静脉和硬膜外自控镇痛对肺叶切除术后肺功能的影响

目的　比较静脉与硬膜外病人自控镇痛 (PCIA与PCEA)对肺叶切除术后肺功能的影响。方法　 44例择期行单肺叶切除病人 ,随机分成PCIA组和PCEA组。分别于术前、术后 2 4、48h用脉冲振荡肺功能测定仪 (IOS)测定肺功能。结果　PCEA组与PCIA组术前肺功能无统计学差异 ;术后 2 4h两组与术前比较用力肺活量 (FVC)、1秒用力呼气量 (FVE1 )降幅较大 (P <0 0 5) ,呼吸总阻抗 (Zrs)、共振频率(Fres)、35Hz时呼吸阻力 (R35)、5Hz时呼吸电阻 (X5)升高显著 (P <0 0 5) ;术后 48h两组FVC、FEV1 、Zrs、Fres、R35、X5较术后 2 4h有所恢复 ,但PCEA组恢复更好 (P <0 0 5)。结论　胸科手术后用PCEA、PCIA均能获得较好的镇痛效果 ,但PCEA对病人早期肺功能的恢复作用积极明显     

氟比洛芬酯超前镇痛对腭咽成型术患者术后镇痛效果的影响

目的比较氟比洛芬酯在麻醉不同时期用药对阻塞性睡眠呼吸暂停综合征(OSAS)行腭咽成型手术(UPPP)术后镇痛效果的影响。方法30例OSAS患者随机分为三组,每组10例。Ⅰ组于手术结束前15min缓慢静注氟比洛芬酯100mg;Ⅱ组麻醉诱导后15min缓慢静注氟比洛芬酯100mg;Ⅲ组于麻醉诱导后和手术结束前各静注氟比洛芬酯50mg。三组患者皆选择术后PCIA镇痛,采用芬太尼0.3μg·kg-1·h-1的背景量。以视觉模拟评分(VAS)在双盲下记录患者术后静息状态下1、2、4、6、8、12、24、48h不同时点疼痛程度以及PCIA泵首次按压的时间、累计按压次数、总用药量,并观察不良反应。结果术后1、2、4、6h VASⅡ组低于Ⅰ组(P<0.05),术后1、2、4、6、8、12hVASⅢ组低于Ⅰ、Ⅱ组(P<0.05)。Ⅲ组术后48h内累计PCA,泵按压次数低于Ⅰ、Ⅱ组(P<0.05)。三组患者术后不良反应差异无统计学意义。结论术前和术毕各静注氟比洛芬酯50mg可产生满意的超前镇痛效果,复合术后PCIA能安全、有效地解除UPPP术后疼痛。     

妇科腹部术后硬膜外自控镇痛法的临床疗效观察

目的观察硬膜外自控镇痛法用于妇科腹部手术后患者的镇痛疗效。方法选取将病情分级(ASA)Ⅰ~Ⅱ级妇科腹部手术患者200例,随机分为观察组、对照组,2组患者的平均年龄、身高、体质量等差异无统计学意义(P0.05)。观察组术后均使用硬膜外自控镇痛泵进行镇痛,对照组术后使用单次肌注度冷丁的方法进行镇痛。采用疼痛评分法对48h内镇痛效果进行比较,同时比较恶心、呕吐,尿潴留等不良反应的发生情况及肛门排气时间。结果观察组镇痛效果与对照组之间存在统计学差异(P0.05);观察组的肛门排气时间比对照组明显提前,2组肛门排气时间差异有统计学意义(P0.05)。结论硬膜外自控镇痛法用于妇产科腹部手术后镇痛效果明显、安全可靠、不良反应小。     

无线远程镇痛泵监控系统结合自控镇痛宣教在胸科手术后镇痛中的应用

目的 探讨无线远程镇痛泵监控系统结合自控镇痛宣教在胸科手术后镇痛中的应用效果. 方法 选择60例胸腔镜下食管癌根治术、肺癌根治术患者,按随机数字表法分为无线远程镇痛泵监控系统组(Ⅰ组)和普通电子镇痛泵组(Ⅱ组),每组30例.Ⅰ组采用无线镇痛泵监控系统进行术后镇痛并选择多个时间点对患者及其家属进行术后镇痛宣教,Ⅱ组采用普通电子镇痛泵.记录术后4、8、12、24、48 h的疼痛数字评分(numerical rating scale,NRS)、使用镇痛泵后患者满意度评分和麻醉医师被动回访率等. 结果 与Ⅱ组比较,Ⅰ组4、8、12、24 h的NRS评分均较低(P＜0.05);麻醉医师被动回访率Ⅰ组3例占10％、Ⅱ组13例占43.3％(P＜0.05);Ⅰ组通过远程数据监测发现报警信息8次,Ⅱ组接到病房反馈镇痛不足有13次,至病房进行有效处理的时间Ⅰ组(9±3) min、Ⅱ组(13±7) min(P＜0.05);Ⅰ组术后4、8、12、24 h的患者满意度评分高于Ⅱ组(P＜0.05).结论 无线远程镇痛泵监控系统结合宣教在胸科手术后镇痛中的应用可以为患者实施个体化镇痛管理,改善了镇痛效果,提高了患者的满意度.     

上腹部手术后两种镇痛方法的比较

目的比较上腹部手术后硬麻外镇痛与静麻镇痛的有效性与安全性。方法择期行上腹部手术患者120例,ASAⅠ-Ⅱ级,随机分为术后硬膜外镇痛(A)组和术后静脉镇痛组(B)组。观察患者术后12、24、48、72 h的疼痛VAS评分、Ramsay镇静评分及不良反应等。结果硬膜外镇痛组术后12、24、48、72 h的疼痛VAS评分、Ramsay镇静评分明显低于静脉镇痛组。差异有统计学意义(P<0.05)。结论 A及B组均能有效控制上腹部术后疼痛,而A组较B组效果更平稳有效。     

氯诺昔康复合小剂量芬太尼用于术后静脉镇痛

目的　比较氯诺昔康联合小剂量芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法　选择行腹部及四肢手术后患者 180例 ,随机分为三组 ,每组 6 0例 ,均以一次性镇痛泵 (1ml/h)行静脉术后镇痛。F组 :芬太尼 0 2 5 μg·kg 1·h 1;LF组 :氯诺昔康 15 μg·kg 1·h 1+芬太尼 0 1μg·kg 1·h 1;L组 :氯诺昔康 2 0 μg·kg 1·h 1。观察各组患者 6 0h内的镇痛评分 (VAS)及并发症的发生情况。结果　三组患者的静息镇痛评分在 12h内 ,LF组明显低于F组和L组 (P <0 0 5 ) ,而在 12h后无显著差异 (P >0 0 5 ) ;LF组和L组恶心呕吐、皮肤瘙痒、注射部位疼痛、头晕、嗜睡发生率明显低于F组(P <0 0 1) ;三组中均无呼吸抑制或胃肠道出血发生。结论　用氯诺昔康复合芬太尼行术后静脉镇痛可明显减少芬太尼的用量 ,镇痛效果明显优于单纯芬太尼或氯诺昔康。     

氯诺昔康超前镇痛对胃癌患者围术期Th1/Th2平衡的影响

目的 观察氯诺昔康超前镇痛对胃癌患者围术期Th细胞漂移的影响.方法 30例全麻下行胃癌根治术的患者随机均分为两组.Ⅰ组患者术前给予氯诺昔康8mg.手术后PCA泵以氯诺昔康和吗啡镇痛;Ⅱ组仪在术后经PCA泵给予吗啡镇痛.分别于术前(T_0)、术毕(T_1)、术后24 h(T_2)、72 h(T_3)抽取外周血.测定血浆皮质醇(Cor)、干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)浓度.结果 与T_0,时比较,Ⅱ组T_1、T_2时Cor升高.I组Cor仅在T_1时升高(P<0.05).与Ⅱ组比较,I组T_1、T_2时Cor明显降低(P<0.05).Ⅰ组T_2时IL-4低于T_0(P<0.05).与Ⅱ组比较.Ⅰ组T_3时IL-4明显降低(P<0.05).与T_0时比较,两组T_1～T_3时IFN-γ明显上升(P<0.05).Ⅰ组T_1、T_2时IFN-γ明显高于Ⅱ组(P<0.05).与T_0时比较,两组T_1～T_3.时IFN-γ/IL-4均升高(P<0.05);Ⅰ组T_2时IFN-γ/IL-4明显高于Ⅱ组(P<0.05).结论 氯诺昔康超前镇痛能减轻胃癌患者手术后Th1/Th2半衡的漂移程度.改善机体外科创伤后免疫受抑状态.     

曲马多术后自控硬膜外镇痛对血液动力学的影响

目的评估术后患者自控硬膜外镇痛(PCEA)对血液动力学的影响。方法择期妇科手术且行术后PCEA患者60例,ASAⅠ~Ⅱ级,应用美国Bioz.com无创胸阻抗法心排量监测仪对患者术前、术毕、术后1、24、48h的血液动力学进行监测,并比较心排量(CO)、每搏心排血量(SV)、HR、心加速指数(ACI)、外周血管阻力(SVR)的变化。并根据术后24h的视觉模拟评分(VAS)将患者分为两组Ⅰ组,VAS≤5分;Ⅱ组,VAS>5分。结果Ⅰ组术毕、术后1h的CO、SV、SVR和术前比明显降低(P<0·05);术毕、术后1h的HR和术前比较有所增高(P<0·05);在各个时点ACI差异无显著意义。Ⅱ组术毕、术后1h的CO、SV、SVR和术前比明显降低(P<0·05);术毕、术后1、24、48h的HR和术前比较有所增高(P<0·05)。Ⅰ组术后24h的SV、SVR低于Ⅱ组(P<0·05);Ⅰ组术后24、48hHR明显高于Ⅱ组(P<0·05)。两组ACI在各个时点差异均无显著意义。结论PCEA对血液动力学的影响很小,安全性高。良好的镇痛有利于维持血液动力学稳定。     

慢性阻塞性肺病病人术后无创正压通气的临床研究

目的比较术后常规治疗(SMT)加无创正压通气(NPPV)和单独应用常规治疗对伴有中、重度呼吸功能不全的慢性阻塞性肺病人的疗效。方法择期上腹部和胸腔手术病人24例，术前检查有慢性阻塞性肺病合并中度和重度呼吸功能不全，随机分成2组。对照组术后常规吸氧、静注氨茶碱、雾化吸入α     

氯胺酮与吗啡超前镇痛对内脏牵拉痛及术后镇痛的影响

目的探讨氯胺酮与吗啡复合液硬膜外超前镇痛对抑制手术内脏牵拉痛的影响及术后镇痛情况的影响。方法60例ASAⅠ~Ⅱ级择期全子宫切除术患者,均于硬膜外麻醉下行全子宫切除术。随机分为两组,每组30例,即Ⅰ组(对照组):术前不施行超前镇痛;Ⅱ组(实验组):切皮前10 min将氯胺酮30 mg与吗啡2 mg用生理盐水稀释成5 ml注入硬膜外腔。所有患者术后均行自控硬膜外镇痛(PCEA)。镇痛药物为0.15%罗哌卡因+5 mg吗啡,共100 ml。观察两组患者术中牵拉反应、术后镇痛情况及并发症。结果Ⅱ组用药对抑制术中牵拉痛的效果明显优于Ⅰ组(P<0.01);Ⅱ组PCEA泵首次触发时间较Ⅰ组显著延长(P<0.01),48 h内有效触发次数显著减少(P<0.01),24 h PCEA泵总用量明显减少(P<0.05),术后并发症无明显差异。结论氯胺酮与吗啡硬膜外超前镇痛能明显抑制术中牵拉痛,提供良好的术后镇痛效果,减少阿片类药物的用量。     

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.