肺中叶病变的外科治疗(附58例临床分析)

５８例肺中叶病变行外科治疗，其中恶性病变３０例（５２％），良性病变２８例（４８％），术后并发症４例（７％）。无手术死亡和术后近期死亡。强调下列情况应尽早手术治疗：（１）中叶恶性病变。（２）中叶病变，尤其中叶不张，不能除外恶性。（３）中叶良性病变致中叶不张，内科治疗１个月无效者。对中叶病变的病因诊断、手术切除范围及术中应注意的环节，作了较详细的讨论。     

肺中叶病变的外科治疗

５８例肺中叶病变行外科治疗，其中恶性病变３０例，良性病变２８例（１８％），术后并发症４例（７％），无手术死亡和术后近期死亡，强调下列情况应尽早手术治疗；（１）中叶急性病变。（２）中叶病变、尤其叶不张，不能外恶性、（３）中叶良性病变致中叶不张，内科治疗１个月无效者。对中叶病变的病因诊断、手术切除范围及术中应注意的环节，作了较详细的讨论。     

Bosniak Ⅱ～Ⅲ类型肾囊肿处理方式的再思考

目的 探讨BosniakⅡ类和Ⅲ类囊肿的治疗原则. 方法 2005-2008年手术治疗BosniakⅡ类和Ⅲ类囊肿68例,其中男48例,女20例;年龄23～ 78岁,平均40岁.病变位于左侧37例,右侧31例;病变直径2.1 ～9.5 cm,平均5.1 cm.BosniakⅡ类囊肿31例,其中ⅡF 13例,Ⅲ类囊肿37例.术前诊断为良性病变49例,行肾囊肿去顶减压术,其中5例术中冰冻切片提示恶性病变行根治性肾切除,4例术后病理切片提示恶性病变行二期根治性肾切除.术前诊断为恶性病变19例,其中行肾部分切除术14例,一期行根治性肾切除5例. 结果 68例患者中,病理报告恶性病变21例(30.9％),良性病变47例(69.1％).BosniakⅡ类囊肿中恶性病变3例(9.7％),Ⅲ类囊肿中恶性病变18例(48.6％).术前诊断为良性病变而病理诊断为恶性病变行根治性肾切除9例(18.4％,9/49),术前诊断为恶性病变而术后病理诊断为良性7例(36.8％,7/19).42例患者获随访,随访时间8 ～ 65个月,平均31个月.其中恶性病变15例,良性病变27例.恶性病变患者术后1～4年出现肿瘤复发和(或)转移3例,良性病变术后2～5年出现复发性囊肿6例. 结论 BosniakⅡ类和Ⅲ类囊肿手术时应尽可能行部分肾切除,也可以将囊肿完全切除后行冰冻切片,因为仅取部分囊壁组织有可能漏诊其他部位的恶性病变.     

脾占位性病变68例诊治分析

目的 探讨脾占位性病变的临床诊断特点和治疗对策. 方法 回顾性分析68例脾占位性病变患者的临床资料.结果 超声和CT是诊断脾占位性病变的主要方法.68例脾占位性病变中良性48例,恶性20例.手术治疗47例,其中脾切除37例,脾切除加胰尾切除2例,脾部分切除3例,脾切除加脾窝引流4例,单纯脾囊肿去顶减压1例.1例脾脓肿行脾切除术后发生肺部感染,经抗感染治疗后痊愈; 1例脾脓肿行脾切除术后,发生脾窝脓肿,感染严重,被迫再次开腹行脓肿引流术,其余良性病变经手术治疗后效果好; 恶性病变术后效果差.结论 脾占位性病变良性多见,恶性少见; 影像学检查是诊断脾占位性病变的主要手段.脾切除对成年人是一种有效的治疗方法,良性预后好,恶性预后差; 对儿童、青少年脾良性病变,脾部分切除是一种很好的选择.     

中叶病变的外科治疗

１１０例肺中叶病变行外科治疗，包括原发和继发性肺癌、低度恶性肿瘤４６例，良性肿瘤１２例，良性病变５２例。胸部Ｘ线表现：典型中叶不张者不足１／３，１／３以上病例为肺门团块影或浸润影。纤维支气管镜检查对中叶恶性肿瘤诊断的假阴性达３０％。单纯中叶切除为６０％，中叶合并其他叶切除３０％，开胸探查和右全肺切除各３例。术后并发症中，５５％为感染，胸内出血１６％。无手术死亡和术后近期死亡。强调中叶病种复杂，需综合分析方可做出诊断；对肺门团块、浸润影和中叶不张术前应充分估计和准备；耐心细致的手术操作可减少并发症；４０岁以上原因不明的中叶不张，应首先除外恶性肿瘤，内科治疗不能复张且有腔内器质性梗阻者应尽早手术探查。     

肺磨玻璃结节患者病理诊断及胸腔镜手术治疗的临床分析

目的探究肺磨玻璃结节患者病理诊断及胸腔镜手术治疗的临床效果。方法回顾性分析2016年1月到2018年1月在本院就诊的100例肺磨玻璃结节患者的诊疗情况,分析其病理诊断结果及胸腔镜手术治疗效果。结果病理诊断显示:100例患者包括28例良性及72例恶性肺磨玻璃结节患者,恶性组病变直径(1.52±0.73)cm明显大于良性组(0.81±0.21)cm,两组比较差异有统计学意义(P0.05)。恶性组胸部CT边界不清发生率(94.4%)明显高于良性组(10.71%,P0.05)。41例行肺叶切除,恶性组(39例)明显多于良性组2例,具有统计学意义(P0.05)。29例进行肺楔形切除,恶性组7例,明显少于对照组22例,具有统计学意义(P0.05)。恶性组手术时间,术中出血量及住院时间明显多于良性组,两组比较具有统计学意义(P0.05)。两组患者术后6个月均无复发。术后并发症发生率为9.00%,且两组患者并发症发生率比较无统计学意义(P0.05)。结论磨玻璃样结节患者中恶性病变比例高,可以结合患者病史、身体状况及病理诊断决定是否进行手术切除。胸腔镜手术进行肺叶切除、肺段切除及肺楔形切除均具有较好的治疗效果。     

孤立性肺结节外科治疗:附50例临床分析

目的探讨孤立性肺结节(solitary pulmonary nodule,SPN)的诊断与外科治疗。方法回顾性分析2007年1月~2015年11月我科收治的50例SPN患者临床资料,其中行常规开胸手术治疗40例,包括肺叶切除加淋巴结清扫29例,肺楔形切除8例,肺叶切除3例;胸腔镜手术治疗10例,包括胸腔镜肺叶切除加淋巴结清扫5例及肺楔形切除5例。结果本组50例患者均无围术期死亡,术后恢复顺利。术后病理:肺癌34例(68%),其中腺癌16例、鳞癌14例、细支气管肺泡癌3例、粘液表皮样癌1例;良性肿瘤16例(32%),其中硬化性血管瘤4例、结核球4例、炎性假瘤4例、曲霉菌病2例、平滑肌瘤1例、坏死性肉芽肿1例。肺癌患者平均年龄为61岁,良性肿瘤患者平均年龄为55.5岁。术前胸部CT提示为恶性病变的27例患者,术后病理证实为恶性病变者23例(85.2%),而术前胸部CT提示为良性病变的14例患者,术后病理证实为良性病变者11例(78.6%),总诊断符合率为82.9%(34/41)。术前有临床症状的33例SPN患者,术后病理为肺癌25例(75.8%);术前体检发现的17例SPN患者,术后病理为肺癌9例(52.9%)。肺癌患者中术后病理提示有淋巴结转移者9例,其中术前有临床症状者7例(77.8%);8例(88.9%)为术前胸部CT提示恶性病变者。结论 CT扫描是首选鉴别SPN的无创检查方法,SPN应尽早诊断,尽快外科治疗。胸腔镜微创手术具有其特定的优势,基层医院应加快推进微创技术应用。     

52例孤立性肺结节的临床治疗体会

目的探讨孤立性肺结节的诊断和治疗。方法回顾总结52例孤立性肺结节患者的临床资料,分析手术治疗的效果评价。结果全组术前均行影像学检查和手术治疗,其中肺叶楔形切除20例,单肺叶切除23例,右中、上肺叶切除5例,右中、下肺叶切除3例,肺支气管袖式切除1例。术后病理诊断肺癌29例,依据国际TNM分期,Ⅱ期以上占26例,随访37例,肺癌随访21例,5年内肿瘤广泛转移死亡6例。结论本组孤立性肺结节恶性病变是全组病变的55%,肺癌术后死亡占随访的不足30%,因此强调孤立性肺结节的及时手术切除、术中活检在早期肺癌的诊断和治疗中有着重要的临床价值。     

胰腺囊性病变治疗方法选择

目的:探讨胰腺囊性病变患者治疗方法的选择.方法:回顾性分析127例根据影像学方法以及细针抽吸活检(FNA)诊断为胰腺囊性病变患者的治疗和随访情况.结果:48例患者(38%)初始选择手术治疗,79例患者(62%)初始选择影像学随访;40%(19例)初始手术治疗的患者经术后病理确诊存在恶性肿瘤或癌前病变,随访患者中有9例(11%)因病变有恶变倾向而行手术切除,术后病理确诊恶性肿瘤为3例(3.8%)o对于囊性病变直径<3 cm、无实性占位且临床无症状的囊肿,在影像学随访中恶性转变危险<4%,与手术切除胰腺囊性病变死亡率相似.结论:对无实性占位、囊肿直径小、囊肿无分隔和无症状患者,可初始选择影像学随访.     

超声引导下空芯针穿刺活检在乳腺小结节中的诊断价值

目的探讨超声引导下空芯针穿刺活检(ultrasound guided-core needle biopsy,US-CNB)在直径0. 6～1 cm乳腺结节中的诊断价值。方法回顾性分析我科2016年9月～2018年12月272例287个直径≥0. 6 cm且≤1 cm的乳腺结节采用14G穿刺活检枪行US-CNB的结果。与手术切除病理或随访时间≥1年的结果比较,计算US-CNB诊断乳腺小结节的准确性。结果 US-CNB均顺利完成。87个病灶行手术切除,穿刺与手术病理的总体一致率为81. 6%(71/87)(κ=0. 684,P=0. 000),具有较好的一致性。穿刺病理为良性病变251个(87. 5%,251/287),其中手术切除56个,术后病理良性病变44个,非典型增生12个,无恶性病变。穿刺病理为非典型增生14个(4. 9%,14/287),其中手术切除9个,术后病理非典型增生6个,恶性病变3个;拒绝手术5个。127个穿刺为良性病变、4个穿刺为非典型增生病变随访时间≥1年,乳腺彩超提示病变稳定(病变BI-RADS分类未提高)。结合随访及手术结果,对1 cm以内乳腺结节,US-CNB诊断良性或非典型增生时漏诊恶性病变比例分别为0(0/183)、23. 1%(3/13)。穿刺病理为恶性病变22个(7. 7%,22/287),均手术切除,病理提示浸润性癌20个,原位癌1个,复杂硬化性腺病伴非典型增生1个,阳性预测值95. 5%(21/22)。结论对于直径0. 6～1 cm的乳腺病变,US-CNB可获得准确的诊断信息。对于穿刺病理结果为良性、影像学具有恶性特征的病变,建议进一步行手术切除活检;穿刺病理为非典型增生时,应手术切除活检,以避免遗漏恶性病变。     

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.     

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.     

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.