异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用

目的比较异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用。方法拟在全麻下行口腔-颌面肿瘤择期手术(手术时间达5 h左右)病人30例,ASAⅠ或Ⅱ级,年龄18～65岁,随机分为2组(n=15):异丙酚组(Ⅰ组)异氟醚组(Ⅱ组)。用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测。静脉注射罗库溴铵初始剂量0．6 mg·kg-1后气管插管,持续输注罗库溴铵。调整罗库溴铵的输注速率,T1稳定在基础值的10％时(初始状态),Ⅰ组靶控输注异丙酚维持麻醉,Ⅱ组吸入1 MAC异氟醚维持麻醉,持续5 h,术中维持T1在基础值的10％。记录罗库溴铵输注速率、恢复指数(T1恢复25％至75％的时间,T25-75)以及罗库溴铵停止输注到TOFR为0．9的时间。结果与初始状态比较,Ⅰ、Ⅱ组持续给药30 min-5 h时罗库溴铵输注速率下降(P<0．05);Ⅱ组持续给药1～5 h时罗库溴铵输注速率低于Ⅰ组(P<0．05)。两组间恢复指数和罗库溴铵停止输注到TOFR为0．9的时间差异无统计学意义(P>0．05)。结论罗库溴铵可用于长时间持续输注以维持稳定的肌松。维持T1在基础值的10％的情况下,持续输注罗库溴铵5 h时异氟醚麻醉比异丙酚为主的全凭静脉麻醉罗库溴铵输注速率减少30％,但其恢复指数无差异。     

七氟醚对罗库溴铵肌松效应的影响

目的 研究吸入不同浓度的七氟醚对不同剂量的罗库溴铵肌松效应的影响.方法 90例择期手术患者随机均分为六组.记录各组静注罗库溴铵后其起效时间、四个成串刺激(TOF)无反应时间、T1 25%恢复时间、T1 75%恢复时间及恢复指数(T1 25%恢复到75%的时间).结果 静注等效剂量的罗库溴铵Ⅲ组与Ⅰ组、Ⅳ组与Ⅱ组比较,起效时间差异无统计学意义.而静注等效剂量的Ⅴ组与Ⅰ组、Ⅵ组与Ⅱ组比较,起效时间明显缩短(P＜0.05);在无反应时间、T1 25%恢复时间、T1 75%恢复时间及恢复指数上,复合吸入七氟醚的Ⅲ到Ⅵ组较注入等效剂量的罗库溴铵Ⅰ组与Ⅱ组比较均有明显的延长(P＜0.05或P＜0.01);Ⅱ组与Ⅲ组之间以及Ⅳ组与Ⅴ组之间罗库溴铵的肌松维持时间差异无统计学意义.结论 七氟醚能明显延长罗库溴铵的作用时间,有时间依赖及剂量依赖趋势.     

罗库溴铵对老年病人的药效动力学影响

目的 研究罗库溴铵对老年病人的肌松效应。方法 94例ASA Ⅰ～Ⅱ级的病人按年龄分为4组,Ⅰ组为对照组(28例,32～59岁),Ⅱ组(29例,60～69岁),Ⅲ组(27例,70～89岁)和Ⅳ组(10例,90～97岁)。四组病人均于全麻诱导时静注罗库溴铵0.6mg/kg,并进行四个成串刺激(TOF)肌松监测。术中持续静注罗库溴铵,用注射泵调控给药剂量,T_1维持10％～20％至手术结束。记录罗库溴铵起效时间、T_1为零时间、首次给药后T_110％恢复时间、停药后T_125％恢复时间以及每30min罗库溴铵用量。结果 (1)Ⅰ组病人罗库溴铵起效时间明显比其余三组长(P<0.01),Ⅳ组病人肌松起效时间快于Ⅱ组和Ⅲ组(P<0.01)。(2)Ⅰ组病人T_1为零时间明显比其余3组病人长(P<0.01),Ⅱ、Ⅲ组T_1为零时间相近(P>0.05),Ⅳ组病人则短于Ⅱ组和Ⅲ组(P<0.01)。(3)Ⅰ组和Ⅱ组首次给药后T_110％恢复时间和停药后T_125％恢复时间显著快于Ⅲ组和Ⅳ组(P<0.01)。(4)不同年龄组罗库溴铵用量不同,随年龄增加而减少(P<0.01)。结论 随着年龄的增长,尤其在高龄病人罗库溴铵起效时间,达最大效能时间增快、维持用量减少和肌松持续时间延长。     

肝硬化病人乌司他丁预处理对罗库溴铵肌松作用的影响

目的观察肝硬化病人乌司他丁预处理对罗库溴铵肌松作用的影响。方法选择30例患有肝硬化的成年手术病人,随机均分为两组:乌司他丁组(Ⅰ组),静注乌司他丁5000U/kg后1min,静脉给予罗库溴铵0.6mg/kg;生理盐水组(Ⅱ组),静脉给予生理盐水0.1ml/kg后1min,静脉给予罗库溴铵0.6mg/kg。另选15例无肝脏疾患的、ASAⅠ～Ⅱ级择期成年手术病人为对照组(Ⅲ组),处理同Ⅱ组。肌松监测仪检测四个成串刺激(TOF)的变化,记录三组注药后罗库溴铵的起效时间(注药到TOFr=0)、TOF无反应时间(T1=0持续时间)、T1最大抑制程度、临床时效(TOFr恢复至25%时间)、T1恢复至75%时间、恢复指数。结果与Ⅱ、Ⅲ组比较,Ⅰ组插管剂量罗库溴铵的起效时间明显延长(P<0.05)。Ⅱ、Ⅲ组罗库溴铵肌松的起效时间相似。与Ⅱ组比较,Ⅰ、Ⅲ组T1恢复25%时间和恢复指数明显缩短(P<0.05)。Ⅰ、Ⅲ组罗库溴铵肌松的恢复时间相似。结论肝硬化病人乌司他丁预处理延长罗库溴铵的起效时间,但缩短罗库溴铵肌松作用时间。     

七氟醚对罗库溴铵肌松效应的影响

目的 观察七氟醚对罗库溴铵肌松作用的影响.方法 成人全麻手术患者60例随机均分为三组.每组20例.Ⅰ组丙泊酚静脉麻醉,Ⅱ组吸入七氟醚(1 MAC)15 min,Ⅲ组吸入七氟醚(1 MAC)45 min.在麻醉平稳(Ⅱ、Ⅲ组在呼气末七氟醚浓度稳定在1 MAC)后静脉注射罗库溴铵0.6 mg/kg,记录TOFr的变化.结果 Ⅱ、Ⅲ组罗库溴铵的起效时间分别为97.60 s和94.50 s,明显短于Ⅰ组的119.90 s(P<0.05);Ⅱ和Ⅲ组完全肌松时间(T1消失)明显长于Ⅰ组(32.7 min和44,6 min vs.21.3 min)(P<0.05),Ⅲ组明显长于Ⅱ组(P<0.05);TOF的T2～T4出现的时间及TOFr恢复到25%、50%和75%的时间,Ⅱ、Ⅲ组均长于Ⅰ组,且Ⅲ组长于Ⅱ组(P<0.05).结论 持续吸入1 MAC七氟醚能随吸人时间延长而增强罗库溴铵的神经肌肉阻滞效应.     

异氟醚对罗库溴铵肌松效应影响的实验研究

目的　通过在体兔坐骨神经一胫前肌标本的制备,研究异氟醚对单次静注和连续输注罗库溴铵肌松效应的影响。方法　实验家兔均采用异氟醚全麻。10只家兔分为两组观测,观察组间单次静注罗库溴铵的肌松时效的变化;另取10只家兔分为两组,观察组间罗库溴铵连续输注后的肌松时效和输注量的变化。结果　单次静注罗库溴铵(2 倍 ED95 )时,异氟醚使其作用时间延长约 7min(P<0 .05),同时罗库溴铵对血液动力学影响轻微;连续静注罗库溴铵时,异氟醚使罗库溴铵的静脉输注需要量减少40%(P<0 .05),而对起效和恢复指数无明显影响。结论　异氟醚能增强罗库溴铵的肌松时效。     

054滴注罗库溴铵对氟烷、异氟醚或七氟醚麻醉下儿童的影响

罗库溴铵是蓄积作用不明显的中效非去极化肌松药,可以持续滴注。氟烷、异氟醚、七氟醚以及地氟醚都能增强罗库溴铵的肌松效果。作者为了研究儿童在芬太尼-氧化亚氮、氟烷、异氟醚或七氟醚麻醉时,连续滴注罗库溴铵的用量问题,特选择40例体质良好的3～11岁儿童(ASA Ⅰ～Ⅱ级)随机分成4组,术前均口服咪达唑伦0.3 mg·kg-1。①FN组(芬     

地氟醚对罗库溴铵肌松效应的影响

目的研究地氟醚对罗库溴铵肌松效应的影响。方法成人全麻手术患者30例,随机分为3组静脉麻醉组(Ⅰ组)、吸入地氟醚(1MAC)15min组(Ⅱ组)和45min组(Ⅲ组)。Ⅰ组在麻醉平稳后,Ⅱ组和Ⅲ组分别在呼气末地氟醚浓度稳定15min和45min时静注罗库溴铵0.6mg·kg-1,用肌松监测仪监测TOF(四个成串刺激)的变化。结果Ⅱ组的T1和TOF比值起效时间(min)分别为1.3和0.8,与Ⅰ组2.2和1.5比较,明显缩短(P<0.05);临床肌松时间(T1值恢复至25％基础值的时间)3组分别为29.6,31.7和37.8min,Ⅲ组与Ⅰ组比较明显延长(P<0.05);T     

性别对腹部手术病人罗库溴铵肌松作用的影响

目的研究性别对腹部手术病人罗库溴铵肌松作用的影响。方法拟在全麻下行腹部手术病人24例,年龄20-59岁,ASA Ⅰ或Ⅱ级,分为男性组(M组)与女性组(F组),每组12例。静脉注射异丙酚、芬太尼、罗库溴铵0．6 mg·kg-1行麻醉诱导。以4个成串刺激(TOF)监测神经肌肉阻滞深度,T1达最低时行气管插管。异丙酚靶控输注(效应室浓度3-4μg·ml-1)及静脉注射芬太尼维持麻醉。T1恢复至10％开始输注罗库溴铵,初始速率0．7 mg·kg-1·h-1,维持T1在5％-10％,术毕停用罗库溴铵,新斯的明0．05 mg·kg-1拮抗肌松效应,记录罗库溴铵的肌松作用指标。结果与F组比较,M 组身高与体重较高,T1最大抑制程度、罗库溴铵平均用药速率、新斯的明拮抗后T1自10％恢复到50％的时间、T1自25％恢复到75％的时间差异无统计学意义,起效时间延长,最大效应持续时间、T1恢复到10％的时间缩短;M组第1个10 min罗库溴铵用药平均速率大于其它时间段,且大于F组(P< 0．05)。结论单次静脉注射罗库溴铵的肌松作用存在性别差异,女性较男性病人敏感。     

肝功能不全门脉高压病人罗库溴铵的肌松效应

目的 观察罗库溴铵在肝功能不全门脉高压病人中的肌松效应。方法 70例ASA I-Ⅱ级择期行上腹部手术的病人分为两组:门脉高压组(M组,n=36),对照组(C组,n=34),其中门脉高压组肝功能均属Child-Turcottee分级法Ⅱ级,对照组肝功能正常。两组病人麻醉诱导均为静脉注射咪唑安定0.02 mg·kg-1、异丙酚1.0 mg·kg-1、芬太尼5μg·kg-1和罗库溴铵0.6 mg·kg-1,同时进行肌松监测。麻醉维持采用吸入异氟烷及间断静脉注射芬太尼,罗库溴铵微量泵持续静注维持肌松,维持T1在10％-20％直至手术结束。记录罗库溴铵起效时间,TOF无反应时间,首次给药后,T110％恢复时间,停药后T125％恢复时间,恢复指数以及每30 min罗库溴铵维持用量。结果 M组病人肌松药起效时间、TOF完全阻断时间、首次给药后,T110％恢复时间、停药后T125％恢复时间及恢复指数比C组病人延长(P<0.01)。M组病人持续输注罗库溴铵用量明显小于C组病人(P<0.01)。结论 肝功能不全的门脉高压病人罗库溴铵起效、维持时间和肌松恢复时间明显延长,维持用量明显减少。     

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.