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The harms caused by excessive perioperative intravenous (IV) fluid administration are both well recognized and avoidable. The purpose of this study was to compare the incidence of excess intraoperative fluid administration in pediatric dental surgery patients when either an automated pump-delivery device or a manual gravity-drip device is used. We randomly assigned American Society of Anesthesiologists physical status I and II pediatric dental surgery patients to receive IV fluid via either a manual gravity-drip or automated pump-delivery device. Prior to each case, the attending anesthesiologist determined the target volume of maintenance IV fluid to be administered based on patient weight, estimated fluid deficits, and expected case length. The intraoperative IV fluid delivered was determined at the end of the case by the change in the IV bag weight. The primary outcome was the proportion of procedures that delivered ≥ 10% of the target IV fluid volume. We recruited 105 children aged two to 12 yr (n = 49 in the automated pump-delivery device; n = 53 in the manual gravity-drip device). The proportion of excessive fluid administration was 8/49 (16%) in the automated pump-delivery device group compared with 33/53 (62%) in the gravity-drip group (relative risk of excessive fluid administration, 0.26; 95% confidence interval, 0.13 to 0.51; P < 0.001). Intraoperative fluid administration using an automated pump-delivery device decreased the incidence of excessive IV fluid administration in pediatric dental surgery patients. www.clinicaltrials.gov (NCT03312452); registered 17 October 2017.

The harms caused by excessive perioperative intravenous (IV) fluid administration are both well recognized and avoidable. The purpose of this study was to compare the incidence of excess intraoperative fluid administration in pediatric dental surgery patients when either an automated pump-delivery device or a manual gravity-drip device is used.We randomly assigned American Society of Anesthesiologists physical status I and II pediatric dental surgery patients to receive IV fluid via either a manual gravity-drip or automated pump-delivery device. Prior to each case, the attending anesthesiologist determined the target volume of maintenance IV fluid to be administered based on patient weight, estimated fluid deficits, and expected case length. The intraoperative IV fluid delivered was determined at the end of the case by the change in the IV bag weight. The primary outcome was the proportion of procedures that delivered ≥ 10% of the target IV fluid volume.We recruited 105 children aged two to 12 yr (n = 49 in the automated pump-delivery device; n = 53 in the manual gravity-drip device). The proportion of excessive fluid administration was 8/49 (16%) in the automated pump-delivery device group compared with 33/53 (62%) in the gravity-drip group (relative risk of excessive fluid administration, 0.26; 95% confidence interval, 0.13 to 0.51; P0.001).Intraoperative fluid administration using an automated pump-delivery device decreased the incidence of excessive IV fluid administration in pediatric dental surgery patients.www.clinicaltrials.gov (NCT03312452); registered 17 October 2017.RéSUMé: OBJECTIF: Les effets néfastes causés par une administration liquidienne intraveineuse (IV) périopératoire excessive sont à la fois bien connus et évitables. L’objectif de cette étude était de comparer l’incidence d’administration liquidienne peropératoire excessive chez les patients pédiatriques de chirurgie dentaire lors de l’utilisation d’une pompe à perfusion automatique vs un système goutte à goutte manuel par gravité. MéTHODE: Nous avons randomisé des patients pédiatriques de chirurgie dentaire de statut physique I et II selon l’American Society of Anesthesiologists à recevoir des liquides intraveineux soit par un système goutte à goutte manuel par gravité ou via une pompe à perfusion automatique. Avant chaque cas, l’anesthésiologiste en charge a déterminé le volume cible de liquide IV de maintien à administrer selon le poids du patient, les déficits liquidiens estimés, et la durée anticipée du cas. La quantité de liquides IV peropératoires administrés était déterminée à la fin du cas par le changement du poids du sac de liquide IV. Le critère d’évaluation principal était la proportion d’interventions ayant administré ≥ 10 % du volume liquidien IV cible. RéSULTATS: Nous avons recruté 105 enfants âgés de deux à 12 ans (n = 49 dans le groupe pompe automatique; n = 53 dans le groupe goutte à goutte manuel). La proportion d’administration liquidienne excessive était de 8/49 (16 %) dans le groupe pompe automatique, comparativement à 33/53 (62 %) dans le groupe goutte à goutte (risque relatif d’administration liquidienne excessive, 0,26; intervalle de confiance 95 %, 0,13 à 0,51; P0,001). CONCLUSION: L’administration liquidienne peropératoire à l’aide d’une pompe a réduit l’incidence d’administration liquidienne IV excessive chez des patients pédiatriques de chirurgie dentaire. ENREGISTREMENT DE L’éTUDE: ww.clinicaltrials.gov (NCT03312452); enregistrée le 17 octobre 2017.

Background Visceral leishmaniasis (VL), caused by protozoa of the Leishmania donovani complex, is a widespread parasitic disease of great public health importance; without effective chemotherapy symptomatic VL is usually fatal. Distinction of asymptomatic carriage from progressive disease and the prediction of relapse following treatment are hampered by the lack of prognostic biomarkers for use at point of care. Methodology/Principal Findings All IgG subclass and IgG isotype antibody levels were determined using unpaired serum samples from Indian and Sudanese patients with differing clinical status of VL, which included pre-treatment active VL, post-treatment cured, post-treatment relapsed, and post kala-azar dermal leishmaniasis (PKDL), as well as seropositive (DAT and/or rK39) endemic healthy controls (EHCs) and seronegative EHCs. L. donovani antigen-specific IgG1 levels were significantly elevated in relapsed versus cured VL patients (p, Author Summary Visceral leishmaniasis (VL) is a systemic disease with highest prevalence in South Asia, East Africa, and Brazil. VL is caused by protozoan (unicellular) parasites of the Leishmania donovani complex, transmitted to humans when an infected sandfly takes a bloodmeal. Within the human host, the parasites replicate within cells, particularly of bone marrow and spleen. Without effective treatment, symptomatic VL is usually fatal. As outlined in a recent World Health Organisation report, the development of new diagnostic tools to test for successful cure after chemotherapy is a research priority. In this work we investigated the association of clinical status of VL patients (active pre-treatment, and those deemed cured or relapsed post-treatment) with subclasses of the IgG antibody response made to L. donovani infection. We show that high levels of subclass IgG1 are found in pre-treatment and relapsed patients, but are very much lower in patients deemed to be cured. We further show that the decrease in IgG1 is detectable in patients 6 months after successful treatment, and that this detection method can be adapted to a rapid diagnostic test format requiring minimal technical expertise. Thus we believe that IgG1 levels are potentially a biomarker of post-chemotherapeutic monitoring.