寰枢椎椎弓根钉内固定术治疗寰枢椎不稳疗效分析

目的探讨经寰枢椎椎弓根钉内固定术治疗寰枢椎不稳的临床疗效。方法回顾性分析自2015-06—2018-12采用后路寰枢椎椎弓根钉内固定术治疗的32例寰枢椎不稳,术中稳定寰枢椎复合体,在寰椎后弓和枢椎椎板间植骨。结果32例均获得随访,随访时间6~24个月。术中、术后均未发现椎动脉、脊髓、神经根损伤,颈部疼痛、僵硬及神经功能均明显改善。术前JOA评分为(7.7±0.8)分,术后3个月改善为(14.6±0.7)分,术后1年为(15.3±0.8)分;术后3个月JOA评分改善率为(76.3±5.4)%,术后1年JOA评分改善率为(83.5±7.3)%。本组寰椎、枢椎各置入64枚椎弓根钉,术后复查寰椎60枚椎弓根钉位置良好、枢椎64枚椎弓根钉位置良好,寰椎4枚椎弓根钉穿入椎动脉孔内侧约1 mm,考虑与内倾角度不足,但按置钉标准位置仍属于良好。27例行后路植骨者均骨性融合,5例因枢椎骨折脱位行C1~3固定且未植骨者术后6个月骨折愈合后拆除内固定物。结论寰枢椎椎弓根钉内固定术治疗寰枢椎不稳能显著增强寰枢椎稳定性,且复位满意、固定节段短、植骨融合率高,可取得满意疗效。     

寰椎后弓环抱钩连接枢椎椎弓根螺钉治疗寰枢椎不稳

目的探讨寰椎后弓环抱钩连接枢椎椎弓根螺钉治疗寰枢椎不稳的可行性及其临床疗效。方法 2009年6月—2013年12月,本院收治寰枢椎不稳患者22例,采用寰椎后弓环抱钩连接枢椎椎弓根螺钉手术治疗,其中男15例,女7例;年龄24~86岁,平均52.2岁。其中17例有不同程度的脊髓受压。术前Frankel分级B级3例,C级4例,D级10例,E级5例。术前日本骨科学会(Japanese Orthopaedic Association,JOA)评分为(9.82±0.80)分。术后定期观察内固定物的可靠性及植骨融合情况。结果所有患者均获随访,随访6~12个月,平均9个月。所有患者植骨融合良好。术后JOA评分(14.59±1.22)分,与术前相比有明显改善。术前Frankel分级B级3例,术后恢复至C级、D级各1例;术前C级4例,术后恢复至D级2例,E级1例;术前D级10例,术后恢复至E级3例。结论寰椎后弓环抱钩连接枢椎椎弓根螺钉内固定系统,术中操作安全简便、复位固定可靠、植骨融合率高,可作为现有寰枢椎内固定系统的有效补充。     

寰枢椎椎弓根螺钉结合横联加压环抱内固定术在不稳定性寰椎骨折治疗中的临床应用

目的:探讨寰枢椎椎弓根螺钉结合横联环抱加压内固定术治疗不稳定性寰椎骨折的临床效果。方法:回顾性分析2013年8月～2017年8月采用寰枢椎椎弓根螺钉结合横联加压环抱内固定术治疗的不稳定性寰椎骨折患者14例,其中男9例,女5例;年龄22～59岁,平均43.1±1.2岁。患者均有明确颈部外伤史,其中6例患者出现四肢麻木、无力等不同程度的脊髓神经损害表现。术前均行X线片、CT及三维重建、MRI等影像学检查明确诊断,术前行颅骨牵引,在全身麻醉下行后路寰枢椎椎弓根螺钉结合横联加压环抱内固定术。记录手术时间、出血量及并发症情况,JOA评分法评估患者术前及术后1年时的神经功能状态。术后1周内、3个月、半年及1年以上定期复查颈椎正侧位X线片,评估内固定位置及骨折愈合情况。结果:所有患者均顺利完成手术,术中无椎动脉、脊髓及神经根损伤发生,术中1例出现静脉丛损伤,经止血纱填塞,出血得到控制,未出现颅脑缺血症状。手术时间80～140min,平均120.3±10.5min;出血量150～310ml,平均180.5±30.5ml。术前JOA评分5～11分,平均7.3±0.5分;术后1年JOA评分13～17分,平均14.4±0.3分,改善率为76.5%～93.4%,平均(86.5±0.9)%。所有患者寰椎骨折于术后3～6个月达骨性融合,平均3.3±0.2个月,末次随访未发生螺钉移位、松动、断裂等内固定物相关并发症。结论:寰枢椎椎弓根螺钉结合横联加压环抱内固定术治疗不稳定寰椎骨折,具有骨折复位彻底、固定牢靠的特点,是治疗不稳定寰椎骨折的有效方法。     

寰椎后弓椎板钩联合枢椎椎弓根螺钉固定治疗游离齿状突并可复性寰枢椎脱位

背景：游离齿状突并可复性寰枢椎脱位常需要手术治疗,但目前缺乏操作简单且安全有效的寰枢椎内固定方式。 目的：评估寰椎后弓椎板钩联合枢椎椎弓根螺钉固定植骨融合治疗游离齿状突并可复性寰枢椎脱位的疗效。 方法：回顾性分析2005年7月至2012年6月采用寰椎后弓椎板钩联合枢椎椎弓根螺钉固定自体髂骨植骨融合术治疗游离齿状突并可复性寰枢椎脱位患者l1例。对脱位复位情况、内固定植骨融合率、JOA功能评分、影像学评估及术后并发症等进行分析。 结果：11例术中均未发生椎动脉和脊髓损伤。术后均获得随访,随访时间为12~37个月,平均25个月,均未发生内固定物松动、断裂,术后疼痛和神经症状均得到缓解,术后JOA评分较术前明显改善（P＜0.01）,寰枢椎均融合。 结论：寰椎后弓椎板钩联合枢椎椎弓根螺钉固定植骨融合术治疗游离齿状突并可复性寰枢椎脱位是一种安全有效的方法。     

经后路寰枢椎椎弓根螺钉固定融合术治疗寰枢椎失稳

目的:探讨应用寰枢椎椎弓螺钉固定技术治疗寰枢椎失稳的临床疗效。方法:对2003年6月至2010年3月对收治的32例寰枢椎失稳患者采用寰枢椎椎弓根螺钉技术进行治疗,其中男21例,女11例;年龄28～66岁,平均42.5岁;齿状突骨折18例,先天性游离齿状突7例,Jefferson骨折合并齿状突骨折4例,类风湿性关节炎致寰枢椎不稳3例。所有患者均伴有寰枢椎半脱位或失稳。术前JOA评分4～14分,平均(9.1±0.3)分。术前完善颈椎X线(包括动力位片)、螺旋CT三维重建及MRI等影像学检查,在CT轴位片上对寰枢椎椎弓根螺钉的置入点、置入角度及钉道长度等数据进行测量,并行颅骨牵引术。手术在全麻下进行,直视下完成寰枢椎椎弓根螺钉的置入、复位和植骨融合,植骨块被向后预弯的横联紧紧卡压于寰椎后弓与枢椎椎板棘突之间。比较术前和术后6个月的JOA评分,并计算改善率。结果:32例患者共置入寰枢椎螺钉128枚,无脊髓、神经根和椎动脉损伤发生。所有患者获随访,时间6～48个月,平均16个月。术后JOA评分11～17分,平均(15.9±0.2)分,平均改善率为86.1%。骨折的齿状突均完全愈合,植骨块全部融合,无内固定断裂和松动。结论:寰枢椎椎弓根螺钉固定技术是治疗寰枢椎失稳的有效方法,具有固定牢靠,操作相对安全方便、融合率高等优点,值得临床应用。     

寰枢椎椎弓根钉固定融合治疗寰枢椎失稳

目的探讨经后路寰枢椎椎弓根钉固定融合技术治疗寰枢椎失稳的手术方法、疗效。方法采用后路寰枢椎椎弓根螺钉系统,固定、融合治疗32例寰枢椎失稳患者,术中在C型臂X线机辅助下行C1、C2置钉,复位固定,取自体髂骨行椎板间植骨。术后颈托固定3个月。结果 32例128枚螺钉成功置入,复位满意,术中未发生椎动脉和脊髓损伤。患者全部获327个月定期随访,螺钉位置良好,钉棒无松动、断裂,术后36个月均获植骨融合。术前JOA评分（8.6±2.8）分;术后3个月JOA评分（14.9±1.8）分,恢复率76%92%,平均83%。结论经后路寰枢椎椎弓根钉固定融合技术具有直视下置钉、短节段固定、固定牢靠、植骨融合率高等特点,有利于稳定寰枢关节及脊髓功能的恢复,是一种较为理想的治疗寰枢椎失稳的内固定术式。     

寰枢椎椎弓根钉内固定与融合术治疗寰枢椎不稳

目的观察采用寰枢椎椎弓根钉内固定与融合术治疗寰枢椎不稳的效果。方法对21例寰枢椎不稳行寰枢椎椎弓根钉内固定与融合术。结果本组平均随访23个月,神经症状得到不同程度的改善;螺钉位置良好,6个月后患者均获植骨融合;术后8个月JOA评分(13.9±2.1)分。结论寰枢椎椎弓根钉内固定治疗寰枢椎不稳是寰枢椎后路固定较好的手术方式。     

经椎弓根螺钉固定治疗不稳定性寰椎骨折——附22例报告

目的评价应用寰枢椎椎弓根螺钉固定技术治疗不稳定性寰椎骨折的临床疗效及安全性。方法采用寰枢椎椎弓根螺钉短节段固定加植骨融合技术对22例不稳定性寰枢骨折患者进行手术治疗,观察术后临床疗效、寰枢椎稳定性、手术并发症及植骨融合情况。结果所有患者寰枢椎间稳定性得到即刻恢复。平均随访时间26.4个月,无脊髓及椎动脉损伤等并发症发生,X线及CT复查显示螺钉位置良好,植骨融合时间平均3.4个月。结论采用寰枢椎椎弓根螺钉固定技术治疗不稳定性寰椎骨折.力学稳定性好,植骨融合率高,手术并发症少,是理想的术式。     

“直视法”椎弓根螺钉固定术治疗不稳定性寰枢椎骨折

目的评价应用"直视法"寰枢椎椎弓根螺钉固定术治疗不稳定性寰枢椎骨折的临床疗效及安全性。方法2011年1月—2014年12月,本院采用"直视法"寰枢椎椎弓根螺钉固定术并髂骨块植骨融合治疗22例寰枢椎不稳定性骨折患者,观察置钉的安全性、术后临床疗效、寰枢椎稳定性、手术并发症及植骨融合情况。结果所有患者寰枢椎椎弓根螺钉均一次置钉成功,寰枢间稳定性得到即刻恢复,无脊髓及椎动脉损伤等并发症发生,平均随访26.4月,影像学资料示螺钉位置良好,固定牢固,植骨融合时间平均3.4个月。结论采用"直视法"寰枢椎椎弓根螺钉固定术治疗寰枢椎不稳定性骨折,具有安全系数高、力学稳定性好、植骨融合率高及手术并发症少等优点,是治疗不稳定性寰枢椎骨折较为理想的技术。     

“in-out-in”多皮质枢椎椎弓根螺钉在寰枢椎脱位或不稳后路手术中的应用

目的:探讨应用“in-out-in”多皮质枢椎椎弓根螺钉后路融合内固定治疗寰枢椎脱位或不稳的临床疗效。方法:回顾性分析2014年1月~2016年1月,采用“in-out-in”多皮质枢椎椎弓根螺钉后路融合内固定治疗的26例寰枢椎脱位或不稳患者资料,男17例,女9例,年龄25~63岁,平均43±9岁;单侧椎动脉高跨10例,双侧高跨2例,C2/3融合致单侧枢椎椎弓根发育不良12例,双侧发育不良2例。患者均表现为颈部疼痛,VAS评分1~6分,平均3.12±2.13分;23例伴肌力下降及感觉异常,日本矫形外科协会(JOA)评分为5~11分,平均7.9±2.1分。术前行X线、CT和MRI检査,术后7d及3、6、12个月行X线和CT检査,观察植骨融合情况;比较各时间点VAS及JOA评分。结果:手术顺利完成,手术时间125~215min(153.7±27.9min);出血量160~650ml(263.1±68.5ml),3侧椎弓根钉应用“in-out-in”技术置钉过程中,出血多,改为椎板钉;无脊髓血管损伤及其他严重并发症发生。患者均获得8~20个月随访,平均12±4个月,术后6个月影像学检査见植骨均融合,无内固定松动,断裂发生。术后7d、3个月、6个月及末次随访时VAS评分分别为1.13±0.72、1.11±0.93、1.09±0.98及1.07±0.81分,较术前明显减轻(P0.05);术后7d、3个月、6个月及末次随访时JOA评分分别为12.9±1.8、13.4±2.3、13.6±1.9及13.8±2.1分,与术前比较明显改善(P0.05)。结论:“in-out-in”多皮质枢椎椎弓根螺钉后路融合内固定治疗寰枢椎脱位或不稳,临床疗效肯定。     

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.     

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.