急性坏疽性胆囊炎的相关危险性因素分析

目的:分析急性坏疽性胆囊炎的相关危险因素,探讨提示胆囊坏疽风险的临床和实验室指标。方法:对我院225例急性胆囊炎行胆囊切除术病人的临床资料进行回顾性分析,用单因素和多元回归分析筛选急性胆囊炎并发胆囊坏疽的相关危险因素。结果:白细胞计数(P=0．001)、体温(P=0．001)、有无胆囊结石(P=0．001)、谷丙转氨酶(P= 0．001)及血清总胆红素(P=0．001)与并发胆囊坏疽的有相关性。结论:对白细胞计数升高(≥15×10~9/L)、体温(≥38．0℃)和无结石性急性胆囊炎的病人应警惕胆囊坏疽的可能。排除合并胆道结石、急性胆管炎及或急性胰腺炎后,谷丙转氨酶和血清总胆红素升高也是胆囊坏疽的提示因素。     

坏疽性胆囊炎发生的危险因素分析

目的 探讨坏疽性胆囊炎的危险因素,提高术前诊断坏疽性胆囊炎的准确性。方法 回顾性分析39例坏疽性胆囊炎与441例非坏疽胆囊炎患者术前临床资料,采用Logistic回归分析法分析性别、年龄、肥胖、糖尿病、体温、右上腹肌紧张状态、腹部B超表现、白细胞计数等指标与坏疽性胆囊炎之间的关系。结果 经单因素Logistic回归分析发现,患者年龄≥60岁,肥胖,糖尿病,体温≥38 ℃,右上腹肌紧张,B超显示胆囊颈部结石嵌顿,胆囊壁厚≥4 mm,胆囊周围积液及胆囊壁线性中断为坏疽性胆囊炎的危险因素。多因素Logistic回归分析发现,最终胆囊颈部结石嵌顿（OR=7.182,P=0.001）、胆囊壁厚≥4 mm（OR=12.493,P＜0.001）、体温≥38 ℃（OR=13.216,P＜0.001）及胆囊壁线性中断（OR=15.337,P＜0.001）4个因素进入回归方程。结论 胆囊颈部结石嵌顿、胆囊壁厚≥4 mm、体温≥38 ℃及胆囊壁线性中断为坏疽性胆囊炎的独立危险因素,其影响强度依次增强。     

急性进展迅速型坏疽性胆囊炎的危险因素分析

目的 探讨急性进展迅速型坏疽性胆囊炎的危险因素.方法 回顾性分析同济大学附属同济医院肝胆外科2013年1 月至2019年12月收治的急性坏疽性胆囊炎病人临床资料,采用Logistic回归分析方法分析性别、年龄、高血压、糖尿病、最高体温、白细胞计数、C反应蛋白、墨菲征、胆囊周围积液、胆囊壁线性中断、胆囊结石颈部嵌顿与急性...     

急性坏疽性胆囊炎69例的腹腔镜治疗

目的 探讨腹腔镜治疗急性坏疽性胆囊炎中转开腹的危险因素及影响预后的指标。方法 总结69例急性坏疽性胆囊炎腹腔镜手术的临床资料，包含术前临床指标和预后相关因素。计量资料采用x^-±s表示，行t检验；计数资料行χ^2检验。结果 腹腔镜手术成功完成45例，中转开腹24例；中转开腹的危险因素为年龄（χ^2=2．234，P=0．034）和合并心血管疾病（χ^2=4．983，P=0．027）；早期行腹腔镜手术和术中及时中转开腹的病例预后较好。结论 急性坏疽性胆囊炎应早行腹腔镜探查，若操作困难，应早期及时中转开腹手术；对于高龄和合并有心血管疾病的患者，应行开腹胆囊切除术。     

基于东京指南(2018)下中度(Ⅱ级)急性胆囊炎行腹腔镜胆囊切除中转开腹危险因素分析

目的探讨中度(Ⅱ级)急性胆囊炎行腹腔镜胆囊切除(LC)中转开腹的危险因素。 方法回顾性分析2014年1月至2016年1月137例急性胆囊炎患者资料,57例患者行LC,80例患者行LC中转开腹,依据手术方式不同分成LC组和中转开腹组。所有数据采用SPSS13.0统计软件进行处理。计量资料以( ±s)表示,对各变量进行正态性检验,各变量未通过正态性检验(P<0.05),以连续性变量以中位数(四分位间距)表示并做秩和检验。多因素分析采用Logistic回归分析,P<0.05为差异有统计学意义。 结果(1)单因素分析结果显示：患者年龄、急性胆囊炎发生次数、患者本次发病最高白细胞计数、患者最高体温、彩超诊断下胆囊厚度、胆囊大小中转开腹组均显著高于LC组(P<0.05),LC医师年资中转开腹组均显著低于LC组(P<0.05)。(2)多因素分析结果显示：急性胆囊炎发生次数,患者本次发病最高体温是中转开腹的独立危险因素,LC医师年资是中转开腹的独立保护因素。 结论急性胆囊炎发生次数、患者体温是中度(Ⅱ级)急性胆囊炎行LC中转开腹独立危险因素,有经验的手术医师可以减少该类疾病中转开腹的概率。     

发生坏疽性胆囊炎的预后因素

在美国每年约行5 0万例胆囊切除术,其中仅少数为急症手术,坏疽性胆囊炎仅占急性胆囊炎的2 %～2 9.2 %,伴较高的并发症率和死亡率。Teefy统计48%病例术前未作正确的坏疽诊断。Hunt等报道年迈、冠心病史和白细胞增多者的坏疽性胆囊炎危机增加,惜病例统计数太少。作者统计美国休斯敦战士医疗中心等单位于1 998～2 0 0 1年收治1 1 3例急性胆囊炎,包括45例坏疽性胆囊炎( 3 9.8%)病例,均经病理学确诊,其发生情况如表1所示。表1　坏疽性胆囊炎发病情况变量上限线急性胆囊炎( 68例)坏疽性胆囊炎( 4 5例)年龄≥5 7岁74.1 %90 .9%男性男89.7%97.7%女…     

不同手术时机腹腔镜胆囊切除术治疗急性结石性胆囊炎的疗效及中转开腹影响因素研究

目的探讨不同手术时机腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎的疗效及中转开腹的影响因素。方法回顾性分析120例急性结石性胆囊炎患者的临床资料,根据LC手术时机的不同,将症状出现48小时内者、症状出现48小时后手术者分别纳入早期组(n=67)、晚期组(n=53),比较不同组别患者围手术期相关指标,并对中转开腹的影响因素进行统计学分析。结果早期组患者手术时间及术中出血量均明显少于晚期组,差异有统计学意义(P0.05);2组中转开腹率及并发症发生率比较,差异均无统计学意义(P0.05)。单因素分析显示,年龄≥65岁、体温≥38.5℃、WBC计数≥15×109/L、腹肌紧张、有上腹部手术史、结石嵌顿、胆囊壁厚度≥5mm是LC术中转开腹的影响因素(P0.05);经Logistic多元逐步回归分析,年龄、白细胞计数、胆囊壁厚度均为影响LC术中转开腹影响的独立危险因素(P0.05)。结论急性结石性胆囊炎早期进行LC术(发病48h内)具有手术时间短、术中出血量少的优势,年龄、白细胞计数、胆囊壁厚度均为影响LC术中转开腹的独立危险因素。     

超声引导下经皮经肝胆囊穿刺引流在高龄高危患者急性胆囊炎应用探讨

目的探讨超声引导下经皮经肝胆囊穿刺引流(pereutaneous transhepatic gallbladder drainage,PTGD)在高龄高危患者急性胆囊炎的应用。方法对2013年1月~2015年12月67例接受经皮经肝胆囊引流术治疗的高龄高危急性胆囊炎患者临床资料进行回顾性分析。结果 67例患者均一次置管成功,无死亡病例,患者24小时腹痛缓解率85.1%,术后第1天白细胞计数、中性粒细胞比例、最高体温较术前明显减低(P0.05),丙氨酸转氨酶、总胆红素较术前降低,但差异无统计学意义(P0.05);术后第3天,白细胞计数、中性粒细胞比例、最高体温、丙氨酸转氨酶、总胆红素基本恢复正常(P0.01),术后3例患者出现并发症,分别为:引流管脱出、胆囊出血、引流管折断。结论高龄高危急性胆囊炎患者急诊手术治疗具有极高风险,做为一个过渡桥梁,PTGD是一项安全、简便、有效的方法。     

急性胆囊炎腹腔镜胆囊切除术量化手术指征探讨

目的 :探讨并建立一个急性胆囊炎行腹腔镜胆囊切除术 (LC)手术失败的预测模式 ,并确立量化的手术指征。方法 :回顾分析我院 2 2 8例急性胆囊炎LC的诊治经验。结果 :(1)右上腹手术史或发作史 ,临床症状 ,B超表现 ,技术因素在统计学上和LC失败率有相关性 (P <0 0 5 ) ;(2 )急性胆囊炎行LC失败预测方程式 =0 0 5 2 + 0 12 1右上腹部手术史赋值 + 0 0 6 4临床症状赋值 + 0 0 75胆囊B超表现赋值 + 0 182技术因素赋值 (P <0 0 1)。结论 :危险因素术前评分系统PRFSS大于等于 6分组应首选开腹手术。PRFSS是简单 ,实用 ,可行的评分系统。     

循“A-B-D”路径的腹腔镜胆囊切除术与常规路径腹腔镜胆囊切除术治疗急性化脓性和坏疽性胆囊炎的对比研究

目的探讨循"A-B-D"路径的腹腔镜胆囊切除术在急性化脓性和坏疽性胆囊炎手术治疗中的应用价值。方法回顾性收集2019年9月至2020年12月期间于乐山市人民医院采用循"A-B-D"路径的腹腔镜胆囊切除术治疗的45例急性化脓性和坏疽性胆囊炎病例作为观察组(ABD观察组),同时收集2018年1月至2019年8月期间在乐山市人民医院采用常规路径腹腔镜胆囊切除术治疗的50例急性化脓性和坏疽性胆囊炎病例(常规对照组)作对比,比较2组患者的安全性和有效性相关参数。结果本研究纳入ABD观察组45例(急性化脓性胆囊炎26例,急性坏疽性胆囊炎19例),常规对照组50例(急性化脓性胆囊炎24例,急性坏疽性胆囊炎26例)。2组患者的年龄、性别、体质量指数、疾病类型、胆囊情况、术前合并症等方面比较差异均无统计学意义(P>0.05)。术后ABD观察组无胆管损伤病例,常规对照组发生胆管损伤4例(8.0%),但2组的胆管损伤发生率比较差异无统计学意义(P=0.054);术中ABD观察组中转开腹1例(2.2%),中转开腹率低于常规对照组(10例,20.0%),差异有统计学意义(P=0.017)。其他手术相关指标包括手术时间、术后住院时间、术中出血发生率和术后出血发生率2组比较差异均无统计学意义(P>0.05)。结论循"A-B-D"路径的腹腔镜胆囊切除术可以清晰地辨明胆囊管与肝外胆管的解剖结构,能够有利于防止胆管损伤,并能降低中转开腹率,值得临床尤其是区县基层医院推广应用。     

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.     

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.     

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.