不同频率周期性压力对组织工程软骨的影响

目的观察不同频率周期性压力对组织工程软骨的影响。方法将兔关节软骨细胞接种到PLGA支架上，随机分成4组。A、B、C组分别在频率为0．01、0．1、1Hz的周期性压力（强度0～200kPa）下培养；D组不加压，为对照组。2周后采用组织化学，免疫组织化学法观察四组工程软骨的细胞增殖及基质分泌。并定量检测硫酸糖氨多糖（GAG）含量。结果四组之间Ⅱ型胶原染色面积百分比及GAG含量差异均有统计学意义（分别F=478．379，P〈0．01；F=67．402，P〈0．01）。其中B组工程软骨细胞最多，排列规则，Ⅱ胶原染色面积百分比[（83．95±2．23）％]和GAG含量[（476．33±25．66）μg]最高（P〈0．01）。结论周期性压力对软骨细胞的新陈代谢具有促进作用，其中0～200kPa、0．1Hz频率的周期性压力能最好的促进软骨细胞增殖，合成Ⅱ胶原、GAG等细胞外基质。     

不同持续时间的周期性压力对构建组织工程软骨的影响

目的 探讨在周期性压力条件下构建组织工程软骨每天加压的最佳持续时间.方法 构建自行没汁的生物反应器和往复式加压泵组成的"周期性压力场培养系统",将体外培养的第二代乳兔关节软骨细胞接种到聚乳酸-聚羟幕乙酸共聚物(PLGA)支架上,随机分成四组.第一、二、三组分别在每天持续时间为4、8、12 h的周期性压力(强度0～200 kPa,频率为0.1 Hz)下培养,第四组(对照组)为不加压的静态培养,各组培养时间均为2周.2周后肉眼人体观察,HE染色组织学观察工程软骨细胞增殖及分布;甲苯胺蓝染色法规察硫酸糖氨多糖(GAG)的分泌及分布,并用1,9.二甲基亚甲蓝法定量检测GAG的含接;采用Ⅱ型胶原免疫绀织化学法观察Ⅱ型胶原的分泌及分布,并用image-pro plus图像分析系统对Ⅱ型胶原染色面积行半定量分析.结果 在强度0～200 kPa,频率为0.1 Hz周期性压力作用下,8 h组支架-细胞复合体体积最大,表面光滑、有光泽、有弹性,支架内软骨细胞数量最多,排列最为规则,Ⅱ胶原和GAG含量也最高(P<0.01).结论 软骨细胞的新陈代谢受周期件压力持续时间的影响,在0～200 kPa、0.1 Hz频率作用下,每天持续8 h的周期性压力能更好地促进软骨细胞增殖,合成Ⅱ型胶原、GAG等细胞外基质.     

周期性压力对组织工程软骨的影响及其作用机制

耳的探讨周期性压力对组织工程软骨的影响及其作用机制。方法取3个月龄新西兰兔关节软骨细胞，培养至第4代后，将软骨细胞随机分为两组。一组为压力组，即关节软骨细胞在周期性压力下培养；另一组为对照组，关节软骨细胞在常规条件下培养。采用组织化学、免疫组织化学观察周期性压力对组织工程软骨的结构以及Ⅱ型胶原分泌的影响。采用激光共聚焦显微镜观察周期性压力对软骨细胞内游离钙离子浓度变化的影响。结果周期性压力下培养的组织工程软骨与常规条件下培养的组织工程软骨相比，支架内软骨细胞数量多、排列规则，Ⅱ型胶原丰富，而且软骨细胞内游离钙离子浓度明显高于对照组。结论周期性压力能够通过增加细胞内游离钙离子浓度来促进软骨细胞的增殖，刺激软骨细胞合成分泌Ⅱ型胶原等细胞外基质。     

正钒酸钠对椎间盘软骨细胞功能的抑制作用

目的探讨正钒酸钠（Sodium Orthovanadate,Na3VO4）对椎间盘软骨终板软骨细胞的作用。方法使用酶消化法培养大鼠椎间盘软骨终板软骨细胞,以10、20及30umol／L不同浓度Na3VO4干预第三代软骨细胞。培养7d后,用MTT法检测软骨细胞增殖率,RT-PCR检测Ⅱ型、Ⅸ型胶原和蛋白聚糖（Aggrecan）mRNA的表达,定量RT—PCR检测PTPN1、IGFRmRNA的表达。结果与对照组比较：（1）10umol／L Na3VO4组上述各项检测指标变化不明显,差异无统计学意义;（2）20及30umol／L Na3VO4组软骨细胞增殖率下降（q=31．51,81．42,P〈0．01）、Aggrecan（q=52．09,102．55,P〈0．01）和PTPN1（q=7．67,4．74,P〈0．01）mRNA表达降低;（3）30umol／L Na3VO4组Ⅱ型胶原（q=51．46,P〈0．01）、Ⅸ型胶原（q=8．62,P〈0．01）mRNA表达降低;（4）各浓度Na3VO4组IGFRmRNA均增加（q=13．96,7．67,4．74,P〈0．01）。结论20及30umol／L Na3VO4可抑制椎间盘软骨细胞增殖,降低Ⅱ、Ⅸ型胶原、Aggrecan以及PTPN1的mRNA表达,说明Na3VO4对软骨细胞中PTPs的活性有抑制作用,从而降低了软骨细胞生物学功能。但Na3Vo4对IGFR mRNA无抑制作用,并可能有一定的促表达作用。     

兔髓核细胞体外培养和重组人转化生长因子-β1对其代谢影响的研究

目的：探讨体外单层和立体培养兔髓核细胞时的变化及重组人转化生长因子-β1（rhTGF-β1，10ng／ml）对其代谢的影响。方法：体外培养兔髓核细胞，分为3组。A组，单层培养组；B组，Ⅱ型胶原支架立体培养组；C组，Ⅱ型胶原支架立体培养＋rhTGF-β1（10ng／m1）组。利用倒置显微镜、扫描电镜、RT-PCR、^3H-proline掺入法观察髓核细胞形态学、基因表达水平和总胶原合成的变化。结果：B、C组兔髓核细胞由A组的多角形转为类圆形；与A组相比，B组Ⅱ型胶原、集聚蛋白多糖基因表达水平升高（P〈0．05），总胶原合成升高（P〈0．01）。与B组相比，C组Ⅱ型胶原、集聚蛋白多糖、核心蛋白多糖基因表达水平增高（P〈0．01、P〈0．01、P〈0．05），总胶原合成升高（P〈0．01）。结论：兔髓核细胞由单层培养转到Ⅱ型胶原支架上培养时其基因表达和总胶原合成增强。rhTGF-β1（10ng／ml）增强立体培养的兔髓核细胞基因表达和总胶原合成。     

离心力在体外构建组织工程软骨中的作用

目的探讨离心力对软骨细胞功能表达和组织工程软骨结构的影响。方法采用组织化学和免疫组织化学观察组织工程软骨结构以及Ⅱ型胶原表达情况,应用DMMB分光法测定组织工程软骨硫酸化糖胺多糖(GAG)的含量。结果体外培养2、4、8周时,静态培养的组织较离心培养的组织Ⅱ胶原免疫组织化学染色弱;并且其GAG含量低于离心培养组织GAG含量,各组差异均有统计学意义(F分别为12.3、10.2、9.1,P<0.05)。离心培养的组织工程软骨GAG含量于第4周达到高峰,均值为(7.60±0.79)%。结论离心力刺激软骨细胞分泌GAG和Ⅱ型胶原,并且影响组织工程软骨结构的排列。     

p38丝裂原活化蛋白激酶抑制剂对大鼠骨性关节炎的影响

目的观察p38丝裂原活化蛋白激酶抑制剂SB203580对大鼠膝关节骨性关节炎关节软骨的影响。方法40只sD大鼠随机分为A、B、C、D4组。A、B、C组行单侧膝关节前交叉韧带切除术，A组于术后行关节腔内注射0．1mL浓度为100μm／L SB203580，B组注射等量生理盐水做为实验对照，C组不予任何处理为空白对照组，D组为正常对照组。术后8周处死动物。观察各组标本大体评分、Mankin评分、软骨细胞凋亡指数以及软骨Ⅱ型胶原免疫组化染色。结果40只大鼠均纳入结果分析。大体评分及Mankin评分显示A组软骨退变明显轻于B、C组（P〈0．05）；各组均发现有凋亡的软骨细胞，A组软骨细胞凋亡指数低于B、C组（P〈0．05），D组软骨细胞凋亡指数明显低于其他3组（P〈0．05）；A组关节软骨Ⅱ型胶原染色吸光度值大于B、C组（P〈0．05）。结论p38MAPK抑制剂对关节软骨有一定的保护作用，可以延缓OA进程，对OA有一定的治疗作用。     

重组腺病毒介导外源性SOX9在正常关节软骨细胞中诱导软骨基质合成的体外表达

背景：关节软骨损害是临床一种常见的损伤,软骨形成转录因子SOX9是一种调控Ⅱ型胶原合成的关键因子。 目的：观察以表达外源性SOX9的腺病毒体外成功感染关节软骨细胞后对Ⅱ型胶原和蛋白聚糖（Aggrecan）合成的影响,探讨软骨损伤后修复软骨缺损的基因治疗方法。 方法：体外构建腺病毒载体AdSOX9和AdGFP,成功感染培养的人关节软骨细胞,分别以逆转录聚合酶链式反应（RT-PCR）技术检测了病毒感染前后SOX9、II型胶原和蛋白聚糖基因mRNA的表达,同时以免疫组化技术检测了病毒感染前后关节软骨细胞中Ⅱ型胶原的表达。 结果：应用AdEasy腺病毒构建专利技术体外成功构建了能高效表达外源性SOX9的腺病毒AdSOX9和只表达绿色荧光蛋白GFP的腺病毒AdGFP;以腺病毒AdSOX9和AdGFP体外成功感染人关节软骨细胞后48h,未感染对照组和AdGFP感染组,均检测到了Ⅱ型胶原和蛋白聚糖的表达;而AdSOX9感染组的细胞中,检测到了SOX9基因mRNA的表达明显增高,与未感染对照组和AdGFP感染组相比有显著性差异（P〈0．05）,同时,Ⅱ型胶原和蛋白聚糖的表达也较未感染对照组和AdGFP感染组明显增高,差异显著（P〈0．05）。 结论：以外源性SOX9为目的基因的腺病毒介导基因治疗方法,在促进关节软骨细胞Ⅱ型胶原和蛋白聚糖合成方面得出了初步满意的结果,SOX9可能是关节软骨缺损基因治疗研究领域一个新的理想靶点,值得继续深入研究。     

一氧化氮诱导腰椎软骨终板退变的实验研究

目的探讨一氧化氮（nitricoxide，NO）诱导腰椎软骨终板退变的机制。方法取长枫杂种猪腰椎间盘软骨终板细胞，于含20％胎牛血清的DMEM中培养，建立体外软骨终板细胞培养模型，以光镜及苏木精-伊红染色观察其生物学表现，Ⅱ型胶原免疫细胞化学染色对软骨终板细胞进行鉴定，以外源性NO-硝普钠（sodium nitroprusside，SNP）2mmol／l处理软骨终板细胞、^35S掺入法和^3H-脯氨酸掺入法检测蛋白多糖及胶原的合成，放射性免疫测定法测炎性细胞因子IL-1β、IL-6、TNF-α的生成，碘化丙啶荧光染色及DNA片段电泳观察软骨终板细胞凋亡。结果原代细胞生物学性状最接近体内细胞，多次传代后细胞呈现衰老现象，经免疫细胞化学染色证实此细胞具有Ⅱ型胶原表达。施加SNP后，软骨终板细胞蛋白多糖及胶原合成明显减少（P〈0．01），炎性细胞因子含量明显升高（P〈0．01），细胞凋亡率显著增高（P〈0．01）。结论NO抑制软骨终板细胞蛋白多糖及胶原合成，促进炎性细胞因子及细胞凋亡增加，从而促进软骨终板退变。     

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.