二孔法腹腔镜下腹膜透析导管置管术临床应用研究

目的:观察二孔法腹腔镜下腹膜透析导管置管术临床应用效果,为腹膜透析患者寻找一种简单、安全、有效的置管方法。方法:2017年09月～2018年05月对21例尿毒症患者采用二孔法腹腔镜下腹膜透析导管置管。观察患者的手术时间、术中、术后出血、导管移位、腹膜渗漏、腹膜炎、大网膜包裹等并发症。结果:21例患者置管的手术操作时间平均35.6min(30 min～45 min),术中无腹腔脏器损伤、明显出血。术后1 d内排气,肠功能恢复满意。早期置管的2例患者术后1周出现导管移位,调整导管置入位置后的19例均未发生导管移位,2例早期透析的患者发生腹膜渗漏,1周后透析的患者均未发生腹膜渗漏,1例患者腹腔黏连,经电凝分离后成功置管。所有患者均未发生明显出血、脏器损伤、大网膜包裹及早期腹膜炎。结论:二孔法腹腔镜下腹膜透析导管置管术具有创伤小、手术操作简单、术后恢复快、并发症少等优点,能对腹腔黏连等进行分离操作,具有独特的优势,值得临床推广应用。     

改良腹膜透析置管术对导管相关并发症的影响

目的 探讨通过改进腹膜透析置管手术方法减少导管相关并发症的发生,提高腹膜透析质量.方法 2014年12月至2015年12月于本院住院的145例终末期肾脏病行腹膜透析置管的患者,随机分为观察组71例和对照组74例进行对照研究,观察并比较两组患者术后1年内漂管移位、网膜包裹、血块或纤维素阻塞、漏液、腹膜炎、隧道炎以及出口感染等并发症的发生率.结果 观察组患者采用改良腹膜透析置管术后1年内导管移位3例(4.22％),网膜包裹2例(2.81％);对照组1年内导管移位10例(13.51％),网膜包裹5例(6.75％),两组比较差异具有统计学意义(P＜0.05).术后随访1年内两组患者总的导管相关并发症发生率,观察组为22.53％(16/71),对照组为40.55％(30/74),具有显著统计学差异(P＜0.05).结论 改良后的腹膜透析置管术可有效降低导管相关并发症,进一步提高腹膜透析的质量,且手术操作简易、方便、安全,利于在基层医院开展运用,具有一定的临床应用价值.     

腹膜透析患者腹内置管位置对导管并发症的影响

目的通过B超测量腹膜透析患者腹内导管末端与盆腔最低位置间的距离,并初步探讨该距离对导管相关并发症的影响。方法选择2014年6月至2016年12月在华中科技大学同济医学院附属协和医院肾内科住院行腹膜透析置管的137例患者作为研究对象,年龄19～74岁。根据男女解剖结构上的差异,将这些患者分为男性组76例和女性组61例。另外,通过B超测量出的患者术后一周腹膜透析管腹内段末端位置与盆腔最低位置间的距离将各组又分为0～3 cm组、3～5 cm组、5 cm组3个亚组。追踪观察137例患者腹膜透析过程中是否出现腹痛、血性腹膜透析液及灌引流是否通畅等临床表现,随访3个月。收集整理数据并分析比较男女2组间及各亚组之间的差异。结果 2组患者的3个亚组中发生导管相关并发症的发生率均有显著性差异(P0.05),且均显示当腹膜透析导管腹内段末端位置与盆腔最低位置间距离为3～5 cm时其发生率最低,明显优于其它2个亚组。另外,该研究发现距离在0～3 cm时,患者易发生腹痛且程度较重;而距离在5 cm时,较易发生漂管及网膜包裹等并发症。结论该研究表明当B超测量出的距离在3～5 cm时,无论男女患者发生上述腹膜透析导管并发症的发生率均较低,这提示腹膜透析置管的医生在手术时,一定要根据患者体型等仔细确定切口位置及导管置入腹内的长度等,减少并发症的发生,提高腹膜透析的质量。     

应用不同腹膜透析导管治疗慢性肾衰竭患者的临床观察

目的 比较Tenckhoff直管与卷曲管在维持性腹膜透析患者中的临床疗效.方法 对行腹膜透析置管术的133例成人慢性肾衰竭病例进行回顾性分析,根据其所使用的腹透置管类型不同,将患者分为末端直管组(68例)和卷曲管组(65例)两组,统计其腹膜透析引流速度、并发症、生存时间、退出透析或死亡等结局并进行比较.结果 两组患者腹膜透析的隧道口感染率、腹膜透析液引流速度、生存时间等无差别(P＞0.05).术后2周内导管移位共5例,其中卷曲管4例,直管1例,两组比较有统计学意义(P＜0.05).入液时疼痛,直管组7例,卷曲管组1例,两组比较有统计学意义(P＜0.05).结论 Tenckhoff直管与卷曲管均适用于CAPD患者,各有优缺点,建议个体化选择腹膜透析用管.     

腹膜透析置管术中应用卵圆钳与导丝置管效果的比较

目的 比较腹膜透析置管术中不同置管方法对置管成功率、导管通畅性及术后并发症、导管生存率的影响.方法 回顾性分析198例行腹膜透析置管术并长期随访的持续不卧床腹膜透析(CAPD)患者,其中应用导丝置管108例,卵圆钳置管90例.统计术中的置管重复次数、导管首次通畅率,观察术后腹腔出血发生率、腹壁渗液发生率、导管移位率以及导管生存率.结果 导丝置管重复次数为2.80±0.82次,卵圆钳置管重复次数为1.30 ±0.56次,差异有显著性(P＜0.05);术中导管首次通畅率分别78.7％和91.1％.差异有显著性(P＜0.05);术后腹腔出血发生率分别是7.41％和0,差异有显著性(P＜0.05);腹壁渗液分别有2例和4例,差异无显著性(P＞0.05);术后1年内导管移位发生率分别为11.5％和4.3％,差异有显著性(P＜0.05);术后1年导管生存率分别为93.5％和100％,差异有显著性(P＜0.05).结论 在腹膜透析置管手术中采用卵圆钳置管能够更为准确将导管置入目标位置,提高置管成功率,减少腹腔出血并发症,改善术后导管通畅性、降低术后导管移位以及提高导管生存率,值得推广应用.     

改良的腹膜透析导管固定方法在腹透置管术中的应用

目的 观察改良的腹膜透析(peritoneal dialysis,PD)导管固定方法在PD置管术中的应用.方法 收集2014年6月至2019年6月在扬州大学医学院附属泰兴市人民医院肾脏内科确诊为终末期肾病并选择PD治疗的大于18岁的患者,随机分为常规手术组与改良腹壁固定组,随访6个月,比较两组患者手术用时,术后导管漂管...     

高浓度氟康唑封管治疗腹透患者真菌性腹膜炎的疗效观察

真菌性腹膜炎是腹膜透析（peritoneal dialysis,PD）中的一种严重的腹膜炎,腹部压痛、反跳痛的发生率显著高于腹透并发的其他腹膜炎,预后不良,早期拔管可能可以降低病死率。目前国外学者主张：一旦确诊为真菌性腹膜炎应立即拔除腹透导管并积极抗真菌治疗10d,间隔2～3周后可考虑重新置管继续腹透治疗。这一治疗方案患者需要经历几次手术,患者痛苦大,治疗所需费用高。如何能够控制真菌性腹膜炎而减少腹透拔管率？     

腹腔镜下腹膜透析置管术的临床应用

目的探讨腹腔镜下腹膜透析置管术治疗终末期肾脏疾病的临床疗效及安全性。方法行腹腔镜下腹膜透析置管术治疗的终末期肾病患者175例。首次置管130例,传统置管术后再次置管45例。记录患者术后疼痛评分,随访期间有无隧道感染、置管堵塞、置管移位、重新置管率等相关指标。结果 175例患者均在腹腔镜下顺利完成手术,无中转开腹患者。手术时间30~60分钟,平均45.6分钟;术后3~9天出院,平均4.5天。随访时间3~36个月,平均20.4个月。使用肝素水于术后第2天开始冲洗置管,于术后4~9天后开始透析。4例患者进行腹膜透析治疗时流出淡血性液体,均于术后5~7天消失。患者术后疼痛评分(2.13±0.73)分,术后发生切口感染4例,均经换药处理后痊愈出院。2例患者分别于术后4个月、6个月因隧道口感染行腹膜透析置管取出术,随访过程中未发现导管移位、导管阻塞等情况,临床效果良好。结论腹腔镜下腹膜透析置管术与传统开腹手术比较,切口感染发生率低,并发症少,疼痛轻,恢复快。     

先期人工液腹在经皮腹膜透析置管中的运用

目的 探讨先期人工液腹模式在Seldinger法经皮腹膜透析管置入术中的运用,并观察该术式优劣及并发症情况。方法 回顾性研究2020年6月至2021年9月在福建省龙岩人民医院肾病科住院行Seldinger法经皮腹膜透析管置入的39例患者资料,所有患者术前均在床边彩色多普勒超声下置入输液用中心静脉导管并输入液体1000～1500 mL,留置2～3 h后送患者入手术室,用导丝法把已经置入输液用的导管换成腹膜透析导管。观察先期液腹后换用腹膜透析导管的手术指标及术后3个月并发症情况。结果 39例患者全部顺利置入腹膜透析导管,手术即时成功率100%,无改行开腹病例;无内脏损伤病例;手术室中操作时长(15.1±2.3) min;术口长度(2.1±0.5) cm;术中出血量(14.1±1.8) mL,均未见血性腹透液颜色;导管异位3例(7.7%);腹膜炎1例(2.6%),未见渗漏;术后3个月导管功能均正常,术后到出院的时间(6.1±1.2) d。结论 先期人工液腹Seldinger腹膜透析置管法手术操作简单、安全、快速、舒适,术中及术后相关并发症明显减少。适用于早期开展经皮腹膜透析管置入及基层医院推...     

腹腔镜与传统腹膜透析置管术的前瞻性非随机对照研究

目的:比较腹腔镜与传统腹膜透析置管术的近、远期疗效。方法:选择2016年1月至2018年10月行腹膜透析置管术的137例患者,其中62例于腹腔镜下置管(腹腔镜组),75例行传统开腹腹膜透析置管术(开腹组)。主要终点是导管生存时间。收集患者人口学资料、置管方法、并发症及转归等资料进行分析。结果:两组患者年龄、性别、体质指数、肾脏原发病、术前血红蛋白水平、估算肾小球滤过率等方面差异无统计学意义。腹腔镜组手术时间[(36.3±14.9)min vs.(88.2±32.2)min,P<0.01]、术后住院时间[(4.8±2.6)d vs.(6.8±5.2)d,P<0.01]优于开腹组。开腹组11例(14.7%)发生导管失功,腹腔镜组发生2例(3.2%),两组相比差异有统计学意义(P=0.04),主要与腹膜透析导管尖端移位(0 vs.8,P<0.01)有关。Kaplan-Meier曲线与Cox回归模型分析显示,腹腔镜组具有较好的导管生存率(log-rank P=0.03),手术方式是导管生存的独立影响因素(P=0.049,HR=0.22,95%CI:0.05-0.98)。结论:腹腔镜腹膜透析置管术具有手术时间短、术后康复快、导管功能障碍发生率低、导管生存率高等优势。     

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.