静息态fMRI评估急性酒精暴露对恒河猴脑功能的影响

目的采用静息态fMRI基于分数低频振荡幅度(fALFF)方法评估急性酒精暴露后恒河猴脑功能改变。方法分别对7只健康雄性恒河猴于静脉注射酒精前及注射后10、28、46min进行BOLD fMRI序列及3D结构像扫描,采用fALFF算法获得并比较4个时间点fALFF差异的脑区。结果 4个时间点fALFF总体差异显著的脑区为右侧中央后回、右侧岛叶、右侧小脑、左侧海马旁回、双侧额下回、小脑蚓部、右枕叶、楔前叶、左侧缘上回(P均0.05);静脉注射酒精后fALFF值减低的脑区为双侧额上回、右侧额下回、右侧梭状回、右侧角回、双侧颞上回、右枕叶、左侧外侧沟、左侧中央后回、左侧楔状叶、左侧丘脑、左侧岛叶、前扣带回(P均0.05);静脉注射酒精后fALFF值增高的脑区为右侧额下回、右侧颞中回(P均0.05)。结论酒精暴露急性期脑代谢活动发生显著变化,主要涉及默认网络、奖赏及情绪加工系统、视听皮层等。     

三叉神经痛患者半月节射频热凝术前后静息态fMRI的变化

目的 利用功能MR研究三叉神经痛患者半月节射频热凝术(PRT)前后脑功能局部一致性(ReHo)变化。方法 对31例接受PRT手术的三叉神经痛患者在术前1周及术后6个月分别进行MR扫描,采集其大脑结构及静息态功能图像;同时记录患者的疼痛视觉模拟量表(VAS)评分、面部麻木程度及患病时间。比较患者手术前后全脑ReHo值出现显著变化的脑区,再将这些脑区的平均ReHo值与临床观察指标进行相关分析。结果 与术前相比,患者术后右侧梭状回(FG)和双侧前扣带回(ACC)的ReHo值显著增高(P均0.05),而左侧顶下小叶(IPL)、右侧距状回、右侧颞中回(MTG)、左侧中央后回(PoCG)以及左侧岛叶的ReHo值显著降低(P均0.05)。左侧PoCG的ReHo值与手术前后VAS评分呈正相关,术前右侧MTG的ReHo值与手术前后VAS的变化值呈负相关。结论 PRT术后多个脑区的Re-Ho出现显著变化,这些区域与痛觉感知、情感表达及情绪体验密切相关,其中左侧PoCG具有作为靶点判断疼痛部位及评估疼痛强度的潜在价值。     

针刺治疗老年轻度脑外伤后认知功能障碍的静息态功能磁共振研究

目的利用静息态功能磁共振(rs-fMRI)评估醒脑开窍针刺法对老年轻度脑外伤(mTBI)后认知功能障碍的治疗作用。方法选20例老年mTBI患者为治疗组,20例健康老人为对照组,治疗组在针刺前后行rs-fMRI扫描及蒙特利尔认知评估量表(MoCA)评估,采用比率低频振幅(fALFF)方法,比较治疗组在治疗前后及与对照组之间脑功能的差异。结果老年mTBI组MoCA评分比对照组显著降低,且双侧额叶和顶叶、左侧角回和颞叶等区域fALFF降低;针刺后MoCA评分比针刺前显著升高,双额叶部分区域fALFF值升高。结论老年mTBI后出现多个脑区功能异常,或与认知受损相关,醒脑开窍针刺法可影响双额叶部分区域脑功能,对老年mTBI后认知功能障碍有治疗作用。     

精索显微去神经术治疗慢性睾丸痛1例报告并文献复习

目的：探讨慢性睾丸痛（CTP）的临床特点和诊治方法。方法：报告1例CTP患者的临床资料,患者输精管结扎术后多年双侧CTP,左侧附睾切除后仍无缓解。术前疼痛视觉模拟评分（VAS）：左侧睾丸疼痛8分,右侧4分。人院后接受左侧精索显微去神经术（MDSC）＋右侧输精管再通术。结果：术后随访1年VAS评分：左侧睾丸疼痛2分,右侧0分,患者恢复正常生活工作。结论：MDSC通过切断髂腹股沟神经和精索内相关神经,来阻断睾丸疼痛信号的传导,在特发性或难治性CTP的治疗中值得推荐。     

健康成人膀胱储尿功能的大脑静息态功能网络连接研究

目的:研究采用静息态功能磁共振(rs-fMRI)成像技术分析健康成人膀胱储尿功能的大脑功能网络连接。方法:2014年10月~2016年10月筛选健康受试者44例,其中男19例,女25例,年龄22~50岁,均为右利手。分别在膀胱空虚状态和膀胱充盈状态进行2次rs-fMRI扫描。扫描后通过rs-fMRI分析软件Matlab、SPM8、DPABI等进行处理分析。选取左侧前额叶(X=-39,Y=45,Z=-12);右侧前额叶(X=3,Y=49,Z=40);左侧前扣带回(X=-7,Y=-30,Z=-6);右侧前扣带回(X=9,Y=42,Z=-6);左侧颞叶(X=-33,Y=-51,Z=6);左侧颞上回(X=-57,Y=-18,Z=9)6个种子点,进行全脑功能连接。结果:6个种子的全脑功能连接区域:左侧前额叶,激活区域为双侧岛叶,右侧额下回;抑制区域为左侧海马旁回,左侧枕叶,左侧前额叶。右侧前额叶,抑制区域为左侧岛叶。左侧颞叶,抑制区域为右侧眶额叶。左侧颞上回,激活区域为左侧前额叶,右侧距状回;抑制区域为右侧小脑。左侧颞叶,激活区域为海马旁回;抑制区域为右侧额下回,右侧旁中央小叶。左侧颞上回,激活区域为左侧前额叶,左侧额中回,左侧中央颞叶;抑制区域为右侧岛叶,左侧小脑,左侧颞上回。结论:通过功能连接(functional connectivity,FC)分析发现大脑控尿区域不是某一区域单独完成的,而是广泛的、存在着功能相关性的多个区域共同协调完成的。     

心律失常射频消融术后焦虑状态患者的静息态MRI低频振幅分析

目的采用低频振幅(ALFF)观察心律失常射频消融术后出现焦虑状态患者的全脑功能活动。方法收集符合纳入标准的26例心律失常射频消融术(RFCA)后焦虑状态患者作为RFCA组,纳入同期年龄、性别相匹配的26名健康志愿者作为正常对照组,2组均行fMRI,对2组有差异脑区的ALFF进行双样本t检验,提取有差异的脑区与汉密尔顿焦虑量表评分进行偏相关分析。结果与正常对照组相比,RFCA组左侧颞中回、右侧壳核、左侧杏仁核ALFF增高,左侧前额叶背外侧皮层(DLPFC)、右侧楔前叶、左侧额中叶、右侧枕中叶ALFF减低差异有统计学意义(Alphasim校正,P0.01)。左侧DLPFC的ALFF值与HAMA评分呈负相关(r=-0.872,P=0.013)。结论心律失常射频消融术后焦虑状态患者在静息状态下存在脑功能的异常,ALFF有助于为该疾病的发病机制提供更多证据。     

脑fMRI观察电针神门及三阴交穴治疗失眠机制

目的利用fMRI技术探讨电针神门、三阴交穴治疗失眠的机制。方法对7名失眠患者（失眠组）及6名健康志愿者（正常对照组）分别在无任何刺激状态下行静息扫描、电针刺激双侧神门和三阴交穴下行BOLD-fMRI扫描,观察两组受试者的激活脑功能区。采用SPM基本模式中的单样本t检验进行统计分析。结果两组受试者均可见脑岛（BA13）明显激活。但在失眠组,右侧丘脑腹前核、右侧壳核、左内侧苍白球、左侧中央前回（BA9）、双侧尾状核头部被特异性地激活。结论电针神门、三阴交穴治疗失眠的机制可能是电针刺激激活了丘脑腹前核、尾状核、壳核、内侧苍白球、丘脑网状核以及其他睡眠中枢,整合传入和传出的信息,调节睡眠;并可通过不同的通路调畅情志,舒缓压力,达到助眠作用。     

前庭功能的静息态脑功能磁共振成像

目的探讨基于局部一致性(ReHo)、低频振幅(ALFF)和低频振幅分数(fALFF)的静息态脑fMRI技术对于前庭冰水刺激诱导后脑内前庭功能相关区域的BOLD信号变化。方法纳入20名正常志愿者,在10s内将15ml 0℃冰水注入受试者右侧外耳道,采用平面回波序列和32通道头线圈采集受试者的BOLD静息态脑功能成像数据,采用MatLab 7.1和SPM 8进行数据预处理,预处理后的数据采用REST 1.4软件计算获得ReHo、ALFF和fALFF图像。结果ReHo、ALFF和fALFF图像均出现多个脑区激活增加或减低,其中3个参数值增加即激活脑区主要包括岛叶皮层、颞上回、顶下小叶、脑干、海马旁回、小脑半球等,减低即负激活脑区主要包括额上回、额中回、额下回、颞中回、枕下回、楔前叶等。结论人类存在广泛的涉及前庭信息处理的脑皮层及皮层下网络区域,静息态脑功能成像ReHo、ALFF、fALFF分析方法具有较好的一致性,具备定位前庭功能区的潜在能力。     

机械性伤害性刺激诱发疼痛的脑区定位:功能性磁共振成像研究

目的 应用功能性磁共振成像技术定位机械性伤害性刺激诱发疼痛的脑区.方法 健康男性志愿者20名,年龄20 ～ 40岁,体重指数18 ～ 25 kg/m2,采用300 g von Frey纤维丝刺激志愿者左足心.1周后行功能性磁共振成像扫描,包括10 s的初始采集信号扫描及静息态(20 s)与刺激态(20s)交替循环6次扫描.采用SPM2软件进行图像分析.结果 300 g von Frey纤维丝机械性伤害性刺激诱发疼痛的脑区包括:双侧前扣带回、右侧岛叶和双侧初级体感皮层.结论 机械性伤害性刺激诱发疼痛的脑区包括双侧前扣带回、右侧岛叶和双侧初级体感皮层.     

首发抑郁症伴自杀意念患者中缝核功能连接的改变

目的 观察首发抑郁症伴自杀意念（SI）患者中缝核功能连接（FC）改变。方法 前瞻性纳入98例首发抑郁症患者,根据伴SI与否将其分为伴SI组（n=56）与不伴SI组（n=42）;另以47名健康志愿者为对照组。以静息态功能MRI观察背侧中缝核（DRN）、中缝中央核（MRN）与全脑间的FC;比较3组及两两组间FC,分析伴SI组差异脑区FC与临床资料的相关性。结果 相比对照组,伴与不伴SI组DRN与左侧小脑及左侧壳核的FC均降低（P均<0.05）,MRN与右侧颞下回的FC均升高而与左侧额下回、右侧枕上回、左侧顶下小叶及左侧壳核的FC均降低（P均<0.05）;其中,伴SI组DRN与左侧壳核的FC高于不伴SI组（P<0.05）;相比不伴SI组及对照组,伴SI组MRN与右侧中央后回的FC升高（P均<0.05）。伴SI组MRN与左侧壳核的FC与24项汉密尔顿抑郁量表（HAMD-24）体质量得分呈正相关（r_s=0.297,P=0.026）。结论 首发抑郁症伴SI患者中缝核与皮层和皮层下区的FC存在异常改变,且其MRN与左侧壳核的FC与HAMD-24体质量得分呈正相关。     

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.