供肝热缺血与肝移植术后肺损伤关系的实验研究

目的：探讨心脏停搏供体肝移植中，供肝热缺血与肝移植术后肺损伤的关系。方法：实验以供肝获取前经历的心脏停搏时间0、30和60min分为3组，分别为有心跳组（HB组）、心脏停搏30min组（NHBD－30组）和心跳停搏60min组（NHBD－60组），而后行大鼠原位肝移植。比较术后血清中肿瘤坏死因子（TNF）－α细胞间粘附分子－1（ICAM－1）的变化，并观察肺组织病理和肺组织中ICAM－1免疫组织化学表达。结果：随着供肝热缺血时间的延长，肺组织损害也逐渐回重，术后血清中TNF－α和ICAM－1的值呈上升趋势，各组间差异有显著性。术后6h NHBD-60组出现肺组织中ICAM－1的强表达。结论：在心脏停搏供体肝移植中，TNF－α和ICAM－1的表达上调与术后肺组织损伤有关。     

大鼠心脏停搏供体肝移植供肝活性的研究

目的　比较不同类型的大鼠心脏停搏供体 (NHBD)肝移植中供肝的活性 ,探讨肝移植应用NHBD供肝的可行性。方法　应用氧气极谱法测定线粒体呼吸控制率 (RCR ) ;应用荧光法测定线粒体质子ATP酶活性 ;动脉血气分析 ;肝功检查 ;测定血清细胞因子白细胞介素 (IL) 1β ,IL 6和肿瘤坏死因子 (TNF) α作为应激标志物指标 ;肝组织形态学检测。结果　线粒体质子ATP酶活性与热缺血时间 (WIT)呈负相关 ;在KCL3 0组RCR值、ATP酶活性和PaO2 测定值显著高于OC3 0组 (P <0 .0 5 ) ;在心脏停搏 3 0min时 ,血清ALT及LDH值两组都显著增高 ,KCL60组ALT和LDH明显增高组间差异有统计学意义 (P <0 .0 5 )。结论　肝移植应用NHBD供肝是可行的 ,心跳缓慢停止的NHBD模型供肝活性明显优于心脏骤停NHBD。     

肝移植热缺血损伤与ICAM-1表达的实验研究

目的：探讨细胞粘附分子是否参与肝移植热缺血再灌注这一病理损伤过程。方法：实验以大鼠供肝获取前经历的心脏停搏时间0、30、和60min分为3组，分别为HB组，NHBD－30组和NHBD－60组，而后行大鼠原位肝移植，每组各20对，于术后1，3，6和24h处死取材，分别检测血清中TNF－α和ICAM－1的表达，以及肝组织中ICAM－1的表达。结果：随着供肝经历的热缺血时间的不断延长，术后血清中TNF－α和ICAM－1的表达，以及肝组织中ICAM－1的表达呈上升趋势.天经地义:ICAM-1颂与肝移植中热缺血再灌注损伤。     

肝细胞凋亡与肝移植中热缺血损伤关系的实验研究

目的：探讨肝细胞凋亡是否参与肝移植中热缺血再灌注这一病理损伤过程。方法：实验以大鼠供肝获取前供体所经历的心脏停搏时间0、30和60min将实验动物分为3组：HB组、NHBD－30组和NHBD－60组，而后行大鼠原位肝移植，每组各20对。于术后1、3、6和24h处死取材。移植肝标本采用HE染色、TUNEL技术和透射电镜进行观察，并采集血样以测定TNF－α。结果：HB组几乎未出现肝细胞凋亡。移植术后3－6h，NHBD－30组出现了少量肝细胞凋亡，而NHBD－60组则出现了大量肝细胞凋亡。移植术后24h，NHBD－30组和NHBD－60组则分别出现了局灶性和大片肝细胞坏死。随着供肝遭遇的热缺血时间不断延长，术后TNF－α呈上升趋势，在术后3h达到峰值。结论：肝细胞凋亡参与肝移植中热缺血再灌注损伤，肝细胞凋亡可能是坏死的原因，并且肝细胞凋亡与TNF－α表达关系密切。     

Lazaroid U-74389G预处理对大鼠心脏停搏供体肝移植缺血再灌注损伤的保护作用

目的探讨在心脏停搏供体肝移植中 ,LazaroidU 74 389G预处理对大鼠供肝热缺血损伤的保护作用。方法实验以U 74 389G预处理与否、以及供肝获取前经历的心脏停搏时间 4 5或6 0min分为 4组 ,分别为N 4 5组、N 6 0组、tN 4 5组和tN 6 0组 ,而后行大鼠原位肝移植 ,比较各组术后存活率、肝功能、MDA和肝脏病理学改变。结果N 4 5组、N 6 0组、tN 4 5组和tN 6 0组肝移植术后1周的存活率分别为 2 5 % (2 / 8)、0 (0 / 8)、5 8% (7/ 12 )和 33% (4/ 12 )。U 74 389G的预处理可以显著提高心脏停搏供体肝移植的存活率 ,并能够改善术后肝功能和减轻肝脏病理学改变 ,降低MDA的表达。结论在心脏停搏供体肝移植中 ,U 74 389G预处理可以减轻热缺血再灌注对供肝造成的损伤 ,提高肝移植存活率     

Lazaroid对肝移植缺血再灌注损伤的肝保护作用

心脏停搏供体(NHBD)肝移植的临床应用将部分缓解供肝的短缺。我们先期的研究结果表明U-74389G的预处理可以显著提高心脏停搏供体肝移植的存活率，实验中尽管供肝获取经历45或60min的热缺血损伤。U-74389G预处理两组的1周存活率仍然可以达到58．3％和33.3％，显著高于非预处理两组25％和0％的1周存活率，并且U-74389G的预处理还能够改善术后肝功能和移植肝病理状况。在此基础上。我们利用大鼠原位肝移植的模型来探讨Lazaroid U-74389G预处理对供肝热缺血损伤的保护机制。     

大鼠心脏停搏供体肝移植的实验研究

目的 探讨大鼠原位肝移植过程中,供肝可能耐受心脏停搏热缺血损伤的时间极限,方法 雄性SD大鼠,以供肝获取前供体大鼠经历心脏停搏时间0、15、30、45、60min分为5组（HB组、N-15组、N-30组、N-45组和N-60组）,而后行大鼠原位肝移植,比较各组的术后肝功能、肝脏病理和存活率。结果 HB、N-15、N-30、N-45和N-60的大鼠肝移植术后1周存活率分别为：100%（8/8）、75%（6/8）、62.5%(5/8)、25%（2/8）和0%（0/8）。其中HB、N-15、N-30组和N-45组的大鼠肝移植最长存活时间超过30d。结论 大鼠供肝对于热缺血损伤的时间应越短越好,但耐受30min心脏停搏热缺血损伤时,仍可使1周存活率达62.5%,极限时间为45min。     

供体热缺血时间对移植肝的影响

目的 探讨大鼠动脉化原位肝移植中供体热缺血时间对移植肝的影响.方法 实验分为4组:对照组(C)和移植组,移植组根据供肝获取前经历供体心脏停搏时间的不同分为三组:热缺血0 min(W0)、热缺血15 min(W15)和热缺血30 min(W30),其后建立近交系大鼠动脉化原位肝移植模型,每组均为30只大鼠,分别于术后3、7、14和30 d处死,每个时间点各取6只大鼠,分别测定移植肝组织学、肝功能的变化.此外,移植组各组随机选取6只大鼠观察长期生存率(＞100 d).结果 随着供肝热缺血时间的延长,移植肝损伤加重,恢复过程延长.移植组和对照组术后3、7、14和30 d血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)变化无显著性差异.血清碱性磷酸酶(ALP)随着供肝热缺血时间的延长逐渐增高,14 d达到高峰后逐渐下降.术后3、7、14和30 d ALP与供肝热缺血时间具有显著相关性.术后热缺血0、15、30 min长期生存率组分别为100.0%(6/6)、83.3%(5/6)、66.7%(4/6),3组间比较差异无统计学意义(P=0.285).结论 肝移植过程中供肝热缺血主要损伤肝细胞,并随着供肝热缺血时间的延长移植肝细胞损伤加重,肝细胞功能恢复早于其形态学恢复.肝移植术后早期存在胆汁淤积,供肝热缺血时间的延长明显加重胆汁淤积的程度,胆汁淤积的恢复明显晚于肝细胞损伤指标的恢复.在热缺血30 min内来自于心脏停搏的供肝肝移植术后是安全的.     

冷缺血对大鼠部分肝移植肝再生的影响

目的　研究冷缺血对移植肝再生及肿瘤坏死因子 (TNF α)和白细胞介素 10 (IL 10 )表达的影响。方法　建立稳定的大鼠部分肝移植模型。实验分为 :5 0 %肝切除对照组、冷缺血 30min后部分肝移植组 (实验 1组 )和冷缺血 10h后部分肝移植组 (实验 2组 )。观察各组生存率 ,并分别于术后 1d、2d、4d取肝组织 ,免疫组织化学检测各组增殖细胞核抗原 (PCNA)、TNF α、IL 10的表达 ;对各组肝再生增殖及TNF α和IL 10的表达进行相关性分析 ;探讨TNF α和IL 10的变化对大鼠部分肝移植术后肝再生的影响。结果　 5 0 %肝切除组、冷缺血 30min后部分肝移植组和冷缺血 10h部分肝移植组存活率分别为 10 0 % ,79%、2 9% ;冷缺血 10h部分肝移植组与冷缺血 30min部分肝移植组相比 ,PCNA、TNF α表达降低 (P <0 .0 5 ) ,而IL 10表达增高 (P <0 .0 5 )。结论　随着冷缺血时间的延长 ,降低了部分肝移植术后的肝再生能力和生存率。TNF α和IL 10在移植肝肝再生过程中起重要的调控作用。     

供肝热缺血损伤对大鼠肝移植术后胆汁淤积的影响

目的探讨肝移植中供肝热缺血损伤对肝移植术后胆汁淤积的影响。方法实验分为4组：对照组（C）和移植组,移植组根据供肝获取前经历供体心脏停搏时间的不同分为三组：热缺血0min（W0）、热缺血15rain（W15）和热缺血30min（W30）,其后建立大鼠动脉化原位肝移植模型,每组均为30只大鼠,分别于术后3d、7d、14d和30d处死,每个时间点各取6只大鼠,分别测定移植肝组织学、血清ALP和ALT变化。此外,移植组各组随机选取6只大鼠观察长期生存率（〉100d）。结果随着供肝热缺血时间的延长,术后血清ALP逐渐增高,14天达到高峰后逐渐下降。术后第3d、7d、14d、30d血清ALP与供肝热缺血时间具有显著相关性。随着供肝热缺血时间的延长,移植肝损伤加重,并且恢复过程也延长。移植组和对照组术后血清ALT无显著性改变。W0、W15和W30术后长期生存率无明显差别。结论肝移植术后存在胆汁淤积,供肝热缺血时间的延长明显加重胆汁淤积的程度。但是,供肝热缺血30min以内造成的大鼠肝移植术后胆汁淤积并不影响预后。     

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.