Bibliographic record
Abstract
We thank Dr. Fregene for her interest in our study 1. Her concern with respect to interpretation of the results of postoperative pain scores is justified. Our study was not designed to evaluate the impact of any possible peri-operative analgesic effects of magnesium sulphate on the incidence of emergence agitation. We intended to evaluate the modulatory effects of magnesium sulphate on the intrinsic direct central nervous system effects of sevoflurane that may contribute to the development of emergence agitation 2. The primary outcome measure of the study was the difference in the incidence of emergency agitation and the study was only powered to detect this difference. The role of intra-operative magnesium sulphate as an analgesic adjuvant has been extensively studied in adults with recent good evidence supporting its favourable peri-operative analgesic effects 3, 4. In contrast, there is a paucity of published reports investigating the analgesic potentials of magnesium sulphate in children and the results of adult studies cannot be extrapolated to children. Postoperative pain has been suggested as a possible contributing factor to emergence agitation 5. However, emergence agitation can occur in pain-free children undergoing diagnostic radiological procedures 6. Therefore, postoperative pain appears to be an aggravating, not an independent, aetiological factor. It has been recommended that postoperative pain be removed from the emergence agitation equation through the use of adequate postoperative analgesia 7 and this was our rationale for administering incremental doses of fentanyl to manage postoperative pain and emergence agitation. Pain is a subjective experience and it is important to ensure that younger children are competent to provide reliable information on the quality and intensity of their postoperative pain. The Association of Paediatric Anaesthetists of Great Britain and Ireland recently recommended the use of an observational measure in conjunction with self-reporting in pre-school children 8. A rigorous systematic review of behavioural measures of pain concluded that the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) had the highest level of evidence to support its use in children 9. Dr. Fregene suggests that the use of additional intraoperative analgesia might obviate the observed difference in agitation scores. Administration of variable doses of fentanyl intra-operatively 10 and at the end of anaesthesia 11 is associated with a significant reduction in the incidence of emergence agitation. However, a recent meta-analysis 12 concluded that the analgesic properties of fentanyl, ketamine and α2-adrenergic receptor agonists are unlikely to be involved in preventing emergence agitation in children.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".