尼莫地平(nimodipine)对体外培养成骨细胞的影响

目的观察钙通道阻断剂--尼莫地平(nimodipine)对体外培养成骨细胞的作用.方法在新生SD大鼠头颅骨第二继代成骨细胞(OB2)培养液中分别加入不同浓度(10-4～10-12g/ml)尼莫地平,分别观察OB2的增殖功能(用波长570nm处OD值表示),分化功能[用碱性磷酸酶(ALP)活性表示]和矿化功能(用矿化结节数量/视野表示).结果OD值(均值±sf标准差)为0.121±0.009～0.411±0.035;ALP活性(均数±标准差)为0.092±0.008U/mg蛋白质;矿化结节数量/视野(均数±标准差)为1.250±0.893个.结论与对照组比较,尼莫地平各浓度对OB2的增殖、分化和矿化功能作用各异.当尼莫地平浓度为10-9g/ml时,对OB2的增殖和分化功能具有刺激作用(p＜0.05),对OB2的增殖功能具有明显的抑制作用(p＜0.01);当浓度降低(10-11g/mi)时,对OB2的增殖功能失去作用(p＞0.05).     

尼莫地平对体外培养成骨细胞的影响

目的 观察尼莫地平对体外培养成骨细胞的作用.方法 在新生SD大鼠头颅骨第2继代成骨细胞(OB2)培养液中分别加入不同浓度(10-1～10 9g/L)尼莫地平,分别观察OB2的增殖功能(用波长570nm处OD值表示),分化功能(用碱性磷酸酶ALP活性表示)和矿化功能(用矿化结节数量/视野表示).结果 增殖功能OD值为0.12±0.01～0.41±0.04;ALP活性为0.09±0.01U/mg蛋白质;矿化结节数量/视野为1.3±0.9个.结论 与对照组比较,尼莫地平各浓度对OB2的增殖、分化和矿化功能作用各异.当尼莫地平浓度为10 6g/L时,对OB2的增殖和分化功能具有刺激作用,对OB2的矿化功能具有显著的抑制作用;当浓度升高(10-2g/L)时,对OB2的增殖功能具有明显的抑制作用;当浓度降低(10 8g/L)时,对OB2的增殖功能失去作用.     

长春新碱对体外培养成骨细胞的影响

目的　观察抗癌药物长春新碱对体外培养成骨细胞的作用。方法　在新生SD大鼠头颅骨次代成骨细胞 (OB2 )培养液中分别加入不同浓度 (10 -1～ 10 -9g/L)长春新碱 ,分别观察OB2 的增殖功能 (用波长 5 70nm处OD值表示 )、分化功能 [用碱性磷酸酶 (ALP)活性表示 ]和矿化功能 (用矿化结节数 /视野表示 )。结果　OD值实验组为 0 0 91± 0 0 0 5～ 0 2 97± 0 0 44 ,对照组为 0 34 7± 0 0 35 ;ALP(U/g蛋白质 )活性实验组为 77± 12 ,对照组为 81± 4;矿化结节数 /视野 (个 )实验组为 1 0±0 816,对照组为 1 5± 1 0。结论　从绝对数来看 ,各浓度长春新碱对OB2 的增殖、分化和矿化功能均具抑制作用。与对照组比较 ,长春新碱对OB2 增殖功能的抑制作用具有极显著性意义 (P <0 0 1)。     

骨折愈合刺激素对体外培养成骨细胞的影响

目的　观察骨折愈合刺激素对体外培养成骨细胞的作用。方法　在新生SD大鼠头颅骨次代成骨细胞 (OB2 )培养液中分别加入不同浓度 (2× 10 2 U/L～ 2× 10 4U/L)骨折愈合刺激素 ,观察OB2的增殖功能 (用波长 5 70nm处OD值表示 ) ,取药物敏感浓度 (2× 10 2 U/L)分别观察分化功能〔用碱性磷酸酶 (ALP)活性表示〕和矿化功能 (用矿化结节数量 /视野表示 )。结果　OB2 增殖功能 (OD值 )实验组为 0 336± 0 0 73～ 0 35 9± 0 0 5 1,对照组为 0 347± 0 0 35 ;OB2 分化功能〔ALP(U/g蛋白质 )活性〕实验组为 83± 9,对照组为 81± 4 ;OB2 矿化结节数量 /视野 (个 )实验组为 6 0± 1 82 6 ,对照组为1 5± 1 0。结论　骨折愈合刺激素各浓度对OB2 的增殖和分化功能均无明显作用 (P >0 0 5 ) ,而对其矿化功能具有明显的刺激作用 (P <0 0 1)。     

脱氢表雄酮对离体大鼠成骨细胞代谢和一些细胞因子的影响

目的 研究脱氢表雄酮(DHEA)促进成骨细胞(OB)增殖的作用和机制.方法 体外分离培养大鼠OB,取传一代细胞,分别给予10-5、10-7、10-9,mmol/L DHEA培养72 h,以10-8mmol/L雌二醇(estradiol,E2)为阳性对照,另设空白对照组.以细胞形态学和碱性磷酸酶(ALP)染色鉴定.应用光镜、四唑盐(MTT)法检测细胞的生长和增殖.茜素红染色观察成骨细胞矿化结节形成功能;同时双抗体夹心ABC-ELISA法测定不同浓度DHEA培养液中对VEGF、OPG、TGF-β、IL-1β和GM-CSF浓度的影响.结果 不同浓度DHEA组OB增殖能力均有上升,其中以10-7mmol/L DHEA组最显著(P＜0.01),其作用和E2相似(P＞0.05);不同浓度DHEA组ALP的活性均升高,亦以10-7 mmol/L DHEA组最显著(P＜0.01),10-7、10-9mmol/L DHEA的作用和E2和相似(P＞0.05);10-9mmol/L DHEA组单位细胞数的ALP活性高于空白对照组(P＜0.05).不同浓度DHEA组矿化面积及矿化面积比均有显著增加(P＜0.01),其作用和E2相似.在低浓度DHEA组的培养中对OPG、TGF-β1、VEGF的反应呈上升趋势与对照组有显著差别与0B增殖能力呈正相关;在高浓度DHEA组的培养中对IL-1β、GM-CSF的反应呈下降趋势与对照组有显著差别与OB增殖能力呈负相关.结论 DHEA能够促进大鼠OB生长和增殖,其作用可能与刺激OPG、TGF-β、VEGF;抑制IL-1β,GM-CSF途径有关.     

Genistein对乳腺癌细胞致成骨细胞生物学功能改变的影响

目的 探讨Genistein对乳腺癌细胞致成骨细胞(osteoblast, OB)增殖、分化和矿化功能的影响,观察Genistein在乳腺癌骨转移的病理条件下是否能调节OB生物学功能.方法 源于大鼠颅盖骨的原代OB与50%来自人源性乳腺癌细胞系MDA-MB-231或MCF-7的条件培养基(conditioned medium,CM)共同培养,并加入5×10-7 mol/L (G7)、5×10-8 mol/L (G8)或5×10-9mol/L (G9) 的Genistein进行干预.MTT法观察其对OB增殖的影响;PNPP偶氮法观察其对OB碱性磷酸酶(alkaline phosphatase, ALP)活性的影响;茜素红S(ARS)进行矿化结节染色并计算面积以观察其对OB矿化能力的影响.结果 MDA-MB-231和MCF-7细胞条件培养基可显著抑制OB的增殖.用Genistein干预1 d、3 d和5 d后,OB增值率可有不同程度的提高,差异有统计学意义(P<0.05).此外,乳腺癌细胞条件培养基可明显下调OB的ALP活性,而用不同浓度的Genistein干预后,OB的ALP活性分别较MDA-MB-231和MCF-7细胞条件培养基组增加22.7%、32.4%、63.5%和27.7%、32.0%、58.3%(P<0.05).Genistein还可改善乳腺癌细胞条件培养基对OB矿化能力的抑制,增加OB形成的矿化结节面积.结论 在乳腺癌骨转移的病理条件下,Genistein可促进OB的增殖、分化和矿化能力,改善乳腺癌细胞对OB生物学功能的抑制作用.     

钙敏感受体缺失对小鼠成骨细胞增殖与分化的影响及机制研究

目的 探讨钙敏感受体(CaSR)在小鼠成骨细胞增殖与分化中的作用,以及Wnt信号通路在其促进成骨细胞增殖及分化过程中的调节作用. 方法 取新生同窝野生型小鼠(对照组)和CaSR敲除纯合子小鼠(实验组)各4只,分离培养颅骨成骨细胞并传至第3代,分别于培养2、4、6、8d时采用CCK-8法测定细胞的吸光度(OD)值,检测成骨细胞碱性磷酸酶(ALP)的活性.取培养6d的细胞行实时荧光定量-聚合酶链反应(RT-qPCR)检测核心结合因子(Runx2)、ALP、骨钙素(OCN)、核激活因子受体配体(RANKL)、骨保护素(OPG)及β-链蛋白的mRNA基因表达水平;采用Western Blot检测β-链蛋白、Wnt-5a、胰岛素样生长因子-1(IGF-1)、Runx2的蛋白表达水平. 结果 培养6d时对照组和实验组成骨细胞的OD值(1.55±0.05、1.26±0.02)和ALP活性[(0.023±0.002)、(0.017±0.001)U/mg· prot]均达到峰值,与其他时间点比较差异均有统计学意义(P＜0.05);同一时间点实验组成骨细胞的OD值和ALP活性均低于对照组,差异有统计学意义(P＜0.05).与对照组比较,培养6d时实验组成骨细胞的Runx2、ALP、OCN、RANKL/OPG、β-链蛋白的mRNA表达水平,以及β-链蛋白、Wnt-5a、IGF-1、Runx2的蛋白表达水平均显著降低,两组比较差异均有统计学意义(P＜0.05). 结论 CaSR缺失将导致成骨细胞的增殖和分化障碍,其机制可能与经典的Wnt信号通路抑制有关.     

蓇密钙片与马鹿角多肽对成骨细胞增殖分化的研究

目的观察蓇密钙片及马鹿角多肽对鼠胚成骨细胞MC3T3-E1的增殖分化作用及细胞内OPG、RANKL mRNA的表达。方法采用MEM(10%FBS)培养液培养细胞,细胞计数法描绘成骨细胞生长曲线;MTT法检测蓇密钙片(0、50、100、500、1000μg/ml)、马鹿角多肽(0、5、50、500μg/ml)和钙尔奇D对照组对鼠胚成骨细胞MC3T3-E1增殖的作用;蓇密钙片(0、50、100、500、1000μg/ml)、马鹿角多肽(0、5、50、500μg/ml)和钙尔奇D对照组干预鼠胚成骨细胞MC3T3-E1 72 h后,比色法检测细胞内碱性磷酸酶(alkaline phosphatase,ALP)的含量,RT-PCR法检测骨保护蛋白(osteoprotegerin,OPG)、核因子КB激活受体配体(receptor activator of NK-КB ligand,RANKL)mRNA的表达。结果蓇密钙片及马鹿角多肽作用于MC3T3-E1成骨细胞72 h后,可促进其增殖,OD值增加(P0.05),增加ALP的含量,促进OPG mRNA表达,同时抑制RANKL mRNA表达。结论蓇密钙片及马鹿角多肽促进MC3T3-E1成骨细胞增殖分化,可能与促进成骨细胞OPG mRNA表达、抑制RANKL mRNA表达有关,从而促进骨形成,抑制骨吸收。     

补肾中药HU-ECS对培养成骨细胞增殖、分化及矿化功能的影响

目的：为了解补肾中药HU-ECS对体外培养成骨细胞的作用。方法：应用MTT法、对硝基苯磷酸盐法及茜素红染色方法观察HU-ECS对体外培养民骨细胞的增殖、ALP表达及矿化结节形成的影响。结果：HU-ECS具有刺激骨细胞增殖作用（10^-6g/ml组,P＜0.01-0.001）,提高ALP活性及矿化结节形成的数量。结论：HU-ECS具有刺激体外培养成骨细胞增殖及分化成熟的功能。     

锶盐对高浓度地塞米松作用下大鼠成骨细胞的影响

目的 探讨雷奈酸锶(Sr)对高浓度地塞米松(Dex)作用下大鼠成骨细胞（OB)的影响。方法 采用大鼠骨髓基质干细胞(BMSCs)来源的成骨细胞,运用MTT试剂盒和AKP试剂盒分别测定Sr对细胞增殖和分化的影响,定量PCR方法测定Sr对高浓度地塞米松作用下成骨钙素（OC)和转化生长因子-β(TGF-β)表达的影响。结果 Sr浓度在10-5、10-4 mol/L时,能够促进OB增殖和分化(P < 0. 01); Sr浓度为10-4mmol/L能够有效拮抗高浓度Dex( 10-5 mol/L)对成骨细胞分化抑制作用（P <0.01),并能逆转Dex对成骨相关基因OC和TGF-β的抑制作用(P <0. 05,P <0. 01)。结论 Sr能够对大鼠BMSCs来源的成骨细胞的增殖、分化有促进作用,同时10-4 mol/L Sr可以拮抗Dex( 10-5 mol/L)对ALP和成骨相关基因的抑制作用。为Sr防治糖皮质激素性骨质疏松提供了细胞学依据。     

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.