The very first anaesthetics were gaseous. These early slow, irritant or flammable drugs were ultimately displaced by intravenous agents, despite other beneficial properties. Preliminary work with two new insoluble, potentially rapid-acting nonflammable anaesthetics showed desflurane, the less soluble, to be too irritant while sevoflurane was smooth and well-tolerated. This thesis set out to examine possible clinical andlor financial benefits from the use of sevoflurane in day case patients. A double-blind comparison showed sevoflurane to induce anaesthesia almost as rapidly as the most common intravenous drug, but to minimise apnoea and hypotension, with a smoother transition to the maintenance phase and faster emergence from brief day case anaesthesia. While a few patients found gaseous induction unpleasant, this was not confirmed by an audit of sevoflurane's more widespread use. Further work evaluated alternative, vital capacity, induction techniques. However, simple tidal breathing was found to be equally effective but more consistent, appearing to be the method of choice, even compared with the most recent, optimised delivery of intravenous anaesthetics. Gaseous induction was shown to facilitate airway maintenance with either a face mask or laryngeal mask. Double-blind comparisons showed that it also provided acceptable conditions for tracheal intubation in the small minority of day case patients in whom this is required. Compared to the usual intravenous anaesthetic, gaseous induction with sevoflurane was shown to be less expensive under most common circumstances. Gaseous induction also reduced anaesthetic consumption during the subsequent maintenance phase, making it the most efficient way in which to use inhalation anaesthetics. Having reestablished gaseous induction as an important technique with clinical and financial benefits in modem day case practice, this thesis concludes with suggestions for future research to further refine the process and find solutions to some minor problems, such as occasional patient reticence and the possibility of increased postoperative nausea.

No description available.

ABSTRACT Purpose: Dexamethasone provides potent analgesic and antiemetic effects. Sevoflurane are associated with an increased incidence of postoperative nausea and vomiting (PONV) and delayed patient discharge compared to propofol. This study was designed to evaluate whether the prophylatic use of dexamethasone with sevoflurane could minimize the incidence of PONV and facilitate early recovery after outpatient anorectal surgery. Methods: Forty outpatients undergoing anorectal surgery were randomly assigned to receive either dexamethasone (5 mg IV; n=20) or an equal volume of saline (n=20) before the induction of anesthesia. Anesthesia was induced with sevoflurane 8% and N2O 67% in oxygen (at 6 L/min) followed by placement of laryngeal mask. Anesthesia was maintained with sevoflurane 2-4% end-tidal in combination with N2O 50% in oxygen 3 L/min. All patients were allowed to breathe spontaneously during the operation. The postoperative nausea and vomiting (PONV), VAS pain score and patient satisfaction were recorded. Results: The incidence of PONV and VAS pain score were significant lower in dexamethasone-treated patients compared with saline-treated ones. The time required for discharge was significantly shorter in dexamethasone-treated patients. Above all, the dexamethasone-treated patients expressed higher satisfaction index. There was no significant difference in recovery time for eye opening, response to commands, orientation, and ambulatory. Conclusions: The prophylactic administration of dexamethasone reduces the incidence of PONV andVAS pain score, promotes recovery to home readiness, and improves the satisfaction after the anesthesia with spontaneously breathing of sevoflurane through laryngeal mask in outpatients undergoing anorectal surgery.

Aim of investigation¡GThe purpose of the randomized, double blind study is to determine whether intravenous ketamine will reduce the frequency of emergence agitation and whether the timing of ketamine administration have any impact on the recovery profile of sevoflurane anesthesia, will also be investigated. Methods¡GWe study 223, under 12 years old, otherwise healthy children of ASA physical status I and II, who will undergo polio-related surgery. During the operation, the keta group (n =96) receive ketamine intravenously; and the Control group(n = 127) receive saline as control and ketamine will be administered only when the Agitation Scale¡Ù3 . In the recovery room, routine standard measurement every 30 minutes monitoring included blood pressure, SaO2, heart rate, respiratory rate, agitation scale, and pain scale. Postoperative pain was assessed using the Objective Pain Scale (OPS). Agitation level will be evaluated by using 5-point agitation scale. The data will be analyzed with SPSS. Results¡GThe use of ketamine on surgery pain management is effective within 30 min after surgery, buy not actually effective thereafter. Multiple factors affect the emergence of agitation. The satisfaction survey shows no difference whether using ketamine or not. Emergence agitation using ketamine expend highest cost. Conclusion¡GIt is considerable to further search a more costive and effective agent than ketamine after sevoflurane anesthesia.

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2003Bitstream added on 2014-06-13T19:00:38Z : No. of bitstreams: 1 reis_mrc_dr_botfm.pdf: 2372864 bytes, checksum: 3670f19e59c1bd70593103929a9e7758 (MD5) / Apesar das diversas evidências clínicas que garantem sua segurança, a questão dos potenciais efeitos adversos do sevoflurano sobre a função renal continua gerando controvérsias. Este estudo, prospectivo, foi realizado com 16 cães, submetidos à indução anestésica com fentanil (20 mg.kg-1) e propofol (6 mg.kg-1), à manutenção com sevoflurano a 3% e à ventilação artificial dos pulmões com fluxo de lL.min-1 e FIO2 = 0,3. Foram realizados cateterismos, instalação de aparelhos de registro, preparação cirúrgica com lombotomia direita para nefrectomia e lombotomia esquerda para ligadura da artéria renal esquerda, por período de 30 minutos, com reperfusão, e cateterização do ureter esquerdo para coleta de urina. Para estudo do fluxo plasmático renal e da filtração glomerular, foi infundida solução de para-aminohipurato de sódio (PAH) e de creatinina. Estudaram-se as alterações que poderiam ocorrer na função renal sob a ação do sevoflurano, após 30 minutos de isquemia renal e posterior reperfusão (GI), e sem isquemia (GC). Foram estudados a freqüência cardíaca, pressão arterial média, pressão de veia cava inferior, fluxo sangüíneo renal, clearance de PAH e de creatinina, resistência vascular renal, fração de filtração, volume urinário, hematócrito, sódio e potássio plasmáticos, osmolalidade plasmática e urinária, clearance osmolar, de água livre e de sódio, excreção urinária e fracionária de sódio, clearance, excreção urinária e fracionária de potássio, pHa, PaO2, SpO2, PaCO2, ETCO2, temperatura corporal, da cal sodada 1 e 2 e ambiente e b2-microglobulina. Foram colhidos fragmentos para estudo histológico... / Despite mounting clinical evidence that supports its safety, the question of the potential adverse effects of sevoflurane on renal function continues to generate some controversy. In a prospective study, sixteen dogs were submitted to anesthesia induction with fentanyl (20 mg.kg-1) and propofol (6 mg.kg-1) and maintenance with 3% sevoflurane, and to the artificial ventilation with lL.min-1 flow and FIO2 = 0,3. There were catheterizations and the installation of registration apparatus, surgical preparation with right lumbotomy to nephrectomy and left lumbotomy to clamping of left renal artery during a period of 30 minutes with reperfusion, and catheterization of the left ureter to urine collection. In order to study effective renal plasma flow and glomerular filtration rate, a solution containing para-aminohippurate sodium (PAH) and creatinine was infused. The changes that could happen in the renal function under sevoflurane effect and after 30 min of renal ischemia and reperfusion (GI), and without ischemia (GC) were studied. The following attributes were studied: heart rate, mean arterial blood pressure, inferior vena cava pressure, renal blood flow, PAH and creatinine clearance, renal vascular resistance, filtration fraction, urinary flow, hematocrit, serum sodium and potassium, serum and urinary osmolalities, osmolar, free water and sodium clearance, urinary and fractionary sodium excretions, potassium clearance, urinary and fractionary potassium excretions, pHa, PaO2, SpO2, PaCO2, ETCO2, body, soda lime 1 and 2, and... (Complete abstract, click electronic address below)

Made available in DSpace on 2014-06-11T19:35:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-15Bitstream added on 2014-06-13T20:06:46Z : No. of bitstreams: 1 diego_las_dr_botfm.pdf: 928445 bytes, checksum: b041c5d0355031145492120fceebec02 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A glibenclamida, sulfoniluréia muito utilizada clinicamente no controle do diabetes mellitus, possui propriedade bloqueadora dos canais de potássio dependentes de adenosina trifosfatona (k+ ATP), opondo-se à possível propriedade pré-condicionante do sevoflurano. Hipovolemia conseqüente à hemorragia suscita reações compensadoras de proteção orgânica. Entretanto, mecanismos protetores como a ativação do sistema renina-angiotensina ensejam agressão renal por vasoconstrição com interferência na função depuradora. O objetivo do presente estudo foi avaliar os efeitos da glibenclamida na função e histologia renais de ratos sob anestesia com sevoflurano em cenário de choque hemorrágico. Neste intuito, estudou-se uma amostra de 20 ratos Wistar. O delineamento consistiu em estudar os animais quanto à pressão arterial, à temperatura retal e ao hematócrito e quantificar atributos da função renal, tais como: ritmo de filtração glomerular (RGF), estudar os animais quanto ao peso, pressão arterial média, temperatura retal e hematócrito e fluxo plasmático renal efetivo (FPR efetivo), fluxo sangüíneo renal e resistência vascular renal (RVR), além de se analisarem as alterações histológicas após a imposição da condição experimental. A amostra foi aleatoriamente dividida em 2 grupos de 10 animais cada (G1 e G2), entretanto apenas um destes (G2) foi submetido a tratamento com glibenclamida venosa (1 mcg.g-1), 60 min antes do início de sangria. Os animais de ambos os grupos foram anestesiados com sevoflurano a 4% sob campânula apropriada e mantidos em respiração espontânea com ar enriquecido com oxigênio, além de sofrerem sangria de 30% da volemia (esta calculada como 6% do peso corporal)... / Glibenclamide, a sulfonylurea widely used clinically for controlling diabetes mellitus, blocks adenosine triphosphate-dependent potassium (K+ ATP) channels, thus opposing the possible preconditioning property of sevoflurane. Hypovolemia from hemorrhage evokes protective compensatory reactions. However, protective mechanisms such as activation of the renin-angiotensin system result in renal impairment by vasoconstriction interfering in the clearance function. This study was designed to evaluate the effects of glibenclamide on renal function and histology in rats in a state of hemorrhagic shock under sevoflurane anesthesia. A sample of 20 Wistar rats was studied for that purpose. The design consisted in studying mean arterial pressure, rectal temperature and hematocrit and quantifying glomerular filtration rate (GFR), effective renal plasma flow (ERPF), renal blood flow (RBF) and renal vascular resistance (RVR), and analyzing histological alterations after the experimental conditions were attained. The sample was randomized into 2 groups of 10 animals each (G1 and G2), only one of which (G2) was treated with intravenous glibenclamide (1 mcg.g-1), 60 min before bleeding was begun. Both groups were anesthetized with sevoflurane at 4% under an appropriate bell jar and kept on spontaneous respiration with oxygen-enriched air, while being bled of 30% of volemia (calculated as 6% of body weight) in 3 stages with 10-min intervals. Evaluation of renal function used estimated renal clearances of paraaminohippurate (ERPF) and sodium iothalamate (GFR), while renal histology was evaluated by investigating the degree of vascular and tubular dilatation, vascular congestion, tubular vacuolization, necrosis and signs of tubular regeneration... (Complete abstract click electronic access below)

Orientador: Yara Marcondes Machado Castiglia / Banca: Yara Marcondes Machado Castiglia / Banca: Pedro Thadeu Galvão Vianna / Banca: Luis Antonio Vane / Banca: José Luiz Gomes do Amaral / Banca: Luís Vicente Garcia / Resumo: A glibenclamida, sulfoniluréia muito utilizada clinicamente no controle do diabetes mellitus, possui propriedade bloqueadora dos canais de potássio dependentes de adenosina trifosfatona (k+ ATP), opondo-se à possível propriedade pré-condicionante do sevoflurano. Hipovolemia conseqüente à hemorragia suscita reações compensadoras de proteção orgânica. Entretanto, mecanismos protetores como a ativação do sistema renina-angiotensina ensejam agressão renal por vasoconstrição com interferência na função depuradora. O objetivo do presente estudo foi avaliar os efeitos da glibenclamida na função e histologia renais de ratos sob anestesia com sevoflurano em cenário de choque hemorrágico. Neste intuito, estudou-se uma amostra de 20 ratos Wistar. O delineamento consistiu em estudar os animais quanto à pressão arterial, à temperatura retal e ao hematócrito e quantificar atributos da função renal, tais como: ritmo de filtração glomerular (RGF), estudar os animais quanto ao peso, pressão arterial média, temperatura retal e hematócrito e fluxo plasmático renal efetivo (FPR efetivo), fluxo sangüíneo renal e resistência vascular renal (RVR), além de se analisarem as alterações histológicas após a imposição da condição experimental. A amostra foi aleatoriamente dividida em 2 grupos de 10 animais cada (G1 e G2), entretanto apenas um destes (G2) foi submetido a tratamento com glibenclamida venosa (1 mcg.g-1), 60 min antes do início de sangria. Os animais de ambos os grupos foram anestesiados com sevoflurano a 4% sob campânula apropriada e mantidos em respiração espontânea com ar enriquecido com oxigênio, além de sofrerem sangria de 30% da volemia (esta calculada como 6% do peso corporal)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Glibenclamide, a sulfonylurea widely used clinically for controlling diabetes mellitus, blocks adenosine triphosphate-dependent potassium (K+ ATP) channels, thus opposing the possible preconditioning property of sevoflurane. Hypovolemia from hemorrhage evokes protective compensatory reactions. However, protective mechanisms such as activation of the renin-angiotensin system result in renal impairment by vasoconstriction interfering in the clearance function. This study was designed to evaluate the effects of glibenclamide on renal function and histology in rats in a state of hemorrhagic shock under sevoflurane anesthesia. A sample of 20 Wistar rats was studied for that purpose. The design consisted in studying mean arterial pressure, rectal temperature and hematocrit and quantifying glomerular filtration rate (GFR), effective renal plasma flow (ERPF), renal blood flow (RBF) and renal vascular resistance (RVR), and analyzing histological alterations after the experimental conditions were attained. The sample was randomized into 2 groups of 10 animals each (G1 and G2), only one of which (G2) was treated with intravenous glibenclamide (1 mcg.g-1), 60 min before bleeding was begun. Both groups were anesthetized with sevoflurane at 4% under an appropriate bell jar and kept on spontaneous respiration with oxygen-enriched air, while being bled of 30% of volemia (calculated as 6% of body weight) in 3 stages with 10-min intervals. Evaluation of renal function used estimated renal clearances of paraaminohippurate (ERPF) and sodium iothalamate (GFR), while renal histology was evaluated by investigating the degree of vascular and tubular dilatation, vascular congestion, tubular vacuolization, necrosis and signs of tubular regeneration... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2014-06-11T19:29:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-23Bitstream added on 2014-06-13T19:58:40Z : No. of bitstreams: 1 orosz_jeb_me_botfm.pdf: 359813 bytes, checksum: 9cd4812427bf03537ef0978642281b62 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Indivíduos submetidos ao ato anestésico-cirúrgico apresentam estresse reacional, caracterizado por resposta inflamatória, devido não apenas ao trauma da cirurgia, mas também ao emprego dos anestésicos. Pesquisas recentes têm dado atenção especial às citocinas envolvidas na resposta inflamatória, mas ainda não há consenso quanto a influência do sevoflurano (SVF) no perfil de citocinas. Esse estudo analisou as citocinas IL-1, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNF- e INF- durante a anestesia com SVF em pacientes com estado físico ASA I, submetidos a cirurgias de pequeno porte, e idade de 18 a 55 anos. Os indivíduos foram distribuídos em dois grupos de 15, sendo os do grupo SVF pacientes submetidos a cirurgia de timpanoplastia ou septoplastia com duração de pelo menos 120 minutos, sob anestesia geral com SVF em 1,0 a 1,5 concentração alveolar mínima (CAM). As amostras de sangue foram coletadas antes da indução anestésica (M1-pré-cirurgia), após indução anestésica e imediatamente antes do início da cirurgia (M2), 120 minutos após o início da anestesia inalatória (M3), e no 1º dia do pósoperatório (M4). Outros 15 indivíduos constituíram o grupo controle, voluntáriosdos quais foi obtida uma única amostra de sangue venoso. A análise dascitocinas foi feita pelo método da citometria de fluxo utilizando o kit BD Cytometric Bead Array. Observou-se diferença significativa em relação a IL-4 (p=0,02), maior entre os pacientes, e IL-5 (p<0,001), maior entre os voluntários. No grupo de pacientes, houve aumento significativo de IL-5 em M3 em relação a M1 (p=0,03), e de IL-6 no momento M4 em relação aos momentos M1 e M2 (p<0,001). Em conclusão, em pacientes adultos com estado físico ASA I submetidos a cirurgias de timpanoplastia ou septoplastia, a anestesia com sevoflurano, com exceção de aumento de IL-5 no intraoperatório... / Patients have stress when submitted to anaesthesia and surgery, characterized by inflammatory response because of the surgery trauma, and possibly due to the anaesthetics. Literature shows controversial data as most studies have been designed using large surgery models. Using minor surgical procedures, in order to reduce tissue injury influence on inflammatory response, this study aimed to evaluate the effects of anaesthesia with sevoflurane (SVF) on plasma cytokine profile from 15 ASA I patients of both genders, aged from 18 to 55, scheduled for tympanoplasty or septoplasty lasting, at least, 120 minutes, with 1.0 to 1.5 minimum alveolar concentration of SVF. Blood samples were drawn at 4 time points: before anaesthesia induction (T1 - baseline), before surgery (T2), at 120 minutes after anaesthesia induction (T3), and on the postoperative first day (T4). The study also included 15 healthy volunteers, not submitted to anaesthesia and surgery, as controls (C) to T1, and from whom blood sample was collected a single time. Plasma IL-1, IL-2, IL-4, IL-5, IL-6, IL- 8, IL-10, IL-12, TNF- e INF-) were assessed in plasma from patients and volunteers by flow cytometry, using the BD® Cytometric Bead Array kit.IL-4 (p=0,02) and IL-5 (p<0,001) differed between groups at T1. In the patient group there were differences on IL-5 (p=0,03) and IL-6 (p<0,001) levels, with peakvalues at M3 and M4, respectively. In conclusion, data showed that with exception to IL-5 and IL-6, adult ASA I patients submitted to minor othorhinolaryngological surgical procedures, under inhalation anesthesia with SVF, have no changes on plasma cytokines profile

L’effet neuroprotecteur des agents anesthésiques est maintenant établi depuis plus de 30ans. Cependant, les mécanismes impliqués restent imparfaitement élucidés. A cours de cetravail nous avons étudié deux volets de leur protection :La première partie porte sur l’implication de la transmission glutaminergique dans leurseffets neuroprotecteurs directs, c'est-à-dire lorsqu’ils sont utilisés au cours d’une l’ischémiecérébrale. Nous avons étudié deux agents anesthésiques de classe distincte: le propofol et lesévoflurane sur des co-cultures de neurones et d’astrocytes corticaux de rat soumis à uneprivation en oxygène et en glucose transitoire (POG). Nous avons ainsi observé que laprésence de propofol ou de sévoflurane pendant la POG prévenait la mort neuronale,l’accumulation de glutamate extracellulaire et la diminution de la capture du glutamateinduites par l’ischémie. Nous avons également montré que cette restauration partielle del’activité de capture du glutamate impliquait des transporteurs distincts entre le propofol et lesévoflurane.La deuxième partie a porté sur la neuroprotection obtenue par un préconditionnement (PC)pharmacologique liée à l’utilisation avant l’ischémie d’agents anesthésique volatils. Nousavons tout d’abord confirmé in vitro l’existence d’une telle protection avec le sévoflurane etmis en évidence le rôle primordial, au cours de cette protection, des canaux potassiques ATPdépendantset des radicaux libres. Puis sur un modèle in vivo d’occlusion transitoire del’artère cérébrale moyenne, le PC par sévoflurane a induit une neuroprotection supérieure àcelle obtenue avec l’utilisation de sévoflurane uniquement pendant l’ischémie. Cependantcette protection est transitoire et ne perdure pas dans le temps. Le sévoflurane ne fait queretarder, sans l’empêcher, la mort neuronale liée à l’apoptose. Il offre cependant une fenêtrethérapeutique intéressante. / The neuroprotective effect of anesthetic agents is now established for over 30 years.However, the mechanisms involved remains to be fully explored. This work focuses on twoneuroprotective strategies:The first part is on the involvement of glutamatergic transmission in their directneuroprotective effects. We studied the effect of two separate classes of anesthetic agents:propofol and sevoflurane on co-cultures of cortical neurons and astrocytes from rats subjectedto a transient oxygen and glucose deprivation (OGD) mimicking cerebral ischemia. Weobserved that the presence of propofol or sevoflurane during OGD prevented neuronal death,accumulation of extracellular glutamate and decreased uptake of glutamate induced byischemia. We also demonstrated that this partial restoration of glutamate uptake mediated bypropofol and sevoflurane involved differential transporters.The second part deals with the neuroprotection achieved by pharmacologicalpreconditioning with regard to the use of volatile anesthetic agents before ischemia. We firstconfirmed in vitro the existence of such protection with sevoflurane. We also highlighted therole of ATP-dependent potassium channels and reactive oxygen species in sevofluranepreconditioning-induced neuroprotection. Then, using an in vivo model of focal transientischemia, we showed that sevoflurane preconditioning significantly improved functionaloutcome and reduced infarct volume. However, this protection was transient. Sevofluraneonly delayed the neuronal death associated with apoptosis but offers an interesting therapeuticwindow.

Les nouveau-nés prématurés sont soumis à un très grand nombre de gestes douloureux. Le sévoflurane, anesthésique volatile, est très largement utilisé en pédiatrie mais suscite cependant des inquiétudes du fait d’effets neurotoxiques retrouvés dans les modèles d’animaux en développement avec des durées d’exposition longues et/ou répétées qui ne reflètent pas les pratiques courantes en néonatologie. Dans une première partie de notre travail, nous avons démontré qu’une exposition courte au sévoflurane chez le rat P7 n’entraine pas d’apoptose mais des changements plus subtils dans la plasticité synaptique. Ces derniers semblent persister après l'exposition au sévoflurane. Dans une seconde partie, nous avons étudié les effets à long terme de l’exposition au sévoflurane chez l’extrême prématuré. Nous avons conduit une étude longitudinale multicentrique portant sur le développement psychomoteur entre 7 et 9 ans de 139 enfants nés extrêmes prématurés, exposés ou non au sévoflurane en période néonatale. Les résultats de notre étude démontrent la possibilité d’un impact sur le développement moteur et cognitif de l’exposition au sévoflurane avant 45 SA indépendamment du terme et du poids de naissance. De plus, nos résultats sont en faveur d’une association entre le nombre, la durée et l’âge d’exposition au sévoflurane et le neuro-développement à l’âge scolaire. Enfin, compte tenu de ces résultats, nous avons réalisé une étude randomisée contrôlée sur la prise en charge non médicamenteuse de la douleur aiguë chez 33 nouveau-nés prématurés. Nous avons démontré l’effet antalgique de l’exposition à une odeur du lait de leur propre mère lors de la réalisation d’un soin douloureux. / Extremely preterm neonates are often subjected to painful procedures. Sevoflurane, a volatile anaesthetic, is used in this population despite concerns about its neurotoxic effects identified in models of developing animals with long or repeated exposure. These conditions do not reflect current neonatal practices for preterm infants. In the initial part of our study, we demonstrated that short exposure to sevoflurane in the P7 rat does not induce apoptosis but rather more subtle changes in synaptic plasticity. The latter appear to persist after exposure to sevoflurane. The objective of our study’s second part was to observe the long-term effects of exposure to sevoflurane in the extremely premature. We conducted a multicenter longitudinal study on the psychomotor development of 139 children, aged seven to nine years old and born before 28 weeks of amenorrhea according to their neonatal exposure to sevoflurane. Our results demonstrated the possibility of an impact on motor and cognitive development from sevoflurane exposure before 45 weeks regardless of birth weight and gestational age at birth. In addition, our findings supported that there was an association between the number, the duration and the child’s age (before 28 weeks) to sevoflurane exposure and neurodevelopment amongst school aged children. Finally, in view of the concerns raised by these long-term effects of analgesic treatments, we conducted a randomized, controlled study on the non-drug management of acute pain in 33 preterm infants. We demonstrated that there was an analgesic effect when there was an exposure to a familiar odor (their own mother’s milk) during a painful procedure.