Paediatric anaesthesia
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The pharmacokinetic (PK) parameters that are important for dosing (e.g., clearance and volume) are well known. They are used in universal mathematical formulae that describe the time course of drug concentration. Additional formulae can be used to describe major covariate effects in children, such as size and maturation. ⋯ While size and maturation are two important considerations in children and assist with dosing estimation, there are also a number of additional PK covariates (e.g., organ function, disease, drug interactions, pharmacogenetics), and identifying these sources of variability allows us to individualize drug dose. Pharmacology is not simply an application of PK, and determinants of drug dose also require an understanding of the variability associated with pharmacodynamic response and a balancing of beneficial effects against unwanted effects. Each child is unique in this respect.
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Paediatric anaesthesia · Jun 2012
Review Historical ArticleA history of pediatric anesthesia: a tale of pioneers and equipment.
The history of pediatric anesthesia is fascinating in terms of how inventive anesthesiologists became over time to address the needs for advances in surgery. We have many pioneers and heroes. We hope you will enjoy this brief overview and that we have not left out any of the early contributors to our speciality. Obviously there is insufficient space to include everyone.
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The future of pediatric anesthesia can be thought of in terms of what will happen to the practice of anesthesia, or what will happen to the profession of pediatric anesthesia. The profession will change both under external forces, and by how pediatric anesthetists themselves decide to shape of the profession. The largest external force is likely to be cost. ⋯ New technologies will have an impact in monitoring and in the gathering and dissemination of information. Practice will also change with changes in surgery. Perhaps the biggest changes will come in areas with the greatest unknowns; neonatal anesthesia is an area with many unknowns and thus great potential for change and improvement.