USS应用于脊柱后凸全脊柱截骨内固定31例

目的　研究USS椎弓根内固定系统应用于脊柱后凸畸形截骨矫治内固定的疗效。方法　根据后凸角度采用一次性多平面全脊椎截骨 ,应用USS椎弓根内固定系统固定 ,对后凸角度矫正率 ,截骨融合率 ,内固定结构稳定性进行随访统计。结果　 31例得到术后平均 12个月随访 ,术前脊柱后凸角平均 73°,术后后凸角平均 12° ,截骨融合率 96 77% ;后凸角矫正率为 83 5 6 % ;无一例发生断钉、断棒及联接结构松脱。结论　采用USS椎弓根内固定系统固定 ,增加了脊椎融合率 ,提高了后凸角矫正率 ,脊柱基本呈流线型恢复生理曲度 ;可早期离床活动 ,无须外固定。     

脊柱后凸畸形翻修术

[目的]总结脊柱后凸畸形翻修术的方法与治疗结果。[方法]2001年6月～2005年8月采用后路全脊椎截骨矫形加椎弓根螺钉框架系统内固定翻修治疗脊柱后凸畸形17例。[结果]椎弓根共置钉168枚,脊椎后凸翻修截骨最多3个平面,最大翻修矫正后凸100°,截骨平面最高达T10,平均矫正脊柱后凸56.2°。[结论]脊柱后凸畸形术后复发,脊柱翻修术可收到良好效果。     

经后路椎弓根截骨短节段椎弓根钉内固定治疗脊柱后凸畸形

目的探讨经椎弓根单椎体截骨短节段椎弓根钉内固定治疗脊柱后凸畸形的临床疗效。方法2001年6月~2003年11月,采用经后路椎弓根截骨短节段椎弓根钉内固定治疗16例脊柱后凸畸形患者。其中男11例,女5例,年龄24~51岁。强直性脊柱炎12例,陈旧性胸腰椎骨折脱位伴不完全截瘫2例,椎体发育不良2例。病程7~25年,平均12.8年。手术前、后均行脊柱全长X线片检查,测量胸椎后凸角、腰椎前凸角、骶骨水平角及骶骨后上角至脊柱矢状轴线的距离,评定植骨愈合情况、内固定位置及手术并发症。按Bridwell-Dewald脊柱疾患疼痛及功能评定标准进行手术前后疗效评价。结果术中出血700~2000ml,平均1100ml;术中硬脊膜破裂1例;术后发生麻痹性肠梗阻1例,下肢短暂性麻痹2例。术后获随访18~35个月,平均25.6个月。植骨愈合满意,无延迟愈合或不愈合。最后随访时,腰椎前凸角从术前9.6±16.4°,矫正至术后42.6±14.3°(P<0.05),平均矫正角度为33°;骶骨水平角的改变与此类似。胸椎后凸角手术前后改变不明显,而骶骨后上角至脊柱矢状轴线的距离由术前97.5±45.6mm降至术后10.7±9.6mm(P<0.05)。术后疼痛、工作及社交情况较术前都有明显改善。结论经后路椎弓根椎体截骨短节段椎弓根钉内固定治疗脊柱后凸畸形,矫正度数大,手术相对安全,可取得较理想的放射学矫形效果及临床疗效。     

脊柱陈旧骨折后凸畸形的矢状面重建

目的:介绍脊柱陈旧骨折后凸畸形矢状面重建的手术方法。方法:18例胸腰椎陈旧骨折并后凸畸形患者采用两种手术方式治疗:14例采用经椎弓根椎体截骨短节段内固定,4例采用前后联合入路减压、前路截骨Z-plate钢板内固定。结果:随访6个月~3年,无骨不连等发生,有1例TSRH固定患者2枚螺钉发生松动。无脊髓损伤并发症。神经功能Frankel分级均有1级以上提高,术后矢状指数平均6°。结论:经椎弓根椎体截骨短节段内固定和前后联合入路减压、前路截骨内固定,可有效地矫正胸腰椎陈旧骨折遗留的脊柱矢状面畸形,并重建脊柱的稳定性。     

经椎弓根次全脊椎截骨加椎弓根螺钉内固定术治疗陈旧性胸腰椎骨折

目的介绍经椎弓根次全脊椎截骨加椎弓根螺钉内固定术治疗陈旧性胸腰椎骨折的手术方法。方法2001年11月～2004年1月,我院共收治10例陈旧性胸腰椎骨折患者,均采用经椎弓根次全脊椎截骨加椎弓根螺钉内固定术治疗。结果所有患者随访11个月～3年。7例有下肢神经症状者均得到缓解,平均Frankel分级改善1级。2例诉腰背部劳累后稍有酸痛。所有患者术后3个月、1年X线片检查均未出现内植物松动、断裂,位置均良好,后突角度由术前的平均32°矫正到术后的15°,且在随访中无明显丢失,术后1年截骨界面完全融合。结论经椎弓根次全脊椎截骨加椎弓根螺钉内固定术可充分矫正脊柱后突畸形,稳定病变节段失稳脊柱,恢复脊髓和神经功能,是治疗陈旧性胸腰椎骨折的良好术式。     

成人脊柱后凸畸形后路全脊椎截骨矫形手术1200例报告

[目的]总结成人脊柱后凸畸形后路全脊椎截骨矫形手术方式。[方法]通过后方入路经双侧椎弓根、椎体行楔形截骨,直到椎体前缘皮质下,并行椎弓根钉棒系统内固定。[结果]共手术矫正后凸及侧后凸畸形1 200例,其中男938例,女262例;发病时间5.6～28年,平均11.6年;年龄15～52岁,后凸畸形时间2.5～26年,平均7.3年。后凸病因:强直性脊柱炎后凸畸形720例;脊柱压缩性骨折246例;脊柱结核132例;先天性脊柱后凸畸形59例;休门氏病后凸43例。最高截骨平面T9水平,单病例最多截骨达4处,平均截骨2处,一处椎体截骨时间平均30 min,出血约100 ml,术中脊髓和神经根保护安全。[结论]成人脊柱后凸畸形后路全脊椎截骨矫形手术截骨规范充分、手术时间短、术中出血少、脊髓和神经根保护安全、截骨创面对合紧密、利于截骨创面愈合。适用于各种原因导致的脊柱后凸畸形截骨矫正手术,显著降低术中和术后并发症。     

后路全脊椎截骨术治疗胸腰段陈旧骨折继发后凸畸形

目的总结全脊柱截骨矫正胸腰段陈旧性骨折继发后凸畸形的治疗经验。方法陈旧性骨折继发脊柱后凸畸形17例,采用全脊柱截骨、椎弓根钉内固定系统固定并牵引闭合截骨间隙,植骨融合。结果术后全组病例均未发生脊髓损伤,临床症状得到不同程度的改善。17例平均随访18个月（8个月～6年）,术后所有病例截骨间隙均达到骨性融合,无一例发生假关节、内固定松动。结论经全脊柱截骨视野开阔,操作安全方便,截骨和内固定同时完成,是治疗脊柱后凸畸形的较好方法。     

脊柱前方垫高-后方闭合截骨矫形术治疗胸腰段脊柱后凸畸形的初步报告

目的探讨采用以脊柱前方垫高后方闭合为技术特征的新型脊柱截骨矫形术治疗胸腰段脊柱后凸畸形的可行性、安全性和有效性。方法自2003年以来,采用新型脊柱截骨矫形术治疗不同病因所致的胸腰段脊柱后凸畸形8例。其中男、女各4例,年龄14～58岁,平均35岁。术前脊柱后凸Cobb角平均为73°(42°～90°),3例合并脊柱侧凸的Cobb角平均为25.7°。术前Frankel分级:C级2例、D级2例、E级4例。8例均伴有较为严重的胸腰背部疼痛,3例伴有膀胱括约肌功能障碍。手术方式均为:单纯后路经双侧关节突关节、椎间隙楔性截骨,切断前纵韧带,先行脊柱前方撑开垫高(将椎间融合器植入椎间截骨面),再行脊柱后方加压闭合及椎弓根螺钉器械固定。结果平均手术时间4.5h(3.5～6.0h),平均术中出血量2280ml(700～4200ml)。术中有1例血压曾一度偏低,术后脑脊液漏1例,此外无其他手术并发症发生。术后脊柱后凸Cobb角平均为8.3°、平均矫正度数为64.7°、平均矫正率为88.6%;术后脊柱侧凸Cobb角平均为18.7°、平均矫正度数为7°、平均矫正率为27.2%。术后平均随访12.8个月(5～23个月),X线片可见原截骨平面均已发生骨性融合,胸腰背部疼痛症状完全消失。术后Frankel分级:C级1例、D级2例、E级5例;3例膀胱括约肌功能障碍者中2例术后症状有改善。结论与现行常用的单纯闭合楔形截骨术式相比,新型脊柱截骨矫形术可有效地避免脊柱过度短缩和脊髓扭曲、折皱的发生,提高了脊柱闭合截骨的安全性;同时也明显地提高了单一节段脊柱后凸畸形的安全截骨矫正度数。可适用于40°～90°的胸腰段脊柱后凸畸形的手术治疗。     

单纯后路经椎弓根截骨或脊椎切除的临床分析

目的探讨一期单纯后路经椎弓根脊柱截骨和脊椎切除操作的可行性和如何避免手术并发症的发生。方法回顾125例重度僵硬性脊柱畸形患者的临床资料,分析采用经椎弓根脊柱截骨技术或经椎弓根扩大蛋壳技术进行脊椎切除操作的可行性、手术时间、出血量、术中术后并发症。所有患者均采用经椎弓根内固定系统矫形固定。结果平均手术时间210min,术中失血平均1400ml。术中发生13例胸神经根损伤,术后无明显不适主诉。6例血气胸,经胸腔闭式引流治愈。6例硬膜撕裂,术后自然愈合。术后1例强直性脊柱炎患者腹部皮肤出现较大张力和水泡,经外敷硫酸镁2周治愈。1例术后发生伤口深部感染,经伤口清创冲洗,4周后治愈。1例发生截骨平面以下瘫痪,经脱水消炎治疗,4个月后完全恢复。并发症主要与初期手术操作有关,特别是椎体外侧壁和后壁截骨时,更易发生并发症。结论单纯后路经椎弓根脊柱截骨和脊椎切除操作简单,可行性好,明显缩短了手术时间,小心操作和掌握操作要点,能够避免手术并发症的发生。     

后路截骨术治疗胸腰椎骨折术后迟发性后凸畸形的疗效分析

目的 分析胸腰椎骨折术后迟发性后凸畸彤的临床特征,探讨后路截骨矫形的术式选择并总结疗效.方法 胸腰椎骨折术后迟发性后凸畸形患者27例,男22例,女5例;年龄24～52岁,平均34岁:后凸畸形Cobb角36°～72°,平均48°.10例采用后路经关节突"V"型截骨术,17例采用后路经椎弓根椎体截骨脊柱缩短术.结果 胸腰椎骨折术后迟发性后凸畸形危险因素为初次后路手术未行植骨融合、初次手术未满意恢复骨折椎体的高度及固定节段过度撑开.经关节突"V"型截骨术后矢状面的纠正平均为24°(14°～43°),经椎弓根椎体截骨术后矢状面的纠正平均为40°(17°～44°);末次随访时经关节突"V"型截骨平均矫正丢失5°,经椎弓根椎体截骨平均矫正丢失3°;26例(96.2%)实现骨性融合,经关节突"V"型截骨术出现1例假关节(3.8%).结论 胸腰椎骨折术后迟发性后凸畸形的临床特征为疼痛、畸形、力学不稳定或神经损害,可以根据畸形僵硬的程度选择不同的后路截骨方式.经椎弓根椎体截骨脊柱缩短术经单一入路就可达到缩短脊柱、纠正畸形、脊髓减压及植骨融合内固定,具有后凸纠正率高、残留畸形小、矫正丢失少及融合率高的优越性,但其技术要求较高、潜在的神经并发症亦不容忽视.     

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.     

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.     

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.