拮抗选择素对缺血/再灌注损伤皮瓣的保护作用

目的探讨E-、P-选择素单克隆抗体在缺血/再灌注损伤皮瓣中的作用。方法将36只健康的Sprague-Dawley雄性大鼠平均分成三组,在其腹部制作缺血/再灌注损伤皮瓣模型后,分别应用生理盐水,E-、P-选择素单克隆抗体,观察皮瓣成活面积及组织改变。结果应用后7d皮瓣成活面积:生理盐水对照组为(18.3±19.60)%;E-选择素单克隆抗体组为(54.38±40.49)%;P-选择素单克隆抗体组为(83.75±17.87)%。组织学观察:生理盐水对照组有大量的炎细胞浸润、组织肿胀、部分皮肤组织坏死;E-、P-选择素单克隆抗体组炎症反应明显轻,坏死组织少,而P-选择素单克隆抗体组的效果尤为明显。结论E-、P-选择素单克隆抗体可以减轻缺血/再灌注皮瓣的损伤,从而提高缺血/再灌注损伤皮瓣的成活面积。     

拮抗选择素对缺血/再灌注损伤皮瓣的保护作用

目的 探讨E-、P-选择素单克隆抗体在缺血/再灌注损伤皮瓣中的作用.方法 将36只健康的Sprague-Dawley雄性大鼠平均分成三组,在其腹部制作缺血/再灌注损伤皮瓣模型后,分别应用生理盐水,E-、P-选择素单克隆抗体,观察皮瓣成活面积及组织改变.结果 应用后7 d皮瓣成活面积生理盐水对照组为(18.3±19.60)%;E-选择素单克隆抗体组为(54.38±40.49)%;P-选择素单克隆抗体组为(83.75±17.87)%.组织学观察生理盐水对照组有大量的炎细胞浸润、组织肿胀、部分皮肤组织坏死;E-、P-选择素单克隆抗体组炎症反应明显轻,坏死组织少,而P-选择素单克隆抗体组的效果尤为明显.结论 E-、P-选择素单克隆抗体可以减轻缺血/再灌注皮瓣的损伤,从而提高缺血/再灌注损伤皮瓣的成活面积.     

地塞米松对中性粒细胞死亡过程的调控

目的　研究地塞米松对中性粒细胞死亡的调控 ,阐明地塞米松防治皮瓣缺血再灌注损伤的机理。方法　 5 0只大鼠等分成 5组。Ⅰ组 :正常皮瓣组 ;Ⅱ组 :阻断动脉 8h ,生理盐水对照组 ;Ⅲ组 :阻断静脉 8h ,生理盐水对照组 ;Ⅳ组阻断动脉 8h ,地塞米松 5mg kg组 ;Ⅴ组 :阻断静脉 8h ,地塞米松 5mg kg组。术后观测皮瓣成活面积 ,检测全血中中性粒细胞凋亡、坏死水平。光镜观察中性粒细胞凋亡及坏死形态 ,电镜观察吞噬细胞吞噬凋亡中性粒细胞形态。结果　Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ组的皮瓣成活面积分别是 ( 99 8± 2 5 ) %、( 18 8± 1 8) %、( 9 0± 0 8) %、( 98 2± 2 4) %、( 96 2± 2 2 ) %。中性粒细胞凋亡含量术后早期Ⅱ、Ⅲ组明显低于另外 3组 ,但第 6天则高于另外 3组。坏死水平术后Ⅱ、Ⅲ组高于另外 3组。皮瓣中吞噬细胞吞噬凋亡粒细胞的数量Ⅳ、Ⅴ组明显高于Ⅱ、Ⅲ组。结论　地塞米松防治皮瓣缺血再灌注损伤的原因在于调理了中性粒细胞凋亡水平 ,减少了其坏死数量 ,增加吞噬细胞吞噬凋亡中性粒细胞的水平。     

岛状皮瓣缺血再灌注损伤的血液流变学改变及地塞米松的调理研究

目的 探讨岛状皮瓣缺血再灌注损伤中血液流变学的变化及地塞米松的调理作用机制。方法 采用Wister大鼠60只，等分为缺血再灌注损伤模型。对照组（Ⅰ组）腹腔注射生理盐水2ml/kg，实验组（Ⅱ组）腹腔注射地塞米松5mg/kg。术后7天观察皮瓣成活面积；电镜观察皮瓣超微结构，计数中性粒细胞的坏死数量；以血液流变检测仪检测红细胞流变学，以微循环检测仪及扫描电镜检测中性粒细胞的流变学。结果 皮瓣成活面积Ⅱ组显著大于Ⅰ组；术后1、2天时，中性粒细胞的坏死数量Ⅱ组显著少于Ⅰ组（P＜0.05）；全血低切黏度、红细胞聚集指数、Casson屈服应力及中性粒细胞的黏附性Ⅰ组明显高于Ⅱ组（P＜0.05）；中性粒细胞的变形性Ⅰ组则比Ⅱ组低。结论 皮瓣缺血再灌注损伤可引起红细胞聚集性增强，中性粒细胞黏附性增加、变形性能力下降和坏死数量增多；地塞米松可有效调理上述指标，减少中性粒细胞的坏死数量，改善皮瓣血运。     

氯化钆抑制枯否细胞对大鼠肝脏缺血再灌注损伤的影响

目的探讨抑制枯否细胞对大鼠肝脏缺血再灌注损伤的影响。方法制作部分肝脏缺血再灌注大鼠模型80只,实验组注射氯化钆,对照组注射生理盐水,检测两组大鼠缺血前、再灌注后5min、1和6h血压、心率的变化,血清转氨酶(AST)、肿瘤坏死因子α(TNFα)和白细胞介素1(IL1)的水平及肝组织超微结构的改变。结果实验组再灌注6h血清TNFα和IL1为(0.475±0.069)μg/L和(0.221±0.056)μg/L,显著低于对照组的(0.831±0.167)μg/L和(0.335±0.127)μg/L(P<0.05),两组血压、心率和AST变化的差异也有统计学意义(P<0.05),实验组大鼠肝脏超微结构的损伤程度轻于对照组。结论抑制枯否细胞活化可减轻肝脏缺血再灌注损伤,枯否细胞在肝脏缺血再灌注损伤中的作用很重要。     

热应激预处理对皮瓣缺血再灌注损伤的影响及机制

目的探索减轻皮瓣缺血再灌注损伤的有效措施。方法采用大鼠腹部岛状皮瓣,制作活体原位热缺血模型,观察热缺血再灌注后皮瓣的成活率、皮瓣组织形态学改变,检测皮瓣超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量、HSP_(70)表达。结果缺血8h 后再灌注,实验组皮瓣存活率明显高于对照组;与对照组相比,实验组皮瓣组织中 SOD 活性较高而 MDA 水平较低;电镜显示,实验组皮瓣毛细血管内膜较完整,细胞肿胀轻,线粒体结构较稳定。结论热应激预处理,能减轻缺血再灌注对皮瓣的损伤,对缺血再灌注皮瓣具有保护作用,其机制可能与热应激预处理抗自由基损害作用及维护细胞膜结构稳定有关。     

热应激预处理对皮瓣缺血再灌注损伤的影响及机制

目的　探索减轻皮瓣缺血再灌注损伤的有效措施。方法　采用大鼠腹部岛状皮瓣,制作活体原位热缺血模型,观察热缺血再灌注后皮瓣的成活率、皮瓣组织形态学改变,检测皮瓣超氧化物歧化酶（ Ｓ Ｏ Ｄ） 活性、丙二醛（ Ｍ Ｄ Ａ） 含量、 Ｈ Ｓ Ｐ７ ０ 表达。结果　缺血８ｈ 后再灌注,实验组皮瓣存活率明显高于对照组;与对照组相比,实验组皮瓣组织中 Ｓ Ｏ Ｄ 活性较高而 Ｍ Ｄ Ａ 水平较低;电镜显示,实验组皮瓣毛细血管内膜较完整,细胞肿胀轻,线粒体结构较稳定。结论　热应激预处理,能减轻缺血再灌注对皮瓣的损伤,对缺血再灌注皮瓣具有保护作用,其机制可能与热应激预处理抗自由基损害作用及维护细胞膜结构稳定有关。     

抗肿瘤坏死因子-α单克隆抗体减轻骨骼肌缺血再灌注损伤的研究

目的　研究抗肿瘤坏死因子 α(TNF α)单克隆抗体对骨骼肌缺血再灌注损伤的作用。方法　SD大鼠 2 4只 ,建立后肢缺血再灌注模型 ,抗TNF α单克隆抗体用量为 2mg/kg体重。采用酶联免疫吸附试验 (ELISA )法、比色法、免疫组织化学、流式细胞计数及电镜观察分别测定血浆TNF α、组织过氧化物酶 (MPO)、血管内皮细胞粘附分子 (ICAM ) 1、中性粒细胞CD18表达及超微结构改变。结果　应用抗TNF α单克隆抗体后血浆TNF α水平显著降低 (P <0 .0 1)。组织MPO(骨骼肌 :2 .11± 0 .2 5vs 4.2 8± 0 .5 5 ,P <0 .0 1;肺 :0 .93± 0 .0 1vs 2 .62± 0 .10 ,P <0 .0 1)、血管内皮细胞ICAM 1及中性粒细胞CD18(4 8.75± 9.2 8vs 1.13± 0 .2 0 ,P <0 .0 1)均明显下降 ,组织结构损伤减轻。结论　抗TNF α单克隆抗体能减轻骨骼肌缺血再灌注损伤。     

局部应用地塞米松增加皮瓣成活的实验研究

目的　研究地塞米松增加皮瓣成活面积的作用机理。方法　 2 4只豚鼠随机分成实验组和对照组两组 ,分别于实验组与对照组豚鼠的背部形成任意皮瓣。将实验组的留置硅胶管中注入地塞米松 (5mg/kg) ,每隔 36h重复等量给药 ,1 0 8h后给药量逐部减少 ,1 80h时停药。将对照组的留置硅胶管中注入生理盐水 (2ml/kg) ,1 0天时观察皮瓣成活面积 ,缝合皮瓣 2 4h后于皮瓣中央取材观察皮瓣组织学。结果　皮瓣成活率 ,实验组为 (72 .5± 4 .9) % ,对照组为 (49.2± 3 .7) %。组织学显示实验组皮瓣中性粒细胞明显少于对照组。结论　局部应用地塞米松增加皮瓣成活 ,其方法简单、有效。其机理与减少了中性粒细胞在皮瓣中的浸润有关     

局部应用地塞米松增加皮瓣成活的实验研究

目的研究地塞米松增加皮瓣成活面积的作用机理.方法 24只豚鼠随机分成实验组和对照组两组,分别于实验组与对照组豚鼠的背部形成任意皮瓣.将实验组的留置硅胶管中注入地塞米松(5mg/kg),每隔36h重复等量给药,108h后给药量逐部减少,180h时停药.将对照组的留置硅胶管中注入生理盐水(2ml/kg),10天时观察皮瓣成活面积,缝合皮瓣24h后于皮瓣中央取材观察皮瓣组织学.结果皮瓣成活率,实验组为(72.5±4.9)%,对照组为(49.2±3.7)%.组织学显示实验组皮瓣中性粒细胞明显少于对照组.结论局部应用地塞米松增加皮瓣成活,其方法简单、有效.其机理与减少了中性粒细胞在皮瓣中的浸润有关.     

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.