,术后抗结核药物治疗9~12个月。结果患者均获得随访,时间6~48个月。9例术前神经功能障碍者术后均获得明显改善:改善至C级1例,D级1例,恢复至E级7例,无神经功能障碍加重者。除1例植骨融合延期外,其余患者植骨均愈合良好。Cobb角术前22.6°~48.5°,术后10°~21°。结论胸腰椎结核采用病灶清除植骨融合及内固定术,彻底清除病变组织,可重建脊柱稳定性,提高脊柱结核的治愈率。     

一期后路经椎弓根截骨病灶清除植骨内固定治疗胸腰段脊柱结核

[目的]探讨治疗胸腰段脊柱结核一期完成病灶清除、矫正脊柱后凸畸形、植骨、后路钉棒固定的临床疗效。[方法]自2004年1月~2008年6月收治活动期胸腰段单节段脊柱结核伴后凸畸形患者34例,采用一期后路椎弓根截骨病灶清除(在胸椎段,先切取左右肋骨后段),钛笼植骨,后路矫形系统内固定。根据术前、术后X线分析植骨融合情况以及脊柱后凸畸形矫正效果。[结果]34例患者随访时间9~28个月,平均18个月,X线片示结核病灶清除彻底,脊柱畸形矫正,Cobb角由术前20°~45°矫正到术后3°~5°,植骨块无移位,2例再次行前路补充植骨术。结核无复发。[结论]该手术入路简捷,病灶清除彻底,360°环形解除压迫,畸形矫正满意,三柱固定,植骨融合,后期脊柱稳定,缩短了卧床时间,减少了相应的并发症。     

一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核

[目的]探讨一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核的可行性及临床疗效。[方法]2007年1月~2014年1月收集23例胸腰段脊柱结核并有后突畸形的患者,伴有椎管及椎旁脓肿形成。其中男13例,女10例;年龄30~69岁,平均(46.48±12.01)岁。脊柱病变节段后凸Cobb角为17°~40°,平均(30.43±5.74)°。术前ASIA分级:B级2例,C级10例,D级7例,E级4例。均采用一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗。通过研究患者ASIA分级、脊柱病变节段后凸Cobb角、术后并发症、Oswestry功能障碍指数(ODI)、VAS疼痛评分、植骨融合时间评估手术疗效。[结果]术后随访21~41个月,平均(29.30±4.97)个月,无脊髓损伤加重及脑脊液漏,无窦道形成。1例术后伤口延迟愈合,1例出现皮下局部脓肿。术前有神经症状者均有不同程度恢复。至末次随访,根据ASIA分级,2例由B级恢复至D级,8例由C级恢复至E级,2例由C级恢复至D级,7例由D级恢复至E级。术后测量后凸Cobb角较术前显著改善(P0.001)。末次随访时ODI、VAS疼痛评分均较术前明显改善(P0.001)。本组无内固定失败及假关节形成,所有患者均在术后5~8个月达到植骨融合,疗效满意。[结论]对于有适应证的脊柱结核,一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核安全有效且手术创伤小。     

强直性脊柱炎合并多节段脊柱结核的外科治疗

目的探讨一期后路病灶清除植骨融合内固定治疗强直性脊柱炎（AS）合并多节段脊柱结核的临床疗效。方法对10例AS合并多节段脊柱结核患者行一期后路病灶清除植骨融合椎弓根螺钉内固定联合化疗治疗。结果 10例均获随访,时间6个月～3年。切口一期愈合,脊柱结核均治愈,无明显全身及局部并发症。在3～6个月均获得牢固愈合,患者全身状况良好。Frankel分级2例C级恢复至D级,4例D级恢复至E级。后凸畸形部分矫正,平均矫正8°±1°,未发现钉棒松动、脱位。结论 AS合并多节段脊柱结核采用后路病灶清除椎弓根螺钉内固定术联合化疗,可加强脊柱稳定,促进病灶吸收愈合,预防和矫正畸形,提高脊柱结核治愈率和植骨融合率。     

一期后路经椎弓根病灶清除、植骨融合、内固定治疗老年胸腰椎结核

目的探讨一期后路经椎弓根病灶清除、植骨融合、内固定术治疗老年胸腰椎结核的疗效。方法 15例老年胸腰椎结核患者,经正规抗结核治疗2周以上,行一期后路经椎弓根病灶清除植骨融合、椎弓根钉内固定。观察手术时间、术中出血量、术后神经功能恢复及植骨融合和脊柱序列保持情况。结果手术时间为（140±21）min,术中出血量为（500±88）ml。15例均获随访,时间24~36个月。神经功能Frankel分级：5例D级恢复到E级4例,1例无恢复。植骨均融合。术后脊柱后凸、侧凸均有不同程度纠正,Cobb角术后为0°~24.2°,末次随访时为0°~25.3°。结论采用一期后路经椎弓根病灶清除、植骨融合、内固定治疗老年胸腰椎结核,创伤小、效果好,但应严格把握手术适应证。     

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.