复方烧伤I号治疗放射性皮肤反应相关因素分析

随机将 6 7例放射性湿性皮肤反应的病人分为两组 ,观察组 ( 35例 )用复方烧伤Ⅰ号局部湿敷 3h后揭去 ,2次 /d ;对照组 ( 32例 )常规用京万红软膏涂抹 ,2次 /d。结果创面愈合时间观察组 ( 4.75± 1.34)d ;对照组 ( 11.0 6±2 .36 )d ,两组比较 ,差异有极显著性意义 (P <0 .0 1)。提示自制复方烧伤Ⅰ号治疗放射性湿性皮肤反应具有良好的效果。     

醋酸精氨酸对创烧伤患者预后的影响及安全性分析——86例多中心、随机、双盲、安慰剂对照试验

目的观察服用醋酸精氨酸对创烧伤患者预后的影响及可能出现的不良反应。方法采用多中心、随机、双盲、安慰剂平行对照的研究方法,将96例创烧伤患者(实际完成86例)随机分为治疗组和对照组,治疗组41例,服用醋酸精氨酸0．4 g·kg-1·d-1;对照组45例,服用安慰剂酪氨酸,剂量同前,均连用7 d。两组患者采用等氮、等热量的营养支持疗法。比较患者创面(切口)愈合时间、住院时间及不良反应发生情况。结果创伤患者治疗组(29例)创面(切口)愈合时间和住院时间分别为(11．1±2．8)、(19±6)d,明显短于对照组(13．2±5．5)、(22±6)d(33例,P< 0．05);烧伤患者治疗组(12例)创面愈合时间和住院时间各为(20±5)、(28±6)d,与对照组(22±8)、(29±8)d(12例)比较,差异无统计学意义(P>0．05)。在整个试验过程中,患者出现的不良反应为恶心、腹泻,其中治疗组1例占2．44％,对照组1例占2．22％,两组比较差异无统计学意义(P= 1．000)。以上不良反应停药后消失。结论服用醋酸精氨酸能显著促进创伤患者创面(切口)愈合,缩短住院时间,且无明显不良反应,但对烧伤患者的预后无明显改善,这可能与病例数较少有关,其确切疗效有待于通过大样本的临床试验予以确定。     

叶酸含漱液防治化疗性口腔溃疡效果观察

将住院化疗致口腔溃疡的 85例病人随机分为观察组 (30例 )和对照 1组 (2 8例 )、对照 2组 (2 7例 ) ,分别于化疗后 3～ 7d行叶酸含漱液 (FGLN)、庆大霉素含漱液 (GLN)含漱、锡类散外敷 2～ 4个疗程 (5～ 7d 1个疗程 )。结果观察组疗效显著优于对照 1组和对照 2组 (均P <0 .0 5 ) ,对照 1组、对照 2组疗效比较 ,差异无显著意义(P >0 .0 5 )。提示FGLN能有效促进口腔溃疡的愈合 ,缩短愈合时间。     

聚维酮碘治疗老年糖尿病压疮疗效探讨

将 4 4例Ⅱ期、Ⅲ期、Ⅳ期压疮病人随机分为观察组和对照组各 2 2例 ,观察组以聚维酮碘治疗 ,对照组采用创面冲洗、庆大霉素与胰岛素敷料包扎结合TPD辐射创面治疗。结果治疗 30d后 ,观察组治愈率为 72 .73% ,明显高于对照组的 36 .36 % (P <0 .0 1) ;平均痊愈时间 (13.4 6± 2 .70 )d ,明显短于对照组 (18.87± 2 .94 )d(P <0 .0 5 )。提示聚维酮碘治疗老年糖尿病病人压疮疗效显著     

三种方法护理化疗性口腔炎的效果比较

目的 比较复方氯己定、海藻生物胶和思密达用于化疗性口腔炎的护理效果,探讨化疗性口腔炎的有效护理方法。 方法 将264例化疗性口腔炎患者随机分为对照组、观察1组、观察2组各88例。对照组常规应用复方氯己定含漱液进行护理,观察1组应用思密达进行护理,观察2组应用海藻生物胶进行护理,护理5 d后比较三组疗效。 结果 护理后对照组、观察1组、观察2组有效率分别为44.32%、78.41%、93.18%,三组比较,差异有统计学意义（P＜0.01）。 结论 复方氯己定、海藻生物胶和思密达护理化疗性口腔炎均有效,但复方氯己定疗效欠佳,思密达次之,海藻生物胶能够更有效地改善与减轻化疗所致口腔炎。     

转Endostatin基因角朊细胞移植对烧伤深Ⅱ°创面愈合及瘢痕增生的影响

目的探讨转内皮生长抑制素(ES)基因角朊细胞移植对烧伤深Ⅱ°创面愈合及瘢痕增生的影响。方法将人体皮肤移植于裸鼠并造成深Ⅱ°烧伤创面。实验分为对照组(11只)、单纯角朊细胞移植组及转ES基因角朊细胞移植组(各10只)。对照组不行细胞移植,创面自行愈合;单纯角朊细胞移植组创面移植培养人角朊细胞;转基因移植组移植转ES基因角朊细胞。观察各组裸鼠创面愈合特点、瘢痕增生情况,并对愈合区组织进行病理切片检查、检测愈合区皮肤组织ES 蛋白表达、I、Ⅲ型前胶原含量。结果转基因移植组裸鼠创面愈合时间(13±5)d与单纯移植组 (14±5)d差异无统计学意义(P>0．05),但明显短于对照组[(25±7)d,P<0．01]。对照组裸鼠创面愈合后瘢痕增生明显,伤后100 d厚度≥0．22 cm,单纯移植组瘢痕增生厚度≥0．17 cm,转基因移植组仅有轻度瘢痕增生,愈合区皮肤组织ES蛋白检测阳性。单纯移植组、转基因移植组愈合区组织前胶原I含量(65．3±8．5)μg／g,(61．4±7．0)μg／g、前胶原I／前胶原Ⅲ比例(0．66±0．15,0．57± 0．13)明显低于对照组(1．51±0．37,P<0．01),而前胶原Ⅲ含量显著高于对照组(P<0．01)。结论转ES基因移植既可加速创面封闭,又能抑制愈合后瘢痕形成。     

纤维蛋白粘合剂在外科手术创面的应用

目的 研究纤维蛋白粘合剂在处理手术创面时的止血、封闭缺损和促进组织生长的作用。方法 按分层随机的方法,将295例施行甲状腺次全切除、乳腺癌根治、肝部分切除、胰十二指肠切除、门奇静脉、断流术、直肠癌根治术的病人分为试验组(148例)和对照组(147例)。结果 试验组和对照组的术后创面平均引流量分别为(863±158)ml和(1120±224)ml(P<0.01),引流液平均血红蛋白浓度分别为(11.6±2.7)g/L和(19.4±3.2)g/L(P<0.01),平均置管时间分别为(69.0±18.2)小时和(108.5±27.4)小时(P<0.01),创面积液的发生率分别为0和2.04％(P<0.05),手术后平均住院时间分别为(18.7±4.0)天和(24.6±6.1)天(P<0.01)。术后并发症和手术死亡率两组无差异(P>0.05)。结论 纤维蛋白粘合剂不仅可安全地应用于各种手术创面,而且能有效地封闭组织缺损或死腔,减少创面出血和渗液,促进组织生长与愈合,缩短手术后住院时间。     

FE复合酶防治烧伤后期肉芽创面感染的临床观察

目的观察FE复合酶控制烧伤后期肉芽创面常见耐药菌感染的作用。方法选取笔者单位烧伤患者30例,随机分为治疗组15例,将FE复合酶50 ml溶于等渗盐水0-150 ml中,使其终浓度为1-3 U/ml,用无菌纱布浸湿该液后湿敷创面,1-2次/d;对照组15例,用庆大霉素+ 等渗盐水纱布湿敷创面,1-2次/d。于用药前及用药后1-5 d取创面分泌物作细菌培养,检测两组患者创面的细菌种类及所用药物对创面细菌的敏感率;观察两组患者创面愈合时间及植皮术后3、5、 8、10、12 d的创面愈合率。结果两组患者创面细菌以铜绿假单胞菌、大肠杆菌、阴沟肠杆菌、甲氧西林耐药金黄色葡萄球菌(MRSA)为主。治疗组对MRSA、表皮葡萄球菌、腐生葡萄球菌、铜绿假单胞菌、大肠杆菌、阴沟肠杆菌的敏感率分别为93．8％、100．0％、100．0％、100．0％、100．O％、95．0％,高于对照组的17．6％、31．3％、28．6％、44．0％、33．3％、28.0％(P<0．01)。治疗组植皮术后创面愈合时间为(10．6±1．5)d,明显短于对照组[(15．3±1．7)d,P<0．01]。治疗组患者植皮术后各时相点创面愈合率均明显高于对照组(P<0．01),植皮术后10 d治疗组创面愈合率为(85．4±2．4)％,与对照组(51．3±1．5)％比较,差异有统计学意义(P<0．01)。结论 FE复合酶可以有效控制创面感染,提高烧伤后期感染创面植皮成功率。     

精神病病人住院期间开放管理模式探讨

目的 探讨舒适护理对精神病病人住院生活质量及疾病康复的影响。方法 将2001年5月至2002年6月住院的416例精神病病人(观察组)实施全开放管理,即24 h允许病人自由出入病区所有区域,7:00-19:00允许病人自由进入病区与医院大门,允许陪护。每天责任护士按护理程序护理病人。与同期住院实行半封闭管理(由护士引导病人出入病室及进行相关医疗活动,不设陪护,按常规护理)的461例精神病病人(对照组)比较满意度、舒适度、治疗有效率、平均住院时间及痊愈病人平均住院时间。结果 观察组满意度评分(96.81±2.33)和舒适度评分(86.81±2.51)显著高于对照组(91.55±3.67、55.84±3.15),均P<0.01;平均住院时间[(31.67±4。13)d]和痊愈病人平均住院时间[(40.38±4.08)d]显著少于对照组[(77.20±5.15)d、(79.48±5.66)d],均P<0.01。结论 对住院精神病病人实施全开放管理可提高病人住院生活质量,缩短康复时间。     

碳纤维敷料在烧伤创面中的临床应用

目的观察碳纤维敷料对烧伤创面的治疗作用。方法选择浅Ⅱ°、深Ⅱ°和残余创面共277例,随机分为对照组(碘伏纱布换药)和治疗组(碳纤维敷料换药)。观察敷料吸收容量、创面炎症反应,并做创面细菌定量和创面组织学检查,记录创面愈合时间等。结果与对照组相比,治疗组敷料吸收容量大,创面炎症反应轻,创周炎症消退快,痂下组织细菌定量低。浅Ⅱ°、深Ⅱ°及残余创面愈合时间分别为(7．4±2．1)d、(16．2±2．6)d、(19．4±6．2)d,均较对照组缩短,对照组分别为(9．6±2．4)d、(19．6±3．4)d和(28．8±10．4)d。结论碳纤维敷料是一种具有吸附能力强、可有效控制炎症反应、促进创面愈合等特点的新型敷料。     

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.