title: A Nomogram for Calculation of Maximum Recommended Dose by Volume of Local Anesthetic in Pediatric Dentistry.
abstract: OBJECTIVE
  Calculation of maximum recommended doses for local anesthetic agents and added vasopressors is complex and error-prone with potentially fatal consequences. The purpose of this investigation was to develop a nomogram to calculate the maximum recommended doses, expressed as volumes (number of cartridges or ml) of local anesthetic for healthy U.S. pediatric dental patients based on body weight, and test its accuracy and reproducibility.
  
  
  METHODS
  Standard mathematical techniques were used to draft the nomogram. Validation was performed using simulated patient data, and Bland-Altman analysis was used to evaluate the accuracy and repeatability of the nomogram.
  
  
  RESULTS
  The nomogram was found to have a bias of 0.01 ml, with limits of agreement -0.04ml to 0.06ml and, thus, was considered to be within an acceptable range for clinical use.
  
  
  CONCLUSIONS
  Our nomogram rapidly calculated the maximum recommended doses by volume of local anesthetic agents in common use to a high degree of accuracy and repeatability.
authors.affiliation: Consultant anaesthetist, Department of Anaesthetics, Morriston Hospital, ABMU NHS Trust, Swansea, Wales, U.K., and honorary associate professor, College of Medicine, Swansea University, Swansea;, Email: drdjwilliams67@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Adjunct faculty, Department of Oral and Maxillofacial Surgery, College of Dental Medicine, Nova Southeastern University, Ft. Lauderdale, Fla., USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Splaver
authors.affiliation: Consultant anaesthetist, Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Bangor, Wales, U.K., and a honorary senior lecturer, Bangor University, Bangor.
authors.forename: Jason
authors.initials: J
authors.lastname: Walker
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D006801:Humans; D049451:Nomograms; D010377:Pediatric Dentistry; D012044:Regression Analysis
chemical_list: D000779:Anesthetics, Local