儿童骨折的微创治疗

目的:探讨儿童骨折的特殊性,对有限内固定治疗效果进行分析。方法:回顾分析手术治疗的132例儿童骨折病例,男107例,女25例,年龄4¹3岁,平均8·3岁。粉碎性骨折60例,横断骨折34例,斜形骨折29例,螺旋骨折9例。开放性骨折44例;新鲜骨折123例,骨折4周内9例。合并其他部位骨折43例57处。结果:132例均获随访,随访时间6个月⁵·5年,平均1·32年。根据评定标准:优良129例,差3例（1例严重肘内翻畸形,1例膝关节屈伸部分受限,1例术后2年余患肢增长12·5mm）。术后创面感染13例,合并肺炎5例。结论:儿童不稳定性骨折适时有限内固定结合外固定疗效可靠并能减少并发症的发生。     

外固定支架结合有限内固定治疗儿童股骨远端骨折

目的 :探讨外固定支架结合有限内固定治疗儿童股骨远端骨折的临床疗效。方法 :自2008年1月至2014年6月,采用外固定支架结合有限内固定法治疗儿童股骨远端骨折17例,其中男12例,女5例;年龄6~13岁,平均10.2岁;病程1 h~2 d。所有患儿经X线片确诊,股骨髁上骨折11例,髁间粉碎性骨折6例。按AO/ASIF分型:A1型9例,A2型5例,C1型3例。观察并记录患者术中及术后并发症、术后放射学检查、下肢长度及膝关节活动度,并采用KSS膝关节功能评分对膝关节功能进行评分。结果:17例患者均获随访,时间6~38个月,平均24.4个月。术后均无神经血管损伤表现,出现外固定针松动1例,针道感染2例,双侧肢体不等长3例。膝关节活动度及长度测量(与健侧对比):平均屈曲受限10°(0°~20°),平均伸直受限4°(0°~10°),平均内/外翻3°(0°~5°)。末次随访时膝关节功能KSS临床评分为96.4±5.0;优16例,良1例。X线片显示所有骨折愈合,未发现骨骺早闭现象。结论:采用外固定支架结合有限内固定方法治疗儿童股骨远端骨折,具有手术操作简单、固定牢固、早期功能锻炼等优点。     

组合式桥接内固定系统固定治疗儿童四肢干骺端骨折

目的探讨组合式桥接内固定系统固定治疗儿童四肢干骺端骨折的疗效。方法回顾性分析2015年10月至2018年12月期间南京医科大学附属常州第二人民医院骨科采用组合式桥接内固定系统固定治疗的16例儿童干骺端骨折患者资料。男11例,女5例;年龄为8~14岁,平均11.0岁。骨折部位:肱骨近端4例,股骨远端3例,胫骨近端3例,胫骨远端6例;骨折按Salter-Harris分型:Ⅱ型6例,Ⅲ型5例,Ⅳ型5例。受伤至手术时间为3~8 d,平均5.3 d。记录患者的骨折愈合时间、并发症发生情况(术后感染、内固定失效)及术后功能恢复情况等。结果16例患者术后获12~18个月(平均13个月)随访。16例儿童患者术后均获骨性愈合,骨折愈合时间为2~5个月(平均2.4个月)。末次随访时4例肱骨近端骨折患者根据Neer评分标准评定疗效:均为优;6例股骨远端骨折或胫骨近端骨折患者根据美国特种医院膝关节功能评分标准评定疗效:优5例,良1例;6例胫骨远端骨折患者根据Baird评分标准评定疗效:优5例,良1例。随访过程中无一例患者发生术后感染、断钉、断棒及骨折不愈合等并发症。结论组合式桥接内固定系统固定治疗儿童干骺端骨折具有微创、操作简单、固定可靠及并发症少等优点,是儿童干骺端骨折的一种可选治疗方案。     

有限内固定结合外固定支架治疗Pilon骨折

目的　探讨有限内固定结合外固定支架治疗胫骨Pilon骨折的临床疗效。方法　采用有限内固定结合外固定支架治疗Pilon骨折 14例。根据Ruedi Allgower骨折分型:Ⅰ型 3例,Ⅱ型 5例,Ⅲ型 6例。按Teeny踝关节功能评分标准进行疗效评价。结果　全部病例获得随访,随访时间 6个月 ~5年,平均 4 1年;骨折愈合时间 6~24周(平均 10 5周)。踝关节功能评分,优 9例、良 2例、可 2例、差 1例。结论　采用有限内固定结合外固定支架治疗Pilon骨折,能减少并发症并获得较好疗效。     

有限切开复位经皮克氏针内固定治疗儿童难复性Gartland Ⅲ型肱骨髁上骨折

目的:采用有限切开复位经皮克氏针固定治疗儿童难复性Gartland Ⅲ型肱骨髁上骨折,观察临床效果。方法:2007年5月至2014年10月对132例难复性Gartland Ⅲ型肱骨髁上骨折进行治疗,其中男82例,女50例;年龄2~14岁,平均5.8岁。根据骨折远端移位方向选择骨膜撕裂侧入路,在医师手指引导下行骨折闭合复位,复位满意后经皮交叉克氏针固定,石膏外固定,早期功能锻炼。结果:132例病例均获随访,时间6~36个月,平均13.7个月。优95例,良27例,一般8例,差2例。结论:有限切开复位内固定治疗儿童难复性Gartland Ⅲ型肱骨髁上骨折操作简单,不受肘部肿胀的影响,复位成功率高,术后肘部功能好。     

儿童髋部锁定加压钢板固定治疗学龄儿童股骨转子下骨折

[目的]探讨儿童髋部锁定加压钢板固定治疗学龄儿童股骨转子下骨折的疗效。[方法]2010年1月~2012年1月采用有限切开复位、儿童髋部锁定加压钢板固定治疗学龄儿童股骨转子下骨折16例。男12例,女4例;年龄8~13.8岁,平均11.6岁。根据Seinsheimer骨折分型:ⅡA型1例,ⅡB型4例,ⅡC型3例,ⅢA型4例,ⅢB型2例,Ⅳ型2例。[结果]所有患儿均获随访,随访时间18~42个月,平均29个月;骨折均获骨性愈合,愈合时间10~19周,平均12.7周。根据Sanders评分系统对髋关节功能评分:优14例(87.5%),良2例(12.5%),优良率100%。伤侧肢体过度生长3~9 mm,平均5mm。切口浅表感染及内固定物取出困难各1例,未出现断钉、内固定松动及继发骨折移位,无骨折迟延愈合、不愈合、畸形愈合及内置物取出后再骨折,无髋内外翻畸形、肢体旋转畸形及股骨头缺血性坏死等并发症。[结论]儿童髋部锁定加压钢板固定治疗学龄儿童股骨转子下骨折具有复位良好,固定稳定,并发症少,术后可早期行关节功能练习等优点,是一种有效的内固定方法。     

肘关节后方入路结合钢板螺钉内固定治疗向后孟氏骨折脱位

目的总结肘关节后方单切口入路结合钢板螺钉内固定治疗向后孟氏骨折脱位的疗效。方法 2012年1月-2014年1月,收治9例向后孟氏骨折脱位患者,均经肘关节后方单切口入路行钢板螺钉内固定。男6例,女3例;年龄25~49岁,平均33.7岁。致伤原因:高处坠落伤5例,摔伤4例。骨折分型:Jupiter A型3例,B型4例,C型2例。均合并不同程度桡骨小头骨折。伤后至手术时间为5~9 d,平均6.5 d。结果术后患者切口均Ⅰ期愈合。9例患者均获随访,随访时间13~32个月,平均16.3个月。X线片复查示骨折均愈合,愈合时间2~4个月,平均3.2个月;随访期间无创伤性骨关节炎及异位骨化等发生。末次随访时,Mayo肘关节功能评分87~95分,平均91.7分;其中优6例,良3例,优良率100%。结论采用肘关节单切口入路结合钢板螺钉内固定治疗向后孟氏骨折脱位具有手术视野显露充分、损伤小等优点,可获得较好疗效。     

维持第四、五掌骨基底间稳定性对于治疗钩骨-掌骨关节损伤的疗效分析

目的探讨维持第4、5掌骨基底间稳定性对于治疗钩骨-掌骨关节损伤的疗效。方法 2015年9月—2017年6月收治13例闭合性钩骨-掌骨关节损伤患者,男12例,女1例;年龄17~55岁,平均30.8岁。致伤原因:拳击硬物10例,摔伤3例。单纯第4掌骨基底骨折2例,第4掌骨基底骨折合并掌骨间韧带断裂1例,第4掌骨基底骨折合并第5掌骨基底骨折7例,第4掌骨基底骨折合并第5掌骨基底骨折伴脱位2例,合并钩骨骨折的第4、5掌骨基底骨折1例。受伤至手术时间5~11 d,平均7.2 d。依据第4、5掌骨基底间稳定性改变程度进行初步分型:Ⅰ型2例、Ⅱ型1例、Ⅲ型7例、Ⅳ型2例、Ⅴ型1例。以复位第4、5掌骨基底间稳定性为原则,采取相应的手术方法内固定。结果术后患者切口均Ⅰ期愈合,无感染、皮肤坏死等发生。13例患者均获随访,随访时间6~18个月,平均9.4个月。骨折均达临床愈合,愈合时间5.5~8.0周,平均6.3周。均未发生钢板断裂、骨折再脱位、骨折畸形愈合及骨不连等并发症。术后6个月手功能根据手外科TAM功能评定标准分级:优9例,良3例,可1例,优良率92.3%。结论第4、5掌骨基底间稳定性对钩骨-掌骨关节损伤的分型和治疗具有重要意义。     

弹性髓内针治疗儿童Judet Ⅲ度桡骨颈骨折13例

目的探讨使用弹性髓内针治疗JudetⅢ度儿童桡骨颈骨折的方法及效果。方法自2009年3月至2012年8月使用弹性髓内针治疗儿童桡骨颈骨折13例,男10例,女3例;年龄5~14岁,平均8.7岁。Judet分度均为JudetⅢ度,其中1例为桡骨颈骨折合并肱骨内上髁骨折。结果 13例均获随访,平均随访时间8.2个月(6~12个月)。术后功能评价优8例,良4例,一般1例,优良率92.3%。结论弹性髓内针治疗儿童桡骨颈骨折是一种操作简单、安全且微创的方法,尤其适用于JudetⅢ度骨折,优良率高,并发症少。     

微创内固定系统在高能量胫骨平台骨折中的应用

目的:探讨微创内固定系统治疗高能量胫骨平台骨折的方法和临床疗效。方法:本组27例,男19例,女8例;年龄21~59岁,平均36岁;其中左侧12例,右侧15例。按Schatzker分型:Ⅴ型9例,Ⅵ型18例。其中合并前交叉韧带撕脱骨折3例,后交叉韧带断裂2例,半月板损伤3例。用改良内外侧联合切口,行微创内固定系统结合有限接触加压钢板(LC-DCP)内固定,其中3例半月板损伤,2例给予修补,另1例部分切除;3例前交叉韧带撕脱骨折给予钢丝固定;2例后交叉韧带断裂行Ⅱ期手术。术后2周、1、3、6个月、1年随访,行摄片及关节活动度检查,测定胫骨平台内翻角(TPA)及后倾角(PA);术后1年行膝关节HSS评分。结果:术后与术后1年TPA及PA平均值的差异无显著性统计学意义(TPA:t=1·012,P=0·356;PA:t=0·667,P=0·521)。术后1年膝关节HSS评分平均为86·9分(56~98分),根据此评分标准:优15例,良7例,中4例,差1例。结论:微创钢板治疗高能量胫骨平台骨折是理想、有效的方法,它具有手术创伤小、并发症少,骨折愈合率高,长期稳定性良好,膝关节功能恢复满意等优点。     

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.