支气管封堵导管在单肺通气中的应用及术后咽喉炎症反应的研究

目的：探讨应用支气管封堵导管和双腔支气管导管在单肺通气的临床效果的比较。方法选取我院60例胸外科手术治疗需单肺通气患者。随机分为对照组和治疗组,每组各30例。对照组患者采用双腔支气管导管手术通气治疗;治疗组患者采用支气管封堵导管手术通气治疗。记录插管时间、定位时间、肺隔离时间及通过声门尝试次数和和肺萎陷程度、术后声嘶、咽痛发生率。结果与采用双腔支气管导管手术通气组比较,支气管封堵导管组术中肺萎陷良好、术野暴露满意,并且在插管时间、肺隔离时间、定位时间及通过声门尝试次数、术后声嘶、咽痛发生率方面均明显低于对照组患者,两组比较,差异有统计学意义（均P＜0.05）。结论支气管封堵导管手术治疗单肺通气患者的临床疗效明显,手术操作简单、安全,且手术后患者的声音嘶哑、咽喉疼痛等并发症的发生率较低,值得在临床上推广使用。     

双腔支气管导管选择

肺隔离术是胸外科手术常用的呼吸管理方法,其将左、右两侧肺通气径路分隔开,可选择性进行单肺通气,防止病侧肺的血、痰液流人健侧,同时术侧肺萎缩可为术者提供良好的暴露。随着医学的进步,支气管肺灌洗术、现代微创胸部外科、肺移植术均要求能有效地实施单肺通气。肺隔离方法包括支气管堵塞、单腔支气管导管、Univent管、双腔支气管导管（以下简称双腔管）等。这些方法中,双腔支气管插管操作简单,双侧气道的可控性强,仍是目前实施单肺通气的主要方法。     

Coopdech支气管阻塞器在单肺通气中的应用效果观察

Coopdech支气管阻塞器是山日本麻醉学专家Ishizaki医师发明的,具有独立结构,可与普通单腔气管导管配合用于双肺隔离.临床使用Coopdech支气管阻塞器进行单肺通气的报道较少.我们对56例拟行胸腔镜肺手术患者分组使用Coopdech支气管阻塞器(日本大研医器株式会社)和双腔气管导管(DLT)插管单肺通气麻醉进行比较,现报道如下.     

结核毁损肺单侧全肺切除的麻醉处理

目的探讨结核毁损肺单侧全肺切除的麻醉处理. 方法 80例结核毁损肺行单侧全肺切除病人,术前肺功能减损轻度者30例(G组),中度者35例(M组),重度者15例(S组).56例行左侧全肺切除:44例使用双腔支气管导管(Carlon管10例、White管20例、左侧Robertshaw管8例、右侧Robertshaw管6例)、右单腔支气管导管7例、气管导管5例.24例行右侧全肺切除:21例使用双腔支气管导管(Carlon管19例、左侧Robertshaw管2例)、左单腔支气管导管2例、气管导管1例.痰量>50 ml/d的16例病人中,采用双腔支气管导管7例、右单腔支气管导管7例、左单腔支气管导管2例. 结果 G组、M组未发生围手术期并发症,S组术后发生急性呼吸衰竭5例(33.33%).痰量>50 ml/d的病人中,2例使用左单腔支气管导管的病人术后均发生健侧支气管病灶播散;而使用双腔支气管导管和右单腔支气管导管未发生结核播散. 结论结核毁损肺重度肺功能减损者,术前FEV1占预计值的百分比<35%,MVV占预计值的百分比<40%,行单侧全肺切除手术要慎重.术前痰量＞50 ml/d的病人,应选择双腔支气管导管或右单腔支气管导管,确保两肺分隔满意,以防止术后健侧支气管病灶播散.     

单肺通气中应用支气管封堵器与双腔支气管导管的比较

目的比较支气管封堵器与双腔支气管导管在胸腔镜下肺大疱切除术中的应用。方法择期80例行胸腔镜下肺大疱切除术患者,随机均分为支气管封堵器组(Ⅰ组)和双腔支气管导管组(Ⅱ组)。Ⅰ组通过支气管封堵器实现单肺通气,Ⅱ组通过插入双腔支气管导管实现单肺通气,所有气管插管均由同一个熟练的麻醉医师完成。观察两组插管时间、定位时间、外科术野暴露程度和术后咽喉疼痛发生情况。结果Ⅰ组插管时间明显短于Ⅱ组(P<0.05),两组定位时间、外科术野暴露程度差异无统计学意义;Ⅰ组术后咽喉痛评分明显低于Ⅱ组(P<0.05)。结论支气管封堵器与双腔支气管导管均能有效应用在胸腔镜下肺大疱切除术患者单肺通气中,应用支气管封堵器可缩短插管时间及减轻患者术后咽喉疼痛。     

支气管阻塞导管的研究及应用进展

多种心胸血管手术的操作需要在单肺通气下完成。通常以三种常用的肺隔离技术提供单肺通气：1）双腔支气管插管（double-lumen tube,DLT）；2）支气管阻塞导管（bronchial blocker,BB）；3）单腔支气管插管（endobronchial tube，ET）。     

Coopdech支气管堵塞导管行左下肺叶隔离的可行性

目的 观察Coopdeeh支气管堵塞导管对肺功能正常的下段食管癌根治术患者作左下肺叶隔离的可行性,以及对患者肺顺应性、吸气峰压和氧合作用的影响.方法 拟行左侧剖胸下段食管癌根治术患者30例,ASAⅠ～Ⅱ级,按随机数字表法,随机分成支气管堵塞导管组(BB组)和左双腔支气管导管(double-lumen endobronchial tube,DLT)组(DLT组),每组15例.丙泊酚靶控输注静脉诱导后.BB组插入8# 单腔气管导管,纤维支气管镜引导9 Fr Coopdech支气管堵塞导管置入左下肺叶支气管,DLT组插入左DLT,2组均作双肺间歇正压通气.20 min后摆放右侧卧位,DLT组行右单肺通气,BB组对堵塞导管套囊充气行右肺和左上肺叶通气.20 min后手术开始,全程采用丙泊酚靶控输注维持麻醉,间歇追加舒芬太尼和顺阿曲库铵.于双肺通气后20 min(T_1),右单肺通气或右肺和左上肺叶通气后20 min(T_2),开胸见左肺或左下肺叶完全萎陷后(T_3),术毕拔出气管导管前(T_4)行动脉血气分析,记录肺顺应性和吸气峰压,并请手术医生在开胸后即刻评价术野清晰度.观察期间,机械通气参数不变.术后第1天作动脉血气分析和胸片检查.结果 2组患者的术野评价,各时点pH、动脉二氧化碳分压,T_1的动脉氧分压、吸气峰压和肺顺应性差异无统计学意义.在T_2～T_4时点,BB组的PaO_2分别为(220±56)mmHg、(188±57)mg Hg、(208±24)mm Hg,高于DLT组(146±38)mm Hg、(140±36)mm Hg、(157±33)mm Hg;肺顺应性分别为(36±9)ml/cm H_2O,高于DLT组(24±6)ml/cm H_2O,(35±12)ml/cm H_2O,BB组的吸气峰压分别为(17.7±2.9)cm H_2O、(17.8±3.2)cm H_2O、(14.82.2)cm H_2O,低于DLT组的(21.7±3.6)cm H_2O、(22.6±2.6)cm H_2O,(16.8±1.8)cm H_2O(P<0.05).BB组术后无肺不张病例,DLT组有1例发生左下肺不张.结论 支气管堵塞导管行左下肺叶隔离能在左侧剖胸下段食管癌根治术中提供清晰的术野,并能降低患者的吸气峰压,改善肺顺应性、增加氧合.     

肺移植麻醉330例临床分析

目的总结肺移植麻醉期间肺隔离技术、麻醉管理及体外膜肺氧合(ECMO)的应用价值。方法收集无锡市人民医院330例肺移植受者的临床资料,年龄(51.4±9.6)岁,ASA分级Ⅲ或Ⅳ级。所有受者术前均需卧床接受吸氧治疗,其中包括6例气管切开和12例气管插管呼吸支持患者。入室后常规给予静脉注射咪达唑仑0.05~0.1 mg/kg、芬太尼4μg/kg、依托咪酯0.2~0.4 mg/kg及维库溴铵0.1 mg/kg后,行气管内插管。气管导管根据手术需要分别选择双腔支气管导管、单腔双囊气管(Univent导管)导管或支气管阻塞器。通气方式均采用压力控制,根据受者血气指标及生命体征调节通气参数,必要时行手控通气。对于术中不能耐受单肺通气或心功能异常的患者给予ECMO辅助。结果 132例单肺移植患者中,121例应用非术侧双腔支气管导管;3例术前气管切开患者和6例术前气管插管给予呼吸支持患者应用支气管阻塞器;2例因身材矮小而应用Univent导管。198例双肺移植中,187例应用左侧双腔支气管导管,其中5例术中因手术操作刺破套囊而更换导管,7例在吻合左侧支气管时退管;6例应用Univent导管;5例应用支气管阻塞器。5例支气管扩张患者和3例特发性肺纤维化(IPF)患者在麻醉诱导后出现痰液阻塞,经处理后4例好转,1例因持续低氧血症而死亡;共148例术中应用ECMO,包括肺动脉高压69例;心功能不全17例;低氧血症57例;高碳酸血症5例。133例术毕即刻撤除ECMO,15例因血流动力不稳定、氧合差,术后继续使用ECMO。结论合理应用肺隔离技术是完成肺移植麻醉的前提;对围麻醉期受者的呼吸和循环进行有效地管理,是确保手术麻醉成功的基础;ECMO是肺移植术中心肺辅助的有效手段,可提高肺移植手术的麻醉成功率。     

肺叶支气管填塞通气对食管癌根治术患者肺内分流的影响

目的 评价肺叶支气管填塞通气对食管癌根治术患者肺内分流的影响。方法 择期行食管癌根治术患者24例，随机分为2组（n=12）：A组为双腔支气管导管组。B组为肺叶支气管填塞气囊组。麻醉诱导后，A组插入双腔支气管导管，B组先插入单腔气管导管，再在纤维支气管镜引导下插入支气管填塞气囊。两组均先行双肺通气30min，再行肺隔离通气至少30min，A组为单肺通气。B组为肺叶支气管填塞通气。术中监测气道压。分别于清醒仰卧位自主呼吸空气时（L）、侧卧位双肺通气30min（T1）和肺隔离通气30min（T2），抽取桡动脉血和中心静脉血标本，测定血气和血红蛋白，计算肺内分流率（Qs／Qt），采用放免法测定动脉血浆血栓素B2（TXB2）和6-酮-前列腺素F1α（6-k-PGF1α）浓度。结果 与A组比较。仅T2时B组PaO2升高，气道压、Qs／Qt及TXB2浓度均降低（P〈0．05）。与Tn比较，T1时两组Qs／Qt均升高（P〈0．05），TXB2浓度变化无统计学意义（P〉0．05）；与T1比较，R时A组Qs／Qt和TXB2浓度升高（P〈0．05），而B组变化无统计学意义（P〉0．05）。两组6-k-PGF1α浓度组内及组间比较差异均无统计学意义（P〉0．05）。结论 肺叶支气管填塞通气可以通过降低开胸手术期间的肺内分流来提高机体的氧合功能。     

食道癌根治术患者单肺通气时Coopdech支气管堵塞器气道管理的效果

肺隔离是指在支气管水平将两侧肺通气径路分隔开的麻醉技术,是实现单肺通气的措施.肺隔离技术可采用双腔气管导管、支气管堵塞器和支气管内导管.     

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.