2 223例安徽地区男性年龄相关前列腺特异性抗原参考值范围

目的对2223例安徽地区参与体检的健康男性血清前列腺特异性抗原(prostate-specificantigen,PSA)水平进行分析,探讨建立安徽地区男性血清PSA的参考值范围。方法收集2010年2月至2011年5月在安徽医科大学第一附属医院进行健康体检的标本2223例,均来自无下尿路症状的健康男性,用罗氏cobas614全自动电化学分析仪及相应配套试剂进行血清PSA检测。结果 2223例健康男性的PSA均数为1.12μg/L,标准差为1.16μg/L,第一四分位数为0.59μg/L,中位数为0.90μg/L,第三四分位数为1.20μg/L,四分位间距为0.61μg/L。PSA95%可信区间为2.78μg/L;2223例中≤3.00μg/L的有2124例,占95.54%,其年龄组成≤65岁的男性为92.84%;>3.00～10.00μg/L的有91例,占4.09%;如以4.00μg/L为参考值,≤4.00μg/L的有2178例,占97.98%;>4.00～10.00μg/L的有36例,占1.61%;>10.00μg/L的有9例,占0.40%,并且各年龄组间均数差异有统计学意义。结论各个年龄组PSA水平与Oesterling标准存在差异,65岁以下人群PSA水平低于欧美及亚洲其他地区人群,65岁以上人群PSA水平高于欧美及亚洲其他地区人群,该现象提示65岁以下人群参考值设在3.00μg/L为宜,65岁以上人群可继续以4.00μg/L作为参考值。     

抗生素及非甾体类消炎药对ⅢA型前列腺炎血清PSA及游离PSA的影响

目的:探讨炎症性慢性骨盆疼痛综合征(ⅢA)患者经过抗生素及非甾体类消炎药治疗的血清前列腺特异性抗原(PSA)水平及游离PSA百分率(F-PSAR)的变化。方法:ⅢA型前列腺炎患者228例,应用抗生素及非甾体类消炎药治疗4周,测定患者治疗前、治疗结束后4周及8周的血PSA水平及F-PSAR,分析治疗前后血PSA水平及F-PSAR的变化。结果:在228例ⅢA型前列腺炎患者中,血PSA治疗前为(3.51±3.03)μg/L,治疗后第4周为(2.75±2.84)μg/L,较治疗前显著下降(P<0.05);而F-PSAR由治疗前0.25±0.05升至0.27±0.03。其中PSA≥4μg/L的患者占28.5%(65/228),在PSA≥4μg/L的患者中,PSA由治疗前(6.24±1.93)μg/L降至治疗结束后第4周(4.58±2.99)μg/L(P<0.05),PSA下降的幅度为(32.9±36.1)%;治疗后PSA<4μg/L患者占27.7%(18/65),F-PSAR由治疗前(16±9)%升至治疗结束后第4周(22±11)%(P<0.05),F-PSAR上升幅度为(51.4±25.8)%。上述指标在治疗后4周和治疗后8周差异无显著性(P>0.05)。结论:慢性前列腺炎亦是血PSA升高的原因之一。在明确前列腺炎的诊断后,可以给予有效的抗感染及抗炎治疗,能显著降低血PSA水平及提高F-PSAR。     

离子交换色谱同时测定尿液草酸及柠檬酸的研究

目的:探讨离子交换色谱测定尿液中草酸、柠檬酸含量的可行性。方法:收集不不同人尿液10份混合,取5ml用0.2μm滤膜过滤,超速离心后取少许按1∶20加入淋洗液稀释,进样,测出尿柠檬酸浓度。结果:在浓度范围分别为草酸0.5～50mg/L、柠檬酸1.0～100mg/L内,2种物质浓度与峰面积的相关系数均在0.999以上,检测限均为0.03mg/L。重复测定其cv分别为3.87%和2.9%,连续测定其cv分别为4.02%和3.5%。尿样回收率在95.8%～103.5%。结论:离子交换色谱测定尿液中草酸、柠檬酸含量分析方法的精密度和准确度符合分析要求,可用于实验室和临床尿草酸和柠檬酸的分析。     

胆囊癌GBC-SD细胞经顺铂处理后的survivin表达及意义

目的: 探讨经顺铂（DDP）处理胆囊癌细胞后survivin表达及其与肿瘤细胞耐药之间的关系。 方法:采用MTT比色法测定胆囊癌细胞对4种化疗药物的敏感性。RT-PCR检测survivin mRNA的表达。Western blot检测survivin蛋白表达的变化。结果:GBC-SD细胞对化疗药物的敏感性从高到低依次为DDP>ADM>5-FU>MMC。化学药物处理后的第1天，3组胆囊癌细胞的survivin mRNA表达水平均降低;其中0.5μg/mL DDP＋GBC-SD组下降了10%，3μg /mL DDP＋GBC-SD组下降36%，6μg /mL DDP＋GBC-SD组下降了28%。第3天，0.5μg/mL DDP组和3μg/mL DDP组GBC-SD细胞的survivin mRNA表达与第1天比较，分别上升22%和64%，但6μg/mL DDP组仍持续降低，仅为第1天的66%。0.5μg/mL DDP组和3μg/mL DDP组作用3d后的GBC-SD细胞中survivin蛋白含量分别升高了15%和12%，而6μg/mL DDP组则下降了80%。 结论:低浓度的DDP即能诱导胆囊癌细胞内survivin的表达增加，这可能是胆囊癌细胞对化疗药物产生耐药性的因素之一。     

LiMAx试验:一种新的判断肝切除患者预后的肝功能检验

背景肝功能衰竭仍是肝切除术后死亡的主要原因之一,并且很难在术前做出预测。本研究介绍一种新的limax检测的临床试验,它提供一种方法用于肝脏肿瘤患者的临床管理。方法每一例肝脏肿瘤并有手术适应症的患者在围手术期均行limax检测,一例患者术前通过三维虚拟手术分析肝脏体积。结果共有329例肝脏肿瘤患者在肝切除术前进行评估。术前Limax值切除组(139例,平均值为351μg/kg/h,从285～451μg/kg/h)显著高于未切除组(29例,平均值为299μg/kg/h,从223～376μg/kg/h),有统计学学差异(P=0.009)。当术后LiMax80μg/kg/h、80～100μg/kg/h和100μg/kg/h时,其院内死亡率分别为38.1%(8/21)、10.5%(2/19)和1.0%(1/99),(P0.0001)。决策树方法避免临界切肝量,术前应用预计会将死亡率从9.4%降低到3.4%(P=0.019)。结论 LiMAx检测在临床上可行并能有效测定肝脏储备功能。结合虚拟切除能够准确计算残余肝功能。LiMAx决策树方法能够显著提高术前评估价值和肝切除术后的疗效。     

重组人肝再生增强因子可抑制大鼠肝星状细胞c-fos基因的表达

目的 观察重组人肝再生增强因子(hALR)对大鼠肝星状细胞c-fos基因表达的影响.方法 在培养的肝星状细胞株中加入高(200μg/L)、中(20μg/L)、低(2μg/L)3种浓度的hALR,于8、24、48、72 h四个时间点收集细胞,提取总RNA;用逆转录定量聚合酶链反应(PCR)方法测定c-fos的基因表达.结果 高、中、低浓度的hALR 3组肝星状细胞c-fos基因的表达水平在8、24、48、72 h四个时间点均明显低于对照组;低剂量组为对照组的50%～53%,中剂量组为对照组的38%～43%,高剂量组为对照组的26%～30%.结论 重组人肝再生增强因子对大鼠肝星状细胞c-fos基因的表达有明显抑制作用.     

肾上腺素静脉内和气管内应用的比较

欧洲英国复苏学会近期已对进展型心力支持进行了简化和现代化改进,如无法经静脉注射肾上腺素时,可用2～3倍的剂量经气管内给予.病人和方法 研究对象不包括不稳定或严重心绞痛、心律失常、严重高血压、近期1年内心肌梗塞发作、充血性心力衰竭、左心室功能不良(射出部分<50%)或明显瓣膜病变等病人.16例拟行常规冠状动脉转流手术,在芬太尼等诱导麻醉下气管插管,给异氟烷和氧气吸入以维持麻醉.术后在重症监护室观察.将病人随机分成两组,给肾上腺素作为心力支持,组1先给3次静脉剂量,随后给2次气管内剂量,均开始以最小剂量,随后递增;组2光给2次气管内剂量,随后给3次静脉剂量.头3例病人的肾上腺素剂量,静脉为 0.03～0.07和 0.1μg/kg,气管内为1.0和3.0μg/kg(小剂量组).最后4例的剂量,静脉为0.07、0.10和0.12μg/kg,气管内为4.0和10μg/kg(属大剂量组).余5例给气管内剂量2.0和5.0μg/kg(属中剂量组).注入每次肾上腺素后,测动脉压和心率,每隔20分钟测定10分钟,算出用药后收缩压和心率平均增加数,绘出Log剂量 反应曲线.     

肾和微量元素锌、铜

肾脏疾病和肾功能衰竭可出现锌、铜代谢的变化,另一方面由于其它疾患所致的锌、铜代谢紊乱也可引起肾脏结构和功能的改变,肾和微量元素锌、铜间有着较为密切的关系,现就有关资料作一综述。肾和微量元素锌一、肾的锌含量 1.肾的含锌量是比较高的。从意外死亡病例中进行肾含锌量的测定,每克肾脏重量约含有230±19μg的锌(112～437μg/g)。从244例因各种疾患致死的病例中进行测定,肾的含锌量为190±100.0βg/g。进一步分析,肾皮质的含量为184±75μg/g(61～423     

盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术的临床应用

目的:评估盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术的临床价值和安全性。方法:2015年12月至2018年05月,对164例(PSA10μg/L 28例、PSA 10～20μg/L 56例、PSA 20.01～100μg/L 53例、PSA100μg/L 27例)可疑前列腺癌患者由同一医疗小组实施盆腔MRI辅助模板定位B超引导经会阴前列腺穿刺活检术。患者平均年龄71.2岁,穿刺前均行血清PSA检测、直肠指检以及盆腔前列腺MRI平扫检查。所有患者均接受截石位穿刺,选择静脉全身麻醉或腰麻,均采用X+12针穿刺。结果:所有患者均顺利完成活检操作,活检针数(2～4)+12针;活检时间15～28 min,平均18 min。术后一过性血尿4例,会阴阴囊皮下淤血12例,发热1例,无尿潴留病例。穿刺病理结果:前列腺腺癌95例,导管上皮癌2例;前列腺增生伴间质慢性炎症63例,前列腺不典型增生症4例。PSA 10、10～20、20.01～100、100μg/L组穿刺阳性率分别为25.00%、42.86%、73.58%、100.00%。PSA10μg/L组与PSA10～20μg/L组相比无统计学差异(P=0.086),但与PSA 20.01～100μg/L和100μg/L组相比差异具有统计学意义(P0.01)。结论:与目前常规使用的经直肠前列腺穿刺术相比,盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术并发症发生率更低,且阳性率显著增高同时穿刺方法更简单易掌握,是诊断前列腺癌的理想方法。     

非职业接触人群中不育夫妇卵泡液及精液中4种重金属元素的含量测定

目的:探讨非职业接触人群中不育夫妇卵泡液和精液中4种重金属:铅、镉、锌和锰的含量。方法:女性行IVF-ET操作,常规取卵后收集卵泡液,丈夫手淫法留取精液,用火焰原子吸收法测定卵泡液及精液中的锌含量,用石墨炉原子吸收法测定铅、镉和锰含量。结果:铅、镉、锌和锰的测定均值在卵泡液中分别是(151.06±421.03)μg/L、(2.02±2.79)μg/L、(0.54±0.55)mg/L和(28.54±50.90)μg/L,在精液中分别是(250.23±600.88)μg/L、(7.42±15.84)μg/L、(189.11±283.08)mg/L和(82.15±202.65)μg/L;检出率在卵泡液中分别为43.8%(21/48)、22.9%(11/48)、75.0%(36/48)和50.0%(24/48),在精液中分别为70.2%(33/47)、31.9%(15/47)、100.0%(47/47)和46.8%(22/47)。结论:精液中4种重金属元素含量均高于卵泡液,检出率除锰以外,也均以精液为高。     

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.