关节镜下射频汽化治疗膝关节骨性关节炎的病例对照研究

目的探讨膝关节骨性关节炎患者行关节镜下清理术中射频汽化的治疗作用。方法 2003年6月～2004年6月在我院行关节镜下清理术应用射频汽化治疗的40例膝骨关节炎为实验组,同期40例关节镜下清理术未应用射频汽化治疗为对照组。手术前、后采用Lysholm评分进行膝关节功能评定。结果实验组术前Lysholm评分为(53.6±6.4)分,术后提高至(83.4±4.7)分(t=21.549,P=0.000)。对照组术前Lysholm评分为(55.5±5.1)分,术后提高至(79.8±6.1)分(t=20.697,P=0.000)。实验组术后Lysholm评分总分(83.4±4.7)分和疼痛项评分(18.6±3.9)分明显高于对照组(79.8±6.1)分和(16.6±3.8)分(t=2.957,P=0.004;t=2.323,P=0.023),但2组术后力量项评分无显著差异[(6.3±1.6)分vs(6.2±1.5)分,t=0.288,P=0.774]。结论关节镜下清理术中应用射频汽化可明显改善膝关节骨性关节炎患者术后关节功能和减轻疼痛。     

膝关节骨性关节炎关节镜下清理和联合髌外侧减压及康复治疗临床疗效的对比研究

目的对比研究膝关节骨性关节炎关节镜下清理和联合髌外侧减压及康复治疗的临床效果。方法依据美国风湿学会膝OA诊断标准选择膝骨性关节炎85例。采用抽签分组,A组行单纯关节镜下清理术,共39例;B组行关节镜下清理术＋髌外侧减压术,共46例。手术均由同一名医生完成。术后由同一康复组实施康复训练。2组均在术前、术后3个月和术后6个月分别用Lysholm评分表、膝关节百分法评分表及简化McGill疼痛量表PPI评分,以及髌骨倾斜试验、髌骨滑动试验等进行评估。结果A组术后3个月Lysholm评分、膝关节百分法和疼痛量表评分明显优于术前;术后6个月与术后3个月比较无显著性差异。B组术后3个月Lysholm、百分法和疼痛量表评分明显优于术前;术后6个月明显优于术后3个月。术后3个月A组恢复情况优于B组,术后6个月B组Lysholm评分优于A组。结论髌骨活动受限的膝关节骨性关节炎患者关节镜下清理术与术后康复可以改善膝部症状与膝关节功能。关节镜下清理联合髌外侧减压术后早期临床症状改善,随着康复训练的进展,6个月后临床症状、体征、膝部功能明显改善,优于单纯的关节镜下清理术。     

关节镜清理术在治疗膝痛风性关节炎中的临床应用——附34例报告

目的探讨关节镜清理术治疗膝痛风性关节炎的临床效果。方法回顾性分析2013年1月至2015年12月广州市番禺区中医院采用关节镜清理术治疗的34例单膝痛风性关节炎患者的临床资料,评估手术前后视觉模拟量表(VAS)评分和Lysholm膝关节功能评分。结果所有患者均经关节镜及病理检查明确诊断,术后随访10~24个月(平均16个月),术后1、6个月VAS评分和Lysholm评分分别为(2.8±1.1)分和(83±4)分、(1.4±1.0)分和(92±3)分,明显优于术前的(6.9±1.1)分和(64±8)分,手术前后比较,差异有统计学意义(P0.05)。术后5例出现发热,经对症处理后体温恢复正常;所有患者切口均甲级愈合,无关节内感染、血管神经损伤及下肢深静脉血栓形成发生。3例患者术后1个月内症状复发,与饮食控制不良相关,经保守治疗后缓解。结论关节镜清理术对非典型性膝痛风性关节炎具有重要的诊断价值,还可明显缓解患者疼痛症状,改善膝关节功能,短期疗效满意。     

关节镜清理术联合复方杜仲健骨颗粒治疗髌股关节炎的临床对照研究

目的观察复方杜仲健骨颗粒对髌股关节炎(PFOA)关节镜清理术预后的影响。方法笔者自2012-08—2014-12行关节镜清理术治疗120例PFOA,按照随机分组的方法 ,60例术后接受复方杜仲健骨颗粒治疗(观察组),60例不联用复方杜仲健骨颗粒(对照组)。分别于术前及术后4周、3、12个月采用Lysholm评分评价治疗效果。结果所有患者获得随访12~20(14.85±2.18)个月。所有患者术后切口均愈合良好,无感染、神经血管损伤等并发症。2组术后症状均获得改善。术后3、12个月观察组Lysholm评分均优于对照组,差异有统计学意义(P0.05)。术后4周及术后3个月时观察组Lysholm评分较对照组改善最为显著,在疼痛、关节不稳定及关节肿胀症状的细节评分差异有统计学意义(P0.05)。结论复方杜仲健骨颗粒可改善髌股关节炎关节镜术后功能及症状,疗效满意。     

关节镜治疗膝关节骨性关节炎疗效观察

目的观察关节镜下治疗膝关节骨性关节炎的临床疗效。方法回顾性观察膝关节镜下清理术治疗早中期膝关节骨性关节炎和广泛清理术结合钻孔微骨折术治疗晚期膝关节骨性关节炎的疗效。结果24个月内,早中期组Lysholm功能评分由术前(41.37±3.46)分提高到(80.3±7.94)分。晚期组Lysholm功能评分由(36.58±4.27)分提高到(75.6±6.36)分。结论对早中期骨性关节炎采用关节镜下有限清理,对晚期骨性关节炎采用关节镜下广泛清理加软骨微骨折术,辅以积极康复治疗,均可取得良好疗效。     

电针在膝骨性关节炎关节镜清理术后增效作用的病例对照研究

目的：探讨电针在膝骨性关节炎关节镜清理术后的增效作用.方法：2008年5月至2010年7月,收治膝骨性关节炎患者78例（78膝）,分为两组,其中试验组42例,男16例,女26例;年龄41～63岁,平均（53.62±6.53）岁;病程8 ～24个月,平均（10.35±6.42）个月;采用关节镜下有限清理术结合术后电针治疗.对照组36例,男14例,女22例;年龄40～62岁,平均（54.34±7.67）岁;病程6～25个月,平均（11.94±5.13）个月;采用单一关节镜下关节清理术治疗.两组患者术后均行股四头肌等长收缩和膝关节屈伸功能锻炼.以视觉模拟评分法（visual analog scale,VAS）和Lysholm膝关节功能评分标准进行治疗前后及组间比较.结果：所有患者获随访,时间12～30个月,平均15.6个月.末次随访时试验组和对照组VAS较术前降低,而Lysholm评分除支撑外,其余各项评分均较疗前升高.两组治疗后VAS比较差异有统计学意义;Lysholm评分在跛行、疼痛、肿胀、爬楼及下蹲方面差异有统计学意义,而交锁和不稳评分差异无统计学意义.结论：电针具有明显缓解临床症状、体征,改善膝关节活动度的作用,在膝骨性关节炎关节镜清理术后具有显著增效作用,其远期疗效优于单用关节镜清理术,对膝关节的功能改善更具优越性,是值得临床推荐的一种治疗膝骨性关节炎的中西医结合疗法.     

关节镜下微骨折术治疗髌股关节炎疗效观察

目的:观察关节镜下微骨折术治疗髌股关节炎的临床疗效。方法:选取运用关节镜下微骨折术治疗髌股关节炎患者38例(42膝),根据VAS评分及Lysholm评分标准综合评定术前和术后3个月的临床疗效。结果:所有患者均获得随访,随访时间8~35个月,平均(19.6±8.6)个月。VAS评分术前(79.22±10.46)分,术后3个月(11.24±3.25)分;Lysholm评分术前(32.1±3.1)分,术后3个月(72.0±4.1)分。手术前后比较,差异均有统计学意义(P0.05)。2例(3膝)患者有轻微疼痛,其余患者疼痛消失或者明显减轻。结论:关节镜下微骨折术是治疗髌股关节炎的有效方法,疗效确切,安全性高,术后并发症少,具有良好的社会效益和经济效益,值得临床推广应用。     

关节镜下髌骨去神经化处理联合微骨折术治疗髌股关节炎

目的 :探讨关节镜下髌骨去神经化联合微骨折术治疗髌股关节炎的临床疗效。方法 :自2015年5月至2018年5月治疗60例膝关节退行性髌股关节炎患者,男28例,女32例;年龄24～56(40.5±3.35)岁。其中30例行单纯关节镜检查清理术(对照组),30例行关节镜下清理、髌骨周围去神经化联合软骨锥髌股关节面微骨折处理(治疗组)。术后采用VAS、Lysholm、Kujala评分评价治疗效果。结果:所有患者术后未出现切口感染、血管神经损伤、下肢深静脉血栓等并发症。60例患者均获随访,时间7～36个月,平均12.5个月。两组患者术后4周VAS评分均改善,而且治疗组改善明显优于对照组,差异有统计学意义(P0.05)。两组患者术后末次随访时行Lysholm、Kujala评分比较,治疗组改善明显优于对照组。结论:髌骨去神经化处理联合微骨折术治疗髌股关节炎能更好地缓解疼痛,改善膝关节功能。     

钙化性冈上肌腱炎的关节外微创清理和治疗

[目的]探讨关节外关节镜下清理治疗保守治疗无效的慢性钙化性冈上肌腱炎的手术方法并评价其疗效.[方法]对18例(男5例,女13例;年龄34～78岁,平均56.4岁)患钙化性冈上肌腱炎伴肩部疼痛和活动受限,且保守疗法超过3个月无效的患者行关节镜下手术治疗.关节镜由肩峰下间隙进入,于肩关节外行肩峰下滑囊清理切除并探查和清除冈上肌腱钙化病灶.采用VAS疼痛评分、Constant-Murley评分和X线对患者进行手术前后的评估.[结果]平均随访时间为9个月(6～15个月),肩部疼痛和功能障碍消失或明显改善,平均VAS疼痛评分术前(7.8±0.6)分,术后(1.7±0.4)分.平均Constant-Mudey评分术前为(61±7)分,术后最后一次复查为(91±4)分.术后X线显示仅2例患者钙化灶有少量残留,但术前症状消失.无需行肩袖修补者.[结论]关节镜下经关节外清除钙化沉积结合滑囊切除对保守治疗无效的慢性钙化性冈上肌腱炎是一种可靠和有效的治疗方法.     

关节镜手术治疗老年性严重退行性髌骨外侧高压症

目的探讨关节镜下外侧支持带松解加清理术治疗老年性严重退行性髌骨外侧高压症的方法及疗效。方法对59例髌骨外侧高压合并髌股关节软骨退变严重的老年患者行关节镜下清理术的同时用射频刀松解外侧支持带。45例切开外侧支持带纤维,不切断股外侧肌(有限松解组);14例切开外侧支持带纤维并切断股外侧肌(完全松解组)。分别观察术后1、2年疼痛及上下楼改变情况和患者术后2年主观满意情况,术后股四头肌肌力恢复时间,手术前及手术后1、2年的Lysholm评分。结果 59例患者症状均改善,Lysholm评分:术前平均64.2分±6.5分,术后2年提高到平均82.8分±4.6分(P<0.05)。有限松解组平均提高18.5分±6.2分,完全松解组平均提高20.3分±8.2分,两组比较差异无统计学意义(P>0.05)。有限松解组患者肌力恢复时间为6.5个月,完全松解组肌力恢复时间为9.1个月,两组比较差异有统计学意义(P<0.05)。患者主观满意率为91.5%。结论对老年患者伴有髌股关节软骨退变严重的髌骨外侧高压症行关节镜下外侧支持带松解加清理术,能有效改善大部分患者的症状,使用外侧支持带有限松解术后恢复较快。     

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.