腹腔镜腹会阴联合切除术治疗低位直肠癌疗效评价

目的前瞻性评估腹腔镜直肠癌腹会阴联合切除术的临床优劣性。方法将2003年7月至2006年4月收治的低位直肠癌患者随机分为两组，37例行腹腔镜腹会阴联合切除术（腹腔镜组），另37例常规开腹行腹会阴联合切除术（开腹组）；比较两组的手术时间、清除淋巴结数目和腹部出血量、术后排气时间、起床活动时间、住院时间、并发症发生率和复发转移率及卫生经济学情况。结果腹腔镜全组患者均顺利完成手术，无中转开腹者；手术时间两组比较差异无统计学意义（P〉0．05），但前10例手术时间比开腹组长（P〈0．01）；腹部出血量少于开腹组（P〈0．01）．但前10例较开腹组多（P〈0．01）；术后肛门排气时间两组差异无统计学意义（P〉0．05）；起床活动时间腹腔镜组早于开腹组（P〈0．01）；住院时间长短两组无差异，但腹腔镜会阴闭合较开腹组早：腹腔镜组腹部创口相关并发症明显少于开腹组（P〈O．05）；两组的清除淋巴结枚数、局部复发及远处早期复发率差异无统计学意义（P〉0．05）；手术费用腹腔镜组明显高于开腹组，但医疗总费用两组差异无统计学意义（P〉0．05）。结论腹腔镜直肠癌腹会阴联合切除术不仅创口小、术中出血少、与腹部创口相关并发症少、术后恢复快，且其手术时间、医疗总费用和肿瘤根治性与开腹手术无差异。     

腹腔镜直肠手术中转开腹的临床评价

目的分析腹腔镜直肠癌手术中转开腹对患者的影响。方法回顾性分析2007年6月至2010年5月136例腹腔镜直肠癌手术,其中中转开腹（CON）41例,与同期开腹直肠癌手术（OPN）56例进行比较,总结中转开腹的原因及阶段,分析手术时间、术中出血量、术后肠功能恢复时间、术后住院时间、手术并发症等情况。结果盆腔狭窄导致直肠切断困难成为腹腔镜直肠癌手术中转开腹的首要原因：CON组同OPN组相比,术中出血量明显减少（P=0．042）,而在手术时间、术后住院时间、术后肠功能恢复时间、手术并发症、留置导尿管时间等方面,两组之间差异无统计学意义（P〉0．05）。结论腹腔镜直肠癌手术中转开腹并不一定能给患者带来不利影响,反而能发挥部分腹腔镜手术的微创优点。     

肥胖病人行腹腔镜阑尾切除术与开腹手术的疗效对比分析

目的对比分析腹腔镜阑尾切除术和开腹阑尾切除术治疗肥胖病人阑尾炎的手术效果。方法回顾性分析2003年1月-2007年11月我院行阑尾切除术治疗肥胖病人阑尾炎104例的临床资料。其中,行腹腔镜阑尾切除术73例,开腹阑尾切除术31例。比较两种术式的手术时间、切口感染和残余脓肿的发生率、住院时间和住院费用的差异。结果比较腹腔镜阑尾切除术组和开腹阑尾切除术组以上各项指标（除住院时间外）差异均无显著性意义（P〉0．05）。结论腹腔镜阑尾切除术治疗肥胖病人阑尾炎与开腹阑尾切除术相比具有创伤小、恢复快、并发症少和平均住院时间短等优点,是治疗肥胖病人阑尾炎较理想的手术方式。     

急性阑尾炎患者的急诊腹腔镜检查与治疗

目的 探讨急性阑尾炎急诊腹腔镜检查与治疗的应用价值。方法 回顾性分析2001年1月至2003年6月收治的经急诊腹腔镜诊治的284例急性阑尾炎患者（腹腔镜组）的临床资料，并与同期收治的224例行常规开腹手术的急性阑尾炎患者（开腹手术组）的诊治结果进行对比分析。结果 腹腔镜组行急诊腹腔镜阑尾切除手术257例；中转手术27例；平均手术时间、术后进食时间、平均住院时间、确诊时间和手术切口长度均明显短于开腹手术组。两组比较，P〈0．05，P〈0．01。结论 急诊腹腔镜的检查与治疗对于入院诊断不确定的急性阑尾炎患者，具有早期诊治、减轻痛苦，缩短住院时间的优点。     

腹腔镜治疗小儿阑尾炎148例分析

目的总结腹腔镜阑尾切除术（LA）治疗儿童阑尾炎的经验。方法回顾性分析2004年1月至2011年4月行LA治疗儿童阑尾炎患儿共148例,对比同期139例开腹阑尾切除术（OA）患儿临床资料,比较术中出血量、术后肠功能恢复时间、术后住院时间、切口感染、置腹腔引流率、拔腹腔引流管时间、腹腔脓肿发生率、肠梗阻发生率、再次手术率差异、手术时间等指标。结果IA组与OA组比较,两组中术中出血量、术后肠功能恢复时间、术后住院时间、切口感染、腹腔脓肿发生率、肠梗阻发生率、再次手术率差异均有统计学意义（P〈0．05）;置腹腔引流率、拔腹腔引流管时间差异无统计学意义（P〉0．05）;LA组较OA组手术时间长,差异有统计学意义（P〉0．05）。结论LA适于治疗各型儿童阑尾炎,安全有效,术后并发症少,美容效果佳,是阑尾炎治疗的一种较好的方法。     

单孔腹腔镜、传统腹腔镜与常规开放阑尾切除手术的对比研究

目的比较经脐单孔腹腔镜、传统腹腔镜与常规开放阑尾切除手术的差别,探讨经脐单孔腹腔镜阑尾切除手术的可行性。方法对广东省佛山市顺德区勒流医院2011年1月至2011年12月收治的183例急性阑尾炎病例,按照随机原则分单孔腹腔镜组（61例）、常规腹腔镜组（61例）和常规开放手术组（61例）,对三组的手术时间、术中出血量、肠道功能恢复时间、住院时间、并发症、中转率进行比较。结果单孔腹腔镜组、传统腹腔镜组的术中出血量、术后肠道功能恢复时间和住院时间少于常规开放组（P〈0．01）;常规开放手术组有1例术后出现切口感染,单孔腹腔镜组3例中转传统腹腔镜手术。对单纯性和化脓性阑尾炎,三种手术方式所需手术时间比较无显著性差异（P〉0．05）;对坏疽性（穿孔性）阑尾炎,单孔腹腔镜组的手术时间明显长于传统腹腔镜和常规开放组（P〈0．01）。结论单孔腹腔镜组、传统腹腔镜组与常规开放组比较在术中出血量、术后肠道功能恢复时间和术后住院时间方面具有优势,单孔腹腔镜组需要更多的手术时间;针对手术时间的进一步分析显示,对于单纯性阑尾炎和化脓性阑尾炎三组之间差异无统计学意义,对于坏疽性阑尾炎传统腹腔镜组更具优势。     

既往腹部手术史对行腹腔镜辅助根治性全胃切除术患者的影响

目的探讨既往腹部手术史对行腹腔镜辅助根治性全胃切除术患者的影响。方法2008年1月至2010年12月间福建医科大学附属协和医院对328例胃癌患者施行腹腔镜辅助根治性全胃切除术,其中既往有腹部手术史者（PAS组）57例,无腹部手术史者（NPAS组）271例。比较两组患者术中及术后情况．并对影响术后并发症发生的危险因素进行单因素及多因素分析。结果PAS组和NPAS组平均淋巴结清扫数目分别为（30．2±10．5）和（31．1±9．4）枚／例,差异无统计学意义（P〉0．05）。与NPAS组相比,PAS组患者手术时间更长[（247．0±60．5）min比（214．7±57．0）min,P〈0．01]、术后并发症发生率更高[21．1％（12／57）比11．1％（30／271）,P〈0．05];但两组患者术中出血量、术中输血例数、中转开腹率、术后下床时间、术后排气时间、进食流质时间、胃管拔除时间和术后住院时间的差异均无统计学意义（P〉0．05）。多因素分析显示,既往腹部手术史并不是影响患者术后并发症发生的独立危险因素（P〉0．05）。结论既往有腹部手术史的胃癌患者行腹腔镜辅助根治洼全胃切除术是可行的。既往腹部手术史虽然会延长手术时间,但其并不是术后并发症的独立危险因素。     

既往腹部手术史对腹腔镜Roux-en-Y胃旁路术的影响

目的:总结腹部手术史患者行腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)的可行性及安全性。方法:回顾分析2011年1月至2013年10月89例LRYGB患者的资料。根据有无腹部手术史将患者分为腹部手术史组(n=19)与无腹部手术史组(n=70)。评估两组患者性别、年龄、美国麻醉医师协会(American Society of Anesthesiologists,ASA)病情分级、腹腔粘连发生率及粘连松解率、手术时间、术中失血量、中转开腹率、术中及术后并发症发生率、住院时间等指标。结果:无腹部手术史组与腹部手术史组患者术中发现腹腔粘连率分别为7.1%与73.7%,其中需松解率分别为0与71.4%,无因松解粘连引发的并发症。腹部手术史组女性患者所占比例、ASA分级及年龄较无腹部手术史组高(P<0.05),腹部手术史与增加的手术时间、住院时间有关(P<0.05)。两组患者术中失血量、中转开腹率、术中与术后并发症发生率差异无统计学意义(P>0.05)。结论:腹部手术史并非LRYGB的手术禁忌证。然而有腹部手术史的患者往往年龄、ASA分级高,增加了手术风险,且术中粘连松解率较高,手术时间、住院时间较长。     

腹腔镜与开腹良性卵巢畸胎瘤剔除术的临床比较

目的比较腹腔镜术与开腹术两种方法行良性卵巢畸胎瘤剔除术的效果。方法94例良性卵巢畸胎瘤患者,随机分为腹腔镜组（48例）与开腹术组（46例）,分别行腹腔镜和开腹畸胎瘤剔除术。结果两组在年龄、体重、开腹术史、肿瘤的大小等方面差异无显著性（P〉0．05）。腹腔镜组术中失血量、术后排气时间、术后病率、术后住院日、镇痛剂使用率均低（短）于开腹组,其恢复日常家务、工作及性生活等方面亦明显优于开腹组（P〈0．01或P〈0．05）。结论腹腔镜行良性卵巢畸胎瘤剔除术创伤小,疼痛轻,并发症少,患者恢复快,值得推广应用。     

急性阑尾炎患者实施腹腔镜阑尾切除术的疗效观察

目的分析急性阑尾炎腹腔镜阑尾切除术的疗效。方法将72例急性阑尾炎患者随机分为2组,各36例。对照组行开腹阑尾切除术,观察组行腹腔镜阑尾切除术。比较2组手术时间、术中出血量、术后肛门排气时间及切口感染率和术后住院时间。结果 2组均顺利完成手术,观察组无中转开腹手术。2组手术时间差异无统计学意义(P0.05)。观察组术中出血量、术后肛门排气时间、切口感染率及术后住院时间均少于对照组,差异均有统计学意义(P0.05)。结论腹腔镜阑尾切除术治疗急性阑尾炎,创伤小、并发症少、患者术后恢复快。     

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.