Contents |    Peds. Intro. |    Goals & Objectives |    MH Treatement |    Preop |    Physiology |    Fluid Therapy |    Monitoring |    Intubation |    Mechanical Ventilation |    Regional |    SBE Prophylaxis |    Epiglottitis |    Pharmacology |

PHARMACOLOGY

Analgesics

Acetaminophen	PO	10 - 20 mg/kg q 4-6 hr
	PR	30 - 45 mg/kg q 3-4 hr
Ketorolac	IM/IV	0.5 mg/kg q 6 hr

Antibiotics - Intravenous

	Single Intraoperative Doses	Max (adult)	Total daily dose mg/kg/day
Ampicillin	50 - 100 mg/kg	2 gm	200 - 300
Cefazolin	20 - 40 mg/kg	1 gm	200
Cefotetan	20 - 30 mg/kg	1 gm	40 - 60
Cefuroxime	25 - 50 mg/kg	0.750 - 1.5 gm	75 - 150
Clindamycin	5 - 10 mg/kg	300 mg	30
Gentamicin	2 mg/kg	100 mg	6

Gentamicin for Neonates:

< 7 days old:
	< 28 wks PCA	2.5 mg/kg/dose q 24 hr
	28-34 wks	2.5 mg/kg/dose q 18 hrs
	Term	2.5 mg/kg/dose q 12 hrs
> 7 days old:
	< 28 wks PCA	2.5 mg/kg/dose q 18 hr
	28-34 wks	2.5 mg/kg/dose q 12 hrs
	Term	2.5 mg/kg/dose q 8 hrs

Anticonvulsants (Status Epilepticus Dosing)

Diazepam	0.1 - 0.3 mg/kg SIVP (avoid with hyperbilirubinemia)
Phenobarbital	10-20 mg/kg/dose IV X1
	then 5-10 mg/kg/dose q 20 min prn
	Max. total dose 40 mg/kg
	Adults: 300-800 mg IV X1, then 120-240 mg q 20 min prn
	Max. total dose 1-2 gm.
Phenytoin	15-20 mg/kg IV load (slow)
	Max. 1 gm/24 hrs
	Therapeutic Levels: 10 - 20 mcg/ml

Antidysrhythmics

Bretylium	IV	5 mg/kg over 1 minute,
		then 5 - 10 mg/kg q 15 -30 min
		Max. 30 mg/kg
Esmolol	IV	0.2 - 0.5 mg/kg IV push
	load	0.5 mg/kg
	infusion	0.05 - 0.3 mg/kg/min
Labetalol	IV	0.5 mg/kg
Lidocaine	IV load	1 mg/kg
		20-50 mcg/kg/min
Phenytoin	IV	1.25 mg/kg q 5 min, up to 15 mg/kg
Procainamide	IV load	15 mg/kg over 30 min, Max 750 mg
	infusion	20-60 mcg/kg/min
Propranolol	IV	10 - 20 mcg/kg, Max 1 mg/kg

Antiemetics

Droperidol	IV	5 - 50 mcg/kg
Metaclopramide	IV	0.15 mg/kg, Max 10 mg
Ondansetron	IV	0.15 mg/kg, Max 4 mg
Dolasetron	IV	0.35mg/kg, Max 12.5 mg

Bronchodilators

Albuterol	inhaled	0.2 - 0.3 ml in 2.5 ml saline via nebulizer
		(onset <5 min, peak 1-2 hrs, 3-4 hr duration)
Aminophylline	IV	5 mg/kg SIVP load (15 min)
	IV	0.5 - 1.1 mg/kg/hr (level 10-20 mg/ml)
Dexamethasone	IV	0.3 mg/kg load
		0.3 mg/kg/24 hr divide q 6 hr
Epinephrine
(aqueous) 1:1000	S/C	0.01 ml/kg q 15 min x 3,
		max single dose = 0.3 ml
Hydrocortisone	IV	7 mg/kg load
	IV	7 mg/kg/24 hrs infuse or divide q 6 hr
Metaproterenol	inhaled	0.2 - 0.3 ml in 2.5 ml saline via nebulizer
		(onset 5-30 min, peak 1 hr, 2-3 hr duration)
Methylprednisolone	IV	2 mg/kg load
	2 mg/kg/24 hrs divide q 6 hrs

Diuretics

Furosemide	IV	1 mg/kg
Mannitol	IV	0.25 - 1 g/kg

Epinephrine dilutions

1:10,000		100 mcg/ml
1:100,000		10 mcg/ml
1:200,000		5 mcg/ml
1:400,000		2.5 mcg/ml

H2 Blockers, Antacids

Cimetidine	IV/PO	20 - 40 mg/kg/day X q6h, max 300 mg/dose
Famotidine	IV/PO	1 - 2 mg/kg/day X q12h, max 40 mg/dose
Ranitidine	IV	1 - 2 mg/kg/day X q6h, max 50 mg/dose
	PO	2 - 4 mg/kg/day X q12h, max 150 mg/dose
Sodium citrate	PO	0.4 ml/kg, max 30 ml

Induction / Sedative Agents

Chloral hydrate	P.O.	50 - 70 mg/kg (hypnotic dose)
		max 1 gm/dose
		max 2 gm/24 hrs
Diazepam	IV	0.05 - 0.3 mg/kg
Etomidate	IV	0.2 - 0.3 mg/kg
Ketamine	IV	1 - 2 mg/kg
	IM/PO	5-10 mg/kg
Methohexital	IV	1 - 2 mg/kg
	PR	30 mg/kg
Midazolam	IV	0.02 - 0.05 mg/kg
	PO	0.5 - 1.0 mg/kg
Propofol	IV	1.5 - 3.0 mg/kg
Thiopental	IV	3 - 5 mg/kg
	PR	20-30 mg/kg

Benzodiazepine Antagonist

Flumazenil

IV

5 - 40 mcg/kg

Inhalational Agents - MAC

Age	Halothane	Isofluorane	Sevoflurane
2-3 yrs	1.08%	1.7%	2.8%
3-10 yrs	0.9%	1.4%	2.5%
Adult	0.76%	1.15%	2.1%

MAC for halothane is low at birth and rises to 0.87% by 12 hrs. This is the generally accepted "neonatal" value. MAC for isoflurane in premature infants is 1.28% <32 weeks, 1.41% 32-37 weeks. MAC for Sevoflurane is 3.3% for newborn.

Inotropes and Vasopressors

divide daily dose: 1/2 SIVP, 1/4 q 8 hr x 2.

Digoxin	IV	premature	20 mcg/kg
		neonate	30 mcg/kg
		<2 yrs	40 mcg/kg
		2-5 yrs	30 mcg/kg
		> 5 yrs	20 mcg/kg
		>10 yrs	0.5 - 1.0 mg per dose
	Therapeutic Levels:		0.8 - 2.0 mcg/L
Dobutamine	IV	2 - 15 mcg/kg/min
Dopamine	IV	2 - 15 mcg/kg/min
Epinephrine	IV	0.1 - 1.0 mcg/kg/min
Milrinone	IV load	50 mcg/kg
	Infusion	0.5 mcg/kg/min
Norepinephrine	IV	0.1 - 0.5 mcg/kg/min
Phenylephrine	IV	0.1 - 0.5 mcg/kg/min

IV Push Doses

Ephedrine		0.1 mg/kg
Epinephrine		1 - 10 mcg/kg
Phenylephrine		1 - 2 mcg/kg

PEDIATRIC RESUSCITATION DOSES

Atropine	IV	20 mcg/kg
Epinephrine	IV	10 mcg/kg 0.1 ml/kg of 1:10,000
Calcium chloride	IV	20 mg/kg
Lidocaine	IV	1 mg/kg q 5-10 min to 4 mg/kg
Dextrose	IV	0.5 g/kg
Naloxone	IV	10 mcg/kg
Na bicarbonate	IV	1-2 mEq/kg (4.2%)
Bretylium	IV	5 mg/kg (5-10 mg/kg q 10 min, <17 mg/kg)
	Defibrillation	2J/kg, then 4J/kg

Muscle Relaxants - INTUBATING DOSES

Atracurium	IV	0.5 mg/kg
Cis-Atracurium	IV	0.1 mg/kg
Mivacurium	IV	0.25 mg/kg (0.2 - 0.3 mg/kg)
Pancuronium	IV	0.1 mg/kg
Rocuronium	IV	0.6 mg/kg (0.3 - 1.2 mg/kg)
Succinylcholine	IV	1-2 mg/kg
	IM	2-4 MG/KG
Vecuronium	IV	0.1 mg/kg

Reversal Agents & Adjuncts

Edrophonium	IV	0.5 - 1 mg/kg
& Atropine	IV	15 - 20 mg/kg
Neostigmine	IV	30 - 70 mcg/kg
& Glycopyrrolate	15 mcg/kg (EQUAL VOLUMES OF EACH)

Narcotics

Alfentanil	IV	0.5 - 3 mg/kg/min
Fentanyl	IV	1 - 5 mg/kg	(Total Dose in OR)
Meperidine	IV	1 - 2 mg/kg	(Total Dose in OR)
	IV	20 - 50 mcg/kg	(Incremental dose in PACU)
Morphine	IV	0.1 - 0.2 mg/kg	(Total Dose in OR)
	IV	20 - 50 mcg/kg	(Incremental dose in PACU)
Sufentanil	infusion	1 - 2 mcg/kg LOAD, 0.1 - 0.2 mcg/kg/hr

These are not the doses required to ablate the stress response to surgery.

Narcotic antagonist

Naloxone

IV

5 - 10 mcg/kg

Parasympathetic antagonists

Atropine	IV/IM	10 - 20 mcg/kg
Glycopyrrolate	IV	5 - 10 mcg/kg
Scopolamine	IV	5 - 10 mcg/kg

Steroids

Dexamethasone	IV	0.3 - 1.0 mg/kg	(load)
Hydrocortisone	IV	2 mg/kg q6h

Vasodilators

Labetalol	IV	0.5 mg/kg
Nitroglycerin	IV	0.5 - 10 mcg/kg/min
Phentolomine	IV	20 mcg/kg/min
Prostaglandin E1	IV	0.1 mcg/kg/min
Na+ nitroprusside IV	0.5 - 5 mcg/kg/min

Miscellaneous

Azathioprine	IV	3 - 5 mg/kg/day
Dantrolene	IV	2.5 mg/kg to 10 mg/kg max.
Dextrose	IV	0.25 - 0.5 gm/kg IV (=2 ml/kg of 25% Dextrose)
Diphenhydramine	IV	0.125 - 0.25 mg/kg q 6 hrs
Insulin	IV	0.02 - 0.1 units/kg/hr