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The maximum effect (EMAX) limits the early additional analgesic gain from combination therapy beyond commonly used doses. ""Increasing numbers of children with congenital and chronic diseases are surviving beyond adolescence. Consequently, arrangements must be put in place to ensure that these groups of patients continue to receive high-quality Ritonavir care into adulthood. Although some medical disciplines have reacted positively to this growing challenge, perioperative care has lagged behind. This review explores some of the difficulties in delivering optimal perioperative care in the transitional period. Key issues, including the paucity of experience in the management of pediatric diseases among adult-trained clinicians and unfamiliarity with child/family focused care, are discussed. We provide some suggestions for the development of transitional healthcare policies. ""Red blood cells are a scarce resource with demand outstripping supply. Use of intraoperative red cell salvage (CS) �C the process of collecting shed blood during surgery and reinfusing it to patients �C is often used as an effective blood conservation strategy. However, little is known about the economic impact of CS during pediatric surgery. A decision tree model was used to estimate the transfusion-related costs per patient (2010 USD) from a healthcare system perspective of four transfusion strategies among children undergoing elective orthopedic or cardiac surgery: Dabrafenib mouse (i) CS followed by allogeneic transfusion, (ii) CS followed by autologous transfusion, (iii) allogeneic transfusion alone, and (iv) autologous transfusion alone. Cell salvage and allogeneic SCH772984 purchase transfusion was the least expensive strategy (USD 883.3) followed by CS and autologous blood transfusion (USD 1,269.7), allogeneic transfusion alone (USD 1,443.0), and autologous transfusion alone (USD 1,824.7). Savings associated with CS use persisted in separate analyses of orthopedic and cardiac surgery, as well as in one-way and probabilistic sensitivity analyses. Use of CS, particularly along with allogeneic blood transfusion, appears cost-saving and cost-effective in pediatric surgery. ""Reduced hemostatic capacity is common following congenital heart surgery using cardiopulmonary bypass (CPB). The etiology is multifactorial with dilutional coagulopathy, as well as platelet adhesion and activation in the CPB circuit and oxygenator. The purpose of the present study was to evaluate platelet count and function in children following CPB. In a prospective, observational study comprising 40 children, platelet count and function (Multiplate Analyzer?) were measured before surgery, immediately after bypass, and on the first postoperative day. Furthermore, conventional coagulation analysis and thromboelastometry (ROTEM?) were carried out. A significant decrease in platelet count was observed immediately after coming of bypass (P?