对比CT引导下不同进针路径经皮肺穿刺活检效果

目的对比观察不同进针路径CT引导下经皮肺穿刺活检效果。方法回顾性分析86例接受CT引导下经皮肺穿刺活检的肺部病变患者,根据规划进针路径是否与床面垂直分为垂直床面(PT)组与非垂直床面(NPT)组,是否与体表垂直分为垂直体表(PB)组与非垂直体表(NPB)组,测量各组实际进针路径与规划路径间的偏移角度、针尖偏移距离及进针深度,统计穿刺次数、穿刺时间及术后气胸、针道出血例数。结果 86例中,83例(83/86,96.51%)获得、3例未获明确病理诊断。术后气胸发生率12.79%(11/86),针道出血发生率33.72%(29/86)。实际进针时,各组角度均有不同程度偏移,PT组偏移角度小于NPT、PB、NPB组,针尖偏移距离小于NPT及PB组(P均0.05);各组穿刺时间、进针深度、穿刺次数及术后气胸、针道出血差异均无统计学意义(P均0.05)。术后发生气胸与未发生气胸者之间,进针深度差异有统计学意义(P0.05);术后针道出血与未出血者间进针深度、穿刺时间及穿刺次数差异均有统计学意义(P均0.05)。偏移角度与进针深度呈负相关(r=-0.37,P0.01),针尖偏移距离与进针深度呈正相关(r=0.45,P0.01)。结论行CT引导下经皮肺穿刺活检时,使患者处于倾斜位,选择垂直于床面且进针较短的穿刺路径有助于减少偏移及并发症。     

小视野扫描方法在肺小结节CT引导下经皮穿刺活检中的应用

目的探讨小FOV扫描方法在CT引导下经皮穿刺活检肺小结节(长径≤20 mm)中的应用价值。方法对104例肺小结节患者分别采用小FOV(n=38,A组)和常规FOV(n=66,B组)行CT引导下经皮穿刺活检,记录病变沿针道距胸膜距离、肺内调整进针次数、手术时间,进针胸膜角等,比较2组肺内出血、气胸的发生率。结果 A组肺内出血总体发生率31.58%(12/38),≥2级肺内出血发生率2.63%(1/38),B组分别为66.67%(44/66)、22.73%(15/66);A组出血发生率明显低于B组(χ~2=14.172,P=0.001)。2组肺气肿、病变沿针道距胸膜的距离、手术时间、肺内调整进针次数差异均无统计学意义(P均0.05)。结论采用小FOV扫描方法行肺小结节CT引导下经皮穿刺活检可明显降低肺内出血、尤其是≥2级肺内出血发生率。     

CT引导下不同路径经皮肺穿刺活检诊断胸膜下结节

目的探讨CT引导下不同路径经皮肺穿刺活检(PTNB)诊断胸膜下结节的价值。方法 147例胸膜下结节患者接受CT引导下PTNB,根据穿刺针与胸膜角度分为长路径组(穿刺针与胸膜角度≤50°,83例)与短路径组(穿刺针与胸膜角度50°,64例),比较两组诊断准确率、单次穿刺成功率及术后出血、气胸等并发症,分析两组中直径≤10 mm、10～20 mm、≥20 mm结节之间调针次数、穿刺时间、患者气胸及出血发生率的差异。结果 2组诊断准确率、单次穿刺成功率及气胸、出血发生率差异均无统计学意义(P均0.05)。长路径组对于直径≤10 mm及10～20 mm结节的调针次数及穿刺时间均短于短路径组(P均0.05)。结论 CT引导下不同路径PTNB对胸膜下结节均具有较高诊断准确率。对直径20 mm胸膜下结节建议长路径穿刺。     

针道封堵技术预防CT引导下经皮穿刺肺结节射频消融同步活检出血

目的观察针道封堵技术预防CT引导下经皮穿刺肺结节射频消融(RFA)同步活检出血的效果。方法回顾性分析66例接受CT引导下经皮穿刺RFA同步活检肺结节患者资料,对其中33例预防性使用明胶海绵-血凝酶封堵剂进行针道封堵(A组),33例未使用(B组),根据术后即刻CT图像判断并对比2组出血程度。结果对66例均顺利完成手术,术中消融区晕征均完全覆盖病灶区域。术后即刻CT显示A组26例无或低级别出血、7例高级别出血,B组17例无或低级别出血、16例高级别出血(P=0.038)。A组21例、B组26例病灶≤2 cm,其中A组16例无或低级别出血、5例高级别出血,B组10例无或低级别出血、16例高级别出血(P=0.017)。结论应用针道封堵技术可在一定程度上降低CT引导下经皮穿刺肺结节RFA同步活检的出血风险。     

CT引导下经皮肺穿刺并发症发生现状及相关因素分析

目的了解CT引导下经皮肺穿刺并发症发生现状及相关的影响因素,为预防并发症的发生提供一定的科学依据。方法收集自2013年6月至2017年6月在本院进行CT引导下经皮肺穿刺的患者82例。平均年龄为(45.47±10.88)岁,其中男性51人,占62.20%,女性31人,占37.80%,有51人有吸烟史,占62.20%,有28人有高血压,占34.15%。收集患者的穿刺针道长度(cm)、病灶大小(cm)、病灶周围肺气肿或肺大疱、穿刺次数和穿刺时间(分钟)等资料。观察患者的并发症,有无出血、气胸等。结果本次研究共纳入82例研究对象,有19人出现了并发症,占23.17%。通过多因素分析发现,穿刺针道长度(cm)、病灶周围肺气肿或肺大疱、穿刺次数和穿刺时间对于并发症的发生有影响。结论 CT引导下经皮肺穿刺并发症的发生率仍较高,针道长度越长、穿刺次数和穿刺时间越多,病灶周围肺气肿或肺大疱等都会导致并发症的发生,因此要重点加强此类人群的重点防护。     

CT引导下经皮肺穿刺活检术后发生肺出血的因素分析

目的观察CT引导下经皮肺穿刺活检术后发生肺出血的危险因素。方法选取347例接受CT引导下经皮肺穿刺活检术患者,对病历资料及术中CT图像进行回顾,分析可能引起肺出血的临床因素,患者因素包括年龄、性别、是否合并肺气肿、主肺动脉直径、是否服用抗血小板药物;手术及病变因素包括穿刺次数、进针角度、病变最大径、形态及病变与胸膜间距离。结果 347例中,168例术后发生肺出血(出血组),其中咯血25例,1例发生血气胸。术后出血组女性比例(P=0.010)、合并肺气肿比率(P=0.016)、亚实性病变比率(P=0.036)均高于未出血组,病灶最大径(P=0.003)、胸膜下病变比率(P0.001)均较未出血组低。主肺动脉直径增宽(≥2.9cm)患者与未增宽患者间术后肺出血发生率差异无统计学意义(χ~2=0.011,P=0.915)。结论 CT引导下经皮肺穿刺活检术后发生肺出血常见,但较少需要临床干预。CT测量主肺动脉直径增宽不是术后发生肺出血的危险因素。     

CT引导与X线透视引导下经皮经肝胆道引流术治疗梗阻性黄疸的效果与安全性对比

目的对比CT引导与X线透视引导下经皮经肝胆道引流术治疗梗阻性黄疸的效果与安全性。方法将2008年6月至2016年6本院收治的80例阻梗性黄疸患者随机分成观察组与对照组,分别在CT引导与X线透视引导下经皮经肝胆道引流术,比较两组的穿刺治疗、黄疸缓解率以及并发症等。结果观察组的穿刺次数、辐射暴露剂量明显的少于对照组,穿刺透视时间、总穿刺时间明显的短于对照组;观察组胆道出血的发生率明显的少于对照组;上述比较差异具有显著性(P0.05)。结论 CT引导下经皮经肝胆道引流术治疗阻梗性黄疸穿刺成功率高,辐射暴露剂量少,黄疸症状缓解率高,安全性好。     

电子计算机X线断层扫描引导下经皮肺切割活检术在疑似肺结核的应用价值及安全性因素分析

目的评价电子计算机X线断层扫描(CT)引导下经皮肺活检术对疑似肺结核的诊断价值及安全因素的探讨。方法回顾性分析98例疑似肺结核患者在CT引导下行经皮肺活检术的临床资料,评价该手术对疑似肺结核的诊断价值及影响术后并发症发生率的因素。结果 98例疑似肺结核病例经CT引导经皮肺活检均获得病理学标本,其中经手术病理直接明确诊断肺结核68例,所有病例最终诊断为肺结核72例,占最终诊断率的94.4%。术后并发症气胸发生率为21.4%,引起气胸并发症的因素,在进针后调整方向是与否、肺气肿有与无、术中咳嗽有与无,年龄60岁与60岁、进针处经实变区域脏层胸膜是与否比较差异具有统计学意义(P均0.05)。术后并发症咯血的发生率为9.2%,引起咯血并发症的因素,在进针后调整方向是与否、术中咳嗽有与无、病灶距脏层胸壁大于3cm是与否、手术穿刺1次与2次或2次以上比较差异具有统计学意义(P均0.05)。结论 CT引导下经皮肺切割活检术对疑似肺结核具有较高的诊断价值;进针部位、术中咳嗽、肺气肿及年龄因素影响气胸发生,咳嗽及病灶深度影响咯血的发生,其中穿刺次数及进针针尖方向调整对气胸和出血的发生均有影响。     

激光水平仪在CT引导经皮肺穿刺活检中的应用

目的探讨激光水平仪辅助CT引导系统在肺肿物穿刺活检中的应用价值。方法将2018年12月至2020年12月64例需穿刺活检的肺占位患者,随即分为研究组和对照组。研究组组32例患者采用激光水平仪联合CT引导下经皮肺穿刺活检;对照组常规CT引导肺穿刺。统计分析两组操作时间,穿刺成功率,并发症发病率。结果研究组操作时间(11.6±2.1)分钟,对照组操作时间(23.2±6.3)分钟,(t=-11.698,P0.01),差异具有统计学意义;研究组成功率93.7%,对照组75.0%,(χ~2=21.8,P0.01),差异具有统计学意义;研究组操并发症发生率18.8%,对照组并发症发生率37.5%,(χ~2=6.01,P0.05),差异具有统计学意义。结论激光水平仪联合CT引导下经皮肺穿刺活检术可使穿刺更加精准,简易。     

对比CT引导肺结节定位针与弹簧圈定位针术前定位亚厘米肺结节效果

目的 对比术前于CT引导下以肺结节定位针与弹簧圈定位针定位亚厘米肺结节的效果。方法 55例亚厘米肺结节(孤立性肺结节,最大径4～10 mm,距胸膜<50 mm)患者于电视辅助胸腔镜手术(VATS)前48 h内接受CT引导下定位病灶,其中30例采用肺结节定位针(定位针组)、25例采用弹簧圈定位针(弹簧圈组),对比2种方法定位时间、CT扫描次数、定位成功率、病灶楔形切除时间、手术成功率及并发症。结果 55例均顺利完成术前定位且VATS均成功切除病灶。2种定位方法之间,CT扫描次数、病灶楔形切除时间及气胸、肺内出血发生率差异均无统计学意义(P均>0.05)。以定位针定位时间长于弹簧圈(P=0.001)。结论 术前于CT引导下以肺结节定位针与弹簧圈定位针定位亚厘米肺结节的安全性和有效性相当,后者操作时间更短。     

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.