胰腺中段切除术在胰腺颈体部良性肿瘤的应用(附15例报告)

目的 探讨胰腺中段切除术在胰腺颈体部良性肿瘤中的临床实用价值.方法 对2005年11月至2009年6月期间收治的胰腺颈体部良性肿瘤并施行胰腺中段切除术的15例病例进行回顾性分析,男性3例,女性12例,年龄30～55岁,平均45岁.其中因上腹部胀痛不适入院4例,其余11例均为常规体检行腹部彩色超声检查发现.结果 本组患者无围手术期死亡.15例患者均行胰腺中段切除,其中14例行胰头断端闭锁、胰尾空肠吻术(单吻合术),1例行胰腺两断端空肠"Ω"吻合(双吻合术).术后病理检查结果显示,胰腺实性假乳头状瘤1例,无功能性胰岛细胞瘤3例,胰腺囊腺瘤11例.术后发生胰瘘3例,均在3个月内自行愈合.所有患者均获得随访,随访时间2～45个月,15例患者无死亡,无新发糖尿病,无肿瘤再发,无胰腺假性囊肿形成.结论 胰腺中段切除术治疗胰腺颈体部良性肿瘤临床效果确切,对患者内、外分泌功能影响小,胰瘘发生率高于胰头十二指肠切除术,只要通畅引流,多能自行愈合.     

中段胰腺切除治疗胰颈体部肿瘤13例体会

目的总结中段胰腺切除治疗胰颈体部肿瘤的临床经验。方法对胰颈体部良性或低度恶性肿瘤13例患者行中段胰腺切除术治疗。术中游离胰颈体部切除肿瘤,行Roux-en-Y胰肠吻合或胰胃吻合。单吻合法5例,"Ω"形双吻合法6例,胰胃吻合法2例,胰肠吻合均放置肠造口管充分减压引流。结果切除胰腺平均直径4.3 cm,手术时间(237±43)分钟,出血量(287±75)ml。术后胰瘘2例,出血2例。浆液性囊腺瘤2例,黏液性囊腺瘤1例,实性假乳头状瘤3例,导管内乳头状黏液瘤2例,神经内分泌瘤1例,神经鞘瘤1例,功能性胰岛细胞瘤2例,无功能性胰岛细胞瘤1例。均痊愈出院,平均住院时间(18±5)天,随访9个月~3年未见低血糖和肿瘤复发及新发糖尿病。结论个体化中段胰腺切除术适合胰颈体部良性或低度恶性肿瘤治疗,保护了胰腺内外分泌功能,是一种安全、疗效确切的手术方式。     

中段胰腺切除术(附10例报告)

目的 探讨中段胰腺切除术的临床应用价值。方法 回顾性分析1990年1月至2003年10月间10例中段胰腺切除术病人的临床资料，男6例，女4例，平均年龄46．6岁。本组病例中病理诊断胰腺内分泌肿瘤5例。胰腺囊腺瘤4例。慢性胰腺炎伴胰石症1例。2例行中段胰腺切除＋胰头空肠、胰体空肠、空肠空肠吻合术，8例行中段胰腺切除＋胰体空肠Roux-en-Y吻合术。结果 术后均无死亡。术后发生胰瘘2例，经保守治疗2个月和2周后均痊愈。仅1例无功能性胰岛细胞瘤的病人术后出现血糖轻度增高，随访1年血糖无变化。10例病人中8例随访至2004年4月均健在，无复发。结论 中段胰腺切除术适用于位于胃十二指肠动脉左侧和近脾静脉与肠系膜下静脉汇合处之间良性或低度恶性的胰腺肿瘤。该术式有利于降低胰腺术后糖尿病的发生和维持胃肠道的功能．     

胰腺中段切除术（附15例报道）

目的 报道并总结15例胰腺中段切除的手术经验.方法 2001年1月至2005年10月期间共有15例患者接受胰腺中段切除手术,其中女11例,男4例;年龄23.8～73.1岁,平均49.4岁;神经内分泌肿瘤8例(其中5例为无功能性),浆液性囊腺瘤5例,黏液性囊腺瘤2例.均采用近端胰腺残端缝合、远端胰腺和空肠袢Roux-en-Y端端套入式吻合.结果 手术平均时间275 min(179～370 min),切除胰腺平均长度45 mm(30～60 mm),肿瘤平均最大径23 mm(15～40 mm).术后发生胰瘘4例(26.7%),其中3例(20.0%)伴有出血.随访时间3个月～5年(平均23个月),1例重症感染伴发多器官功能衰竭者于术后3个月死亡;其余均存活,且随访期间均无新发糖尿病.结论 胰腺中段切除是一种治疗胰腺颈体部良性肿瘤和交界性肿瘤的有效方法.     

胰腺中段切除术的应用

目的探讨胰腺中段切除术(medial pancreatectomy,MP)的临床应用价值。方法回顾性分析13例胰腺良性疾病和1例非侵袭性胰管内乳头状粘液癌行MP的临床资料,12例行MP+胰体空肠Roux-en-Y吻合术,2例行MP+胰头、胰体空肠双吻合术。结果术后3例出现胰瘘,经非手术治疗痊愈。1例术后病理报告为非侵袭性胰管内乳头状粘液癌,目前仍在观察中。余13例患者近期手术效果良好。结论对于胰腺颈体部的良性或低度恶性肿瘤,MP可获得满意的治疗效果。     

胰腺囊性肿瘤19例诊治分析

目的探讨胰腺囊性肿瘤的诊断及外科治疗方法。方法对我院2003年4月至2012年4月期间收治的19例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果本组19例患者中浆液性囊腺瘤8例,黏液性囊腺瘤5例,导管内乳头状黏液瘤4例,实性假乳头状瘤1例,囊腺癌1例。行B超或CT发现胰腺占位病变。位于胰头部5例,胰体部8例,胰尾部6例。行肿瘤摘除术4例,保留脾脏的胰体尾切除术5例,胰体尾＋脾脏切除手术3例,胰十二指肠切除术6例,1例囊腺癌患者困肝脏转移伴腹腔广泛转移、侵犯大血管而肿瘤不能切除仅行胃空肠、胆肠吻合。术后发生胰瘘2例,腹腔感染1例,经保守治疗后康复出院。无同手术期死亡病例。19例患者均进行了随访,随访时间6～80个月,平均45．2个月。1例囊腺癌合并肝脏转移患者于术后7个月死亡,其余良性肿瘤患者均未见复发,最长已存活5年。结论胰腺囊性肿瘤主要靠影像学检查发现,手术切除是理想的治疗方法,选择合适的术式有助于避免术后并发症的发生和改善预后。     

胰腺囊性肿瘤的诊治分析

目的 探讨胰腺囊性肿瘤的合理手术方式及术后并发症的处理.方法 对1997年1月至2009年12月收治的32例胰腺囊性肿瘤患者的临床资料进行回顾性分析,男性6例,女性26例,年龄24～76岁.胰腺浆液性囊腺瘤16例;胰腺黏液性囊腺瘤9例,其中1例为黏液性囊腺癌;胰腺导管内乳头状黏液性肿瘤4例;胰腺实性假乳头状瘤3例.肿瘤位于胰头颈部12例,位于胰体尾部20例.结果 所有患者均经手术治疗,无围手术期死亡;10例行胰十二指肠切除术、1例行保留十二指肠胰头切除术、13例行胰体尾切除术(其中2例行腹腔镜下胰体尾切除术)、3例行胰腺肿瘤摘除术、4例行胰腺中段切除术;1例囊腺癌患者仅行姑息手术.术后发生胃瘫3例、胰瘘5例,均经保守治疗痊愈.全组29例患者获得随访,随访时间4个月～10年,3例患者于术后4～34个月分别死于癌转移或其他疾病,其余26例患者均存活,且未发现肿瘤复发或转移.结论 胰腺囊性肿瘤术前应首选无创的CT检查,及时手术探查是防止肿瘤癌变的重要手段;具体的手术方式选择应按个体化原则,并应遵循损伤控制性手术原则;保留器官的手术方式更要重视术后胃瘫、胰瘘等并发症的处理.     

胰腺中段切除术的临床应用

目的:报道胰腺中段切除术的手术经验。方法:对2008年3月—2011年8月期间8例行胰腺中段切除术的病例资料进行回顾性分析。结果:肿瘤最大径(26.4±5.1)mm。手术时间(242.6±56.3)min,术中出血(205.5±82.4)mL,切除胰腺长度(44.5±8.3)mm,术后发生胰瘘1例(12.5%),胃瘫1例(12.5%),肺部感染1例(12.5%),术后平均住院日(18.3±6.1)d。术后病理提示实性假乳头状瘤2例,浆液性囊腺瘤1例,黏液性囊腺瘤2例,胰岛细胞瘤1例,无功能性胰岛细胞瘤2例。随访时间5个月至3年(平均23个月),患者目前均存活,对手术效果基本满意,未出现新发糖尿病病例。结论:对于胰颈部或体部的良性肿瘤,胰腺中段切除术是安全有效的手术方式,值得临床推广。     

胰腺浆液性囊腺瘤18例报告

目的 探讨胰腺浆液性囊腺瘤的诊断和治疗方法.方法 对1999年10月-2010年10月中国医科大学附属第一医院收治的18例胰腺浆液性囊腺瘤患者的临床资料进行回顾性分析.结果 18例患者中,男3例(16.7%),女15例(83.3%).肿瘤发生在胰体尾部12例(66.7%),胰头部3例(16.7%),胰颈部3例(16.7%),瘤体平均最大径6.5 cm.肿瘤无特异性临床表现,肿瘤体积越大,症状越明显.CT是主要的影像学检查方法,诊断正确率为61.1%.18例均接受手术治疗,其中胰十二指肠切除术3例,胰体尾脾切除术5例,保脾胰体尾切除术5例,胰腺中段切除术3例,肿瘤摘除术2例.10例术后发生胰瘘(55.6%),均治愈.随访6～125个月,平均48.3个月,未见复发.结论 CT是胰腺浆液性囊腺瘤主要的影像学检查方法,对伴有临床症状、难以定性的胰腺浆液性囊腺瘤应手术治疗.浆液性囊腺瘤手术切除后可治愈.     

中段胰腺切除术19例报告

目的 研究中段胰腺切除术在胰腺外科中的应用及临床意义.方法 回顾性分析山东大学附属省立医院2002年1月至2008年6月期间行中段胰腺切除术的19例患者的临床资料.结果 19例患者中9例为胰岛细胞瘤,4例为胰腺黏液性囊腺瘤,3例为胰腺实性假乳头状瘤,2例为胰腺类癌,1例为胰腺囊实性假性乳头状瘤,切缘均为阴性.住院时间10～40 d,平均(17.7±7.9)d,术后胰漏发生率为31.6%.随访时间为6个月至6年不等,除了1例患者随访1.5年后失访外,其余患者均健在,且无肿瘤复发和新发糖尿病病例.结论 中段胰腺切除术对于生长在胰腺颈部或体部的良性或低度恶性肿瘤是一种良好的手术方式,可保留患者的内外分泌功能,减轻胰腺切除术后糖尿病的风险.     

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.