0.25%罗比卡因用于小儿单次骶管阻滞的临床观察

罗比卡因具有对心脏、神经毒性小,感觉-运动阻滞分离等特点,适用于小儿骶管阻滞,本文将探讨罗比卡因在小儿单次骶管阻滞中的应用效果及安全性,为临床提供参考。     

硬膜外甲磺酸罗比卡因复合吗啡应用于妇科术后镇痛的观察

目的比较硬膜外甲磺酸罗比卡因与盐酸罗比卡因复合吗啡用于妇科术后镇痛的临床效果和安全性。方法40例择期在硬膜外麻醉下行经腹子宫全切或子宫肌瘤摘除手术患者,随机分为两组,观察组(n=40)采用0·238%甲磺酸罗比卡因(含0·002mg/ml吗啡);对照组(n=40)采用0·2%盐酸罗比卡因(含0·002mg/ml吗啡)。观察术后15min、2、4、8、24、48h两组患者的视觉模拟评分(VAS)、镇静评分、下肢运动神经阻滞情况及副作用的发生率。结果在各时点两组患者的VAS、镇静评分、下肢运动神经阻滞情况及副作用的发生率差异均无显著意义。结论硬膜外甲磺酸罗比卡因与盐酸罗比卡因复合吗啡术后镇痛具有相似的临床效果和安全性。     

相同浓度罗比卡因与布比卡因用于颈神经丛阻滞的比较

目的评价相同浓度罗比卡因与布比卡因用于颈神经丛阻滞的麻醉效果.方法49例ASAⅠ～Ⅱ级甲状腺肿物切除患者随机分为两组,罗比卡因组(Ⅰ组)31例,布比卡因组(Ⅱ组)18例,分别用0.375%罗比卡因和0.375%布比卡因10 ml阻滞颈浅丛神经,用0.25%罗比卡因和0.25%布比卡因10 ml阻滞其深丛.记录麻醉效果及所产生的并发症,记录麻醉前(T0)、麻醉后即刻(T1)、麻醉后的5 min(T2)、10 min(T3)、15 min(T4)、30 min(T5)及手术结束(T6)时的HR、SBP、DBP、MAP、SpO2、RR、Mv、VT.结果两组麻醉效果相同,产生的并发症也无显著性差异(P＞0.05).罗比卡因对抬头肌力的影响显著弱于布比卡因(P＜0.01).两组HR麻醉后均有显著升高(P＜0.05),SBP、DBP、MAP在T1～T5时有显著升高(P＜0.05),在T6时与T0相比无显著性差异(P＞0.05).与T0比较,两组SpO2、RR、Mv和VT在各时间点上无显著性差异(P＞0.05).结论0.375%罗比卡因和0.375%布比卡因用于颈浅丛神经阻滞,0.25%罗比卡因和0.25%布比卡因用于颈深丛阻滞均产生较好的麻醉效果.罗比卡因由于运动神经阻滞较弱,更适于颈神经丛阻滞.     

罗比卡因硬膜外阻滞行剖宫产时胎儿脐静脉血及产妇静脉血血药浓度的观察

目的观察0.75%罗比卡因用于硬膜外阻滞行剖宫产时胎儿脐静脉血与产妇静脉血的血药浓度。方法随机选择16例ASAⅠ~Ⅱ级行剖宫产的足月单胎初产妇,身高155~165 cm。按体重(kg)=身高(cm)-105计算标准体重,并按2 mg/kg计算硬膜外罗比卡因用药量。取L2~3间隙为穿刺点,头向置管3~3.5 cm。在断脐带后立即抽取脐带静脉血和产妇静脉血送检。观察胎儿及产妇静脉血血药浓度、药物起效时间、术中最高作用平面、注药至切皮时间、注药至胎儿取出时间、基础平均动脉压(MAP)、心率(HR)、用药后15、304、5 min和手术结束时MAP、HR。结果产妇静脉血血药浓度为(851±34)ng/ml,胎儿脐静脉血血药浓度为(307±42)ng/ml。胎儿脐带和产妇静脉血血药浓度的比值(UV/MV)为0.34±0.03。结论0.75%罗比卡因用于硬膜外阻滞行剖宫产是安全有效的。     

罗比卡因复合舒芬太尼硬膜外麻醉效果的临床观察

目的观察硬膜外罗比卡因复合舒芬太尼在下肢手术的麻醉效果.方法40例ASAⅠ～Ⅱ级下肢手术患者随机分为两组：罗比卡因复合舒芬太尼组（S组,n=20）和罗比卡因组（R组,n=20）.硬膜外穿刺部位均为L2～3间隙,每组硬膜外首剂量均为2%利多卡因3 ml（试验量）加0.75%罗比卡因10 ml,S组复合舒芬太尼10μg（1 ml）,R组复合生理盐水1 ml.于单次剂量麻醉期间对镇痛效果,运动阻滞及镇静程度予以分级评定,记录感觉阻滞达T12、T10及最高平面时间、镇痛持续时间和不良反应及辅助用药情况.结果S组感觉阻滞达T12、T10及最高平面时间缩短,镇痛持续时间延长（P＜0.05）,镇痛效果、运动阻滞情况和镇静程度两组差异无显著性（P＞0.05）,未见明显不良反应.结论罗比卡因复合小剂量舒芬太尼可以显著增强罗比卡因的硬膜外麻醉效果.     

罗比卡因和利多卡因对小鼠体外受精和早期胚胎发育的影响

目的 :应用昆明小鼠胚胎体外培养模式和小鼠体外受精模型探讨罗比卡因与利多卡因对体外受精和早期胚胎发育的影响。方法 :( 1 ) 2 -细胞期胚胎培养 :取 4～ 6周昆明雌鼠 ,下午 4～ 6时腹腔注射孕马血清 ( PMSG) 5IU,48h后腹腔注射人绒毛膜促性腺激素 ( h CG) 5IU超排卵 ,随即雌雄合笼。次日早上 9时检查阴栓 ,阳性者于注射 h CG42h后取 2 -细胞期胚胎 ,分别放入含 1、1 0及 1 0 0μg/ ml不同浓度的罗比卡因和利多卡因的M1 6培养液中培养 ,培养液中加入输卵管上皮 ,72 h后观察桑椹胚或囊胚形成率。 ( 2 )体外受精 :从 F1代 ( C57× CBA)杂交雄鼠附睾和输精管取精子 ,从昆明雌鼠取卵母细胞 ,卵母细胞体外受精前暴露于不同浓度的利多卡因和罗比卡因 3 0 min,统计体外受精率。结果 :罗比卡因只在高浓度 1 0 0 μg/ ml时对 2 -细胞至囊胚期的胚胎发育产生明显抑制影响。利多卡因则在 1μg/ ml的浓度即对 2 -细胞期胚胎发育产生明显抑制。而 1 0和 1 0 0μg/ ml的利多卡因和罗比卡因均未对体外受精率有明显影响。结论 :提示罗比卡因可能用于体外受精技术中有关配子和合子取出或植入时的麻醉。     

甲磺酸罗比卡因与盐酸罗比卡因用于硬膜外阻滞的效应比较

目的 评价甲磺酸罗比卡因用于硬膜外阻滞的效应和安全性。方法 45例择期行下腹或下肢手术病人,随机分别接受用甲磺酸罗比卡因(8.94 mg/ml,观察组)或盐酸罗比卡因(7.5mg/ml,对照组)施行的硬膜外阻滞。观察两组在感觉阻滞、运动阻滞、镇痛和肌肉松弛方面的效果,同时观察用药前后肝肾功能变化。结果 观察组和对照组感觉阻滞平面达到T6以上的病例分别为84.3％和76％(P>0.05),Bromage≥3级的病例分别90％和92％(P>0.05)。两组感觉阻滞平面固定时间、Bromage达到最大级别时间、最大级别维持时间和运动阻滞维持时间均无显著性差异(P>0.05)。两组镇痛及肌松满意率无显著性差异。观察组术中2例发生低血压,2例发生心动过缓,而对照组仅1例发生低血压。两组术后24 h天冬氨酸氨基转移酶(AST)、天冬氨酸转氨酶(ALT)、尿素氮(BUN)和肌酐(Cr)均在正常范围。结论 甲磺酸罗比卡因与盐酸罗比卡因行硬膜外阻滞的效应基本相同,且无明显毒性。     

罗比卡因用于硬脊膜外麻醉导致惊厥1例报告

罗比卡因的神经阻滞作用较布比卡因有一定的优越性,并且心脏毒性作用较小。因此罗比卡因自应用于临床以来,一直被认为是较为安全的局麻药物。本文是首次对硬脊膜外麻醉应用罗比卡因导致中枢神经系统中毒反应进行个案报道。 患者为一23岁孕妇,既往体健,无先兆子癎及癫癎史。产前行腰部硬脊膜外穿刺并置管拟行分娩镇痛,此时发现孕妇宫口已完全张开,于是放弃硬脊膜外给药,但仍于原位保留硬脊膜外导管。分娩后次晨,在氧饱和度、动脉血压及心电图实行监护下拟行输卵管结扎术。经硬脊膜外导管回抽无异物后,注入0.75％罗比卡因2ml(15mg),3min后无腰麻表现,又注射4ml     

0.25%罗哌卡因用于小儿骶管阻滞麻醉临床观察

目的评价0.25%罗哌卡因用于小儿骶管阻滞的安全性和有效性。方法15例1~8岁行下肢、会阴手术患儿,均在基础麻醉后行骶管阻滞,注入0.25%罗哌卡因0.8ml/kg。测定骶管阻滞的起效时间和镇痛时间,记录HR、MAP和SpO2及追加镇痛药量,并观察出现的不良反应。结果术中均无需追加镇痛药,麻醉效果满意。起效时间(75±20)min和镇痛时间(312±44)min,未观察到局麻药的毒性反应。结论0.25%罗哌卡因(0.8ml/kg)可提供满意的小儿骶管阻滞麻醉。     

罗比卡因复合舒芬太尼行硬膜外分娩镇痛的最低有效浓度探讨

目的寻求自第一产程起硬膜外分娩镇痛的最适舒芬太尼浓度,及与之配伍的罗比卡因的浓度和剂量。方法选择ASAⅠ~Ⅱ级,妊娠≥36周,产前无服用镇痛催眠药史的初产妇124例,随机分为四组,Ⅰ组:罗比卡因复合0.2μg/ml舒芬太尼组;Ⅱ组:罗比卡因复合0.4μg/ml舒芬太尼组;Ⅲ组:罗比卡因复合0.6μg/ml舒芬太尼组;Ⅳ组:对照组,单纯使用罗比卡因。宫口开至2~3 cm时于L2~3间隙行硬膜外穿刺置管,分别注入15 ml罗比卡因与不同浓度的舒芬太尼混合溶液。根据双盲、序贯的方法,以上一产妇的镇痛效果,确定下一例产妇所用的罗比卡因药液浓度,各组初始的罗比卡因浓度均定为0.12%。结果4例产妇因脐带脱垂、单侧硬膜外阻滞或结果可疑而退出研究,余120例产妇进入分析。各组罗比卡因分娩镇痛的EC50值分别为Ⅰ组:0.074%(95%CI,0.071%~0.078%);Ⅱ组:0.048%(95%CI,0.041%~0.056%);Ⅲ组:0.035%(95%CI,0.029%~0.044%);Ⅳ组:0.111%(95%CI,0.106%~0.116%),各组间差异均有极显著意义(P<0.01)。结论硬膜外复合使用舒芬太尼能剂量相关地降低罗比卡因分娩镇痛的最低有效浓度。使用0.2μg/ml和0.4μg/ml的舒芬太尼得到的罗比卡因的最低有效镇痛浓度分别为0.074%和0.048%,两组均可达到满意镇痛。     

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.