股骨头坏死及融通术数字减影血管造影的初步观察

目的观察和分析了３９例（６４髋）治疗前后的股骨头坏死的数字减影血管造影（ＤＳＡ）的影像学表现。方法对不同病因,不同分期的股骨头坏死行旋股内动脉持管造影和灌注尿激酶、丹参和川芎嗪。结果①股骨头坏死分期与血管造影上下骺动脉分型关系：股骨头坏死０期、Ⅰ期和Ⅱ期表现为股骨头内Ⅱ型血管为主,Ⅳ型和Ⅴ型血管较少;Ⅲ期则Ⅱ型血管减少,而Ⅳ型和Ⅴ型血管增多;②股骨头坏死不同病因与血管造影上干骺动脉分型关系：股骨头     

介入治疗股骨头坏死28例(34髋)临床分析

目的 通过对28例(34髋)股骨头坏死患者的介入治疗,分析其近期临床疗效和影响疗效的相关因素.方法 通过对28例(34髋)股骨头坏死患者采用Seldinger技术穿刺插管,经导管分别将舒血宁、罂粟碱、尿激酶、654-2和低分子右旋糖酐等药物灌入股骨头供血动脉,并根据股骨头血供特点来分配灌注量.结果 血管造影显示,药物灌注后股骨头主要供血动脉均有不同程度增粗、延长,小分支显示增多;6个月跟踪随访总体优良率从32%上升为为73%,Ⅰ～Ⅱ期的效果较好,Ⅲ～Ⅳ期效果较差;特发性效果较好,创伤性效果较差.结论 该方法可以改善股骨头局部血液循环,使坏死骨质吸收、新骨形成,具有显著的近期疗效,病情和病因影响其预后.     

股骨头坏死及融通术后数字减影血管造影的初步观察

目的　观察和分析了 39例 (6 4髋 )治疗前后的股骨头坏死的数字减影血管造影 (DSA)的影像学表现。方法　对不同病因、不同分期的股骨头坏死行旋股内动脉插管造影和灌注尿激酶、丹参和川芎嗪。结果　①股骨头坏死分期与血管造影上下骺动脉分型关系 :股骨头坏死 0期、Ⅰ期和Ⅱ期表现为股骨头内Ⅱ型血管为主 ,Ⅳ型和Ⅴ型血管较少 ;Ⅲ期则Ⅱ型血管减少 ,而Ⅳ型和Ⅴ型血管增多 ;②股骨头坏死不同病因与血管造影上干骺动脉分型关系 :股骨头坏死诱因不同 ,其股骨头内的血管分型也不同 ,创伤性股骨头坏死以Ⅳ型和Ⅴ型为多 ,激素性和酒精性股骨头坏死以Ⅱ型和Ⅲ型为多 ;③股骨头坏死治疗前后与血管造影上干骺动脉分型关系 :治疗前Ⅱ型血管占 2 2 % ,治疗后Ⅱ型血管占 8% ,且Ⅳ、Ⅴ型血管明显增多 ;④股骨头坏死治疗前后与旋股内动脉 /旋股外动脉的血管管径比关系 :股骨头坏死者旋股内动脉扭曲、变细 ,旋股内动脉 /旋股外动脉的血管管径比为 0 6 0± 0 14,经治疗后旋股内动脉增粗 ,旋股内动脉 /旋股外动脉的血管管径比增大为 0 89± 0 2 1。结论　股骨头坏死的发生、发展和股骨头血循环、股骨头骨血管变化有很大的关系 ,血管融通术治疗股骨头坏死值得进一步研究     

选择性血管造影评价股骨颈骨折后股骨头血供变化

目的应用选择性血管造影技术(DSA)探讨不同类型股骨颈骨折后股骨头血供情况及手术对血供的影响。方法对28例股骨颈骨折患者闭合复位螺钉内固定手术前后行患、健侧髋部DSA,统计显影的支持带动脉数目。结果 GardenⅠ~Ⅳ型骨折术前支持带动脉数之间患/健比差异有统计学意义,均值呈递减趋势(P0.05);同型骨折手术前后比较,CardenⅠ~Ⅲ型差异均无统计学意义(P0.05),CardenⅣ型差异有统计学意义(P0.05)。结论 DSA可以较准确地评价不同类型股骨颈骨折后股骨头血供,有利于指导临床治疗方案的选择。     

影像学在股骨头坏死的介入治疗13例临床分析

目的:探讨股骨头缺血性坏死(ANFH)的影像介入治疗效果.方法:对13例ANFH患者的13髋先常规行股动脉DSA,后在股骨头的供血动脉旋股内、外侧动脉内灌注溶栓、扩血管药物,治疗后行股骨头X线平片及/或CT随访半年以评估疗效.结果:术后患者患髋疼痛症状明显减轻,关节功能不同程度改善,股骨头X线平片及/或CT随访1-6个月(平均4.4个月)示FicatI、Ⅱ期患者介入治疗后硬骨头修复明显.结论:股骨头供血动脉内的介入治疗是一种疗效肯定、安全的方法[1].     

带旋髂深血管蒂髂骨瓣植入治疗FicatⅡ期及Ⅲ期股骨头缺血性坏死的远期疗效

目的探讨带旋髂深血管蒂髂骨瓣植入治疗FicatⅡ、Ⅲ期股骨头缺血性坏死(avascular necrosis of femoral head,ANFH)的远期疗效。方法回顾分析2000年10月-2006年2月,采用带旋髂深血管蒂髂骨瓣植入术治疗并获随访的FicatⅡ、Ⅲ期ANFH 32例(43髋)。其中男27例(38髋),女5例(5髋);年龄21~52岁,平均36.6岁。病因:激素性8例(11髋),酒精性18例(23髋),特发性6例(9髋)。病程2~52个月,平均8.2个月。依照骨坏死Ficat分期标准:Ⅱ期26髋,Ⅲ期17髋。术前患髋Harris功能评分(Harris hip score,HHS)为(68.2±8.4)分。依据手术前后HHS评分变化和X线片改变进行临床疗效评价和影像学评价。结果术后切口均Ⅰ期愈合。除2例发生大腿前外侧皮肤麻木外,无其他手术相关并发症发生。4例(6髋)失访,其余患者获随访,随访时间98~187个月,平均129.3个月。5例(6髋)术后症状无缓解或加重,8~69个月时进展至Ⅳ期,行人工全髋关节置换术;余23例(31髋)未行进一步髋部手术;股骨头10年生存率83.78%(31/37)。末次随访时,23例(31髋)HHS评分为(86.7±9.0)分,与术前比较差异有统计学意义(t=—48.313,P=0.000);获优9髋、良13髋、可9髋;治疗成功率75.68%(28/37)。影像学检查示6~8周植骨区开始骨重建迹象,成骨后股骨头密度逐渐变均匀。至末次随访时5髋FicatⅡ期进展至Ⅲ期,3髋FicatⅡ期进展至Ⅳ期,3髋FicatⅢ期进展至Ⅳ期;余26髋外形完整,Shenton线基本连续,关节间隙亦未见明显狭窄,影像学成功率为70.27%(26/37)。结论带旋髂深血管蒂髂骨瓣植入治疗FicatⅡ、Ⅲ期ANFH,能够实现良好的成骨和血管重建作用,远期疗效满意。     

介入法治疗股骨头坏死的血管造影术观察

目的 观察和分析89例(142髋)治疗前后的股骨头坏死的数字剪影血管造影(DSA)的影像学表现。方法 旋股内动脉插管造影和灌注尿激酶、丹参和川芎嗪的基础上将骨髓基质干细胞灌注。结果①根据Atsumi,T股骨头坏死分期与血管造影上干骺动脉分型关系:股骨头坏死0期、1期和2期表现为股骨头内Ⅱ型血管为主,Ⅳ型和Ⅴ型血管较少;3期则Ⅱ型血管减少,而Ⅳ型和Ⅴ型血管增多;②股头坏死治疗前后与血管造影上干骺动脉分型关系:治疗前Ⅱ型血管占21.8％,治疗后Ⅱ型血管占9.1％且Ⅳ、Ⅴ血管明显增多;③股骨头坏死治疗前后与旋股内动脉/旋股外动脉的血管管径比为0.60± 0.14,经治疗后旋股内动脉增粗,旋股内动脉/旋股外动脉的血管管径比增大为0.89± 0.21。结论股骨头坏死的发生、发展与股骨头骨循环、股骨头骨血管变化有很大的关系,血管融通术加骨髓基质干细胞灌注治疗股骨头坏死值得进一步研究。     

应用选择性血管造影技术评价股骨颈骨折后股骨头血供情况及其对临床治疗的指导作用

目的探讨应用选择性血管造影（digital subtraction angiography,DSA）评价股骨颈骨折后早期股骨头血液循环损伤情况,以指导临床治疗。方法采用DSA对25例单侧股骨颈骨折的髋部进行旋股动脉及支持带动脉造影,按DSA结果分型,分别为Ⅰ、Ⅱ、Ⅲ型,以了解各型病例术前、术后的股骨头血供。结果 DSAⅠ、Ⅱ型病例无股骨头坏死,DSAⅢ型病例均出现股骨头坏死。结论 DSA可为股骨颈骨折的治疗提供更多、更有力的临床依据。     

带旋髂深血管蒂骨膜瓣植入治疗未成年股骨颈骨折术后股骨头缺血性坏死

目的探讨带旋髂深血管蒂骨膜瓣植入治疗未成年股骨颈骨折术后股骨头缺血性坏死(avascular necrosis of femoral head,ANFH)的疗效。方法 2006年12月-2011年8月,采用带旋髂深血管蒂骨膜瓣植入术治疗9例(9髋)未成年股骨颈骨折术后ANFH。其中男6例,女3例;年龄10~18岁,平均14.7岁。骨折原因:交通事故伤5例,高处坠落伤3例,摔伤1例。骨折后3~16 d行克氏针或空心螺钉内固定术,术后10个月内股骨颈骨折均愈合。术后10~42个月,平均24.4个月发生ANFH。骨坏死影像学评估按照Steinberg分期标准:Ⅲb期1例,Ⅲc期2例,Ⅳa期1例,Ⅳb期3例,Ⅳc期2例。根据手术前后髋关节功能Harris评分变化和Steinberg分期改变进行临床评价和影像学评估。结果术后患者切口均Ⅰ期愈合,无感染、下肢深静脉血栓形成、供区麻木、疼痛及其他手术相关并发症发生。9例均获随访,随访时间38~76个月,平均52个月。患者患髋或膝内上疼痛缓解,肢体无明显短缩,行走步态改善,患髋关节活动度增加。末次随访时,髋关节功能Harris评分为(92.7±9.9)分,与术前(62.8±3.6)分比较差异有统计学意义(t=—12.244,P=0.000);获优5例、良3例、差1例;治疗成功率为88.89%(8/9)。末次随访时,除1例术前Ⅲb期进展至Ⅳb期外,其余患者分期改善或稳定,影像学成功率为88.89%(8/9)。结论带旋髂深血管蒂骨膜瓣植入治疗未成年股骨颈骨折术后ANFH,能为股骨头提供良好的成骨及血管重建。     

经外科脱位入路打压植骨术与旋转截骨术治疗ARCOⅢ期股骨头缺血性坏死疗效比较

目的比较经髋关节外科脱位入路,采用死骨清理打压植骨术或股骨颈基底部旋转截骨术治疗国际骨循环协会(ARCO)Ⅲ期股骨头缺血性坏死(avascular necrosis of femoral head,ANFH)的疗效。方法将2012年6月—2017年11月收治并符合选择标准的24例(27髋)ANFH患者纳入研究。髋关节外科脱位入路后,12例(14髋)行死骨清理打压植骨术(A组),12例(13髋)行股骨颈基底部旋转截骨术(B组)。两组患者性别、年龄、病程以及ANFH侧别、类型、分期等一般资料比较,差异均无统计学意义(P0.05)。记录两组每侧髋关节手术时间、患者住院时间;影像学检查观察股骨头有无塌陷、截骨块愈合情况,股骨头周围血供情况;采用Harris评分评估髋关节功能。结果两组每侧髋关节手术时间、患者住院时间比较差异均无统计学意义(t=–0.262,P=0.797;t=–0.918,P=0.411)。患者均获随访,A组随访时间为12～28个月,平均19.7个月;B组为14～24个月,平均17.8个月。两组术后6、12个月Harris评分均较术前明显提高(P0.05);两组间比较差异均无统计学意义(P0.05)。术后12个月A组获优3髋、良7髋、差4髋,优良率71.4%;B组获优5髋、良7髋、差1髋,优良率92.3%。术后1周数字减影血管造影检查示,与术前相比两组股骨头周围血供均未被破坏。术后影像学复查显示两组大粗隆截骨块均愈合,B组股骨颈截骨均愈合;术后12个月仅A组2例(2髋)出现新的塌陷。患者关节间隙较术前均无狭窄,无软骨下骨硬化及骨囊肿形成。结论对于ARCOⅢ期ANFH患者,髋关节外科脱位入路后行股骨颈基底部旋转截骨术在延缓塌陷、提高髋关节功能方面优于死骨清理打压植骨术。     

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.