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This rationale further supports that upper ratios of 5?:?1 or 6.7?:?1 be used depending on treatment duration. During infusion, concentrations of ketamine were above 0.6?mg��l?1 and these concentrations are associated with satisfactory analgesia [36]. Anesthesia may require the use of neuromuscular blocking drugs. It may be advantageous to use a modified electroencephalographic signal monitor on these occasions. However, ketamine has minimal effect on bispectral index (BIS) [37]. Consequently, BIS values are >80 when the ketofol 1?? ratio is used. We suggest that a BIS of 60, rather than 50 is targeted when using ratios of 5?? or 6.7?? (Figure?). Ethical approval was not required for this simulation study. Brian Anderson is a Section Editor for the journal Pediatric Anesthesia. This research was funded by departmental sources. B3GAT3 J Hannam was supported by a PhD scholarship from the Green Lane Research and Educational Fund Board, Auckland, New Zealand. This research was carried out without funding. No conflicts of interest declared. ""Introduction:? Intravenous (i.v.) access is sometimes a difficult, time-consuming, and highly frustrating procedure. Obesity is widely believed to be associated with difficult peripheral intravenous access (PIV) placement. This study examined the relationship between body mass index (BMI) and ease of venous access in children undergoing noncardiac surgical see more procedures. Methods:? We prospectively collected data on children aged 2�C18?years undergoing elective noncardiac surgery at our institution. A trained research assistant (RA) was present for PIV placement in all patients and noted the following: age, gender, ethnicity, weight, height, and BMI. We also collected data on i.v. insertion site, number of attempts, number of operators, and the number of i.v. cannula used. The main outcome variable was success or failure of i.v. placement on first attempt. Sample size calculation indicated a need for 40 obese and 40 control patients. Results:? A total of 103 (56 lean and 47 obese) patients comprised the study population. PIV cannulation was achieved on the first attempt in 55.2% while 39.6% of patients had 2�C3 attempts before successful cannulation. Obese children were more likely to have failed attempt at first cannulation than lean controls SCH 900776 research buy (P?