Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2015
ReviewOptimal design in pediatric pharmacokinetic and pharmacodynamic clinical studies.
It is not trivial to conduct clinical trials with pediatric participants. Ethical, logistical, and financial considerations add to the complexity of pediatric studies. Optimal design theory allows investigators the opportunity to apply mathematical optimization algorithms to define how to structure their data collection to answer focused research questions. ⋯ The aim of this review is to demonstrate how to determine optimal sample size, optimal sample times, and the number of samples required from each patient by presenting specific examples using optimal design tools. Additionally, this review aims to discuss the relative usefulness of sparse vs rich data. This review is intended to educate the clinician, as well as the basic research scientist, whom plan on conducting a pharmacokinetic/pharmacodynamic clinical trial in pediatric patients.
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Paediatric anaesthesia · Mar 2015
Comparative StudyComparison of pediatric perioperative risk assessment by ASA physical status and by NARCO-SS (neurological, airway, respiratory, cardiovascular, other-surgical severity) scores.
ASA-PS is a widely used perioperative health assessment method, but with poor reproducibility. A novel objective, pediatric-specific risk classification system based on Neurological, Airway, Respiratory, Cardiovascular, Other categories and Surgical Severity (NARCO-SS) has been validated in only one US center. ⋯ NARCO-SS is a valid risk stratification tool that is better than the ASA-PS in discriminating children with adverse perioperative outcomes. The poor calibration of both scores suggests neither can reliably predict perioperative outcomes in individual patients. Modification of neurological and airway categories may improve the predictive accuracy of the NARCO-SS.
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Paediatric anaesthesia · Mar 2015
Comparative StudyEvaluation of the minimum volume of salvage blood required for the successful use of two different autotransfusion devices.
Autotransfusion in pediatric anesthesia is beneficial in several clinical settings; however, more frequent usage is deterred by process-related costs and the fact that the absolute volume of blood returned may be minimal. ⋯ Red cell mass rather than salvaged blood volume represents a reliable predictor of the successful use of an autotransfusion device. Measuring the hematocrit of the salvaged blood could improve the use of the devices. The investigated devices are likely to be roughly equivalent in effectiveness.