PEDIATRIC Drugs & Data
Indrit Reso, MD March 2002
updated 12/5/2011

INDEX:

Premed /Sedatives:
  Barbiturates/ Hypnotics
  Opioids
  Benzodiazepines
  Ketamine
  Alpha-Agonists
  Antihistamines
Pre-Med Non- Sedatives:
  Anticholinergics
  H2 Antagonists
  Gastric Motility Agents
Other Drugs:
Analgesics
Antagonists
Antibiotics
Anticholinergics
Anticonvulsants
Anti-Emetics (PONV Rx
)
Antihistamines
Antihypertensives
Bronchodilators
Diuretics
Induction Agents
Muscle Relaxants
   
Reversal Drugs
Pressors/ Inotropes
Resuscitation Drugs
Steroids
 
Airway:
Oral Airways
LMAs

Laryngoscopes

ETT Sizes
ETT Insertion Depth
 
Fluids:
Crystalloid IVs
Fluid Requirements
 

PREMED/SEDATIVES:

Barbiturates/Hypnotics
:

Drug

Dose/ route

Onset
(T½)

Adverse Effects

Pento-
barbital or
Seco-
barbital

2-3 mg/kg PO
2-4 mg/kg PR
3-5 mg/kg IM

60-90'
60-90'
10-15'
(17-50h)

May cause paradoxical reaction. Bitter taste when taken PO
May cause persistent pain at IM site. Contraindicated in porphyria

Metho-
hexital

20-30 mg/kg PR

4-8'
(1½-4h)

Unpredictable systemic bioavailability. May cause rectal irritation or defecation.
Contraindicated in temporal lobe epilepsy or porphyria

Chloral
hydrate

50-75 mg/kg PO
(max 1 gm)

1-2h
(8h)

Gastric irritation

Triclofos
(not in US)

25-50 mg/kg PO

1-2h
(8h)

Less gastric irritation

Opioids:

Drug

Dose/ route

Onset
(T½)

Adverse Effects

Morphine

0.1-0.2 mg/kg IM

15-30'
(2-4 h)

Potent respiratory depressant. May cause pruritis, nausea, vomiting

Meperidine

1-2 mg/kg IM

15-30'
(3-4 h)

As for morphine

Fentanyl 
lollipop

10-15 mcg/kg OT

5-20'
(3-3½h)

High incidence of itchy nose. May cause respiratory depression, nausea, vomiting

Sufentanil

1.5-3 mcg/kg 
Nasally

7½'
(148')

Profound respiratory depression
(resuscitative equipment & personnel must be present)
Can cause poor chest compliance, apnea, laryngospasm

Benzodiazepines:

Drug

Dose/ route

Onset
(T½)

Adverse Effects

Diazepam

0.1-0.5 mg/kg
PO, PR, IM

30-90'
(21-37h)

Slow onset and prolonged action. Insufficient doses may cause disinhibition and decrease patient cooperation

Midazolam

0.5 mg/kg PO
0.08-0.3 mg/kg IM
0.4-1 mg/kg PR
0.2-0.3 mg/kg IN
0.2 mg/kg OT

15-30'
10'
10'
10'
10'
(1-2 h)

May cause respiratory depression, particularly in combination with narcotics

Dissociative anesthetics:

Drug

Dose/ route

Onset
(T½)

Adverse Effects

Ketamine

2-5 mg/kg IM
6 mg/kg PO
3 mg/kg IN
8-10 mg/kg PR

30-40"
10'
<30'
10'
(1-2 h)

Contraindicated in patients with increased ICP
Increases HR and BP (not reported with oral routes)
Accumulation of pharyngeal secretions may cause laryngospasm. Use of anticholinergics & benzodiazepines w/ketamine will reduce secretions & emergence delerium

alpha Agonists:

Drug

Dose/ route

Onset
(T½)

Adverse Effects

Clonidine/
Atropine

4 m g/kg PO/
0.03 mg/kg PO

30-60'
(6-20 h)

Perioperative hypotension has been demonstrated in adults.
Sedative effect of clonidine is central Alpha-2 agonist activity.
The combo with atropine is to prevent bradycardia associated with clonidine use.

Antihistamines:

Drug Dose/ route Onset
(T½)
Adverse Effects
Diphen-
hydramine
(Benadryl)
0.125-0.25 mg/kg IV/PO 15-30'
(3 h)
Light sedation only; paradoxical response possible
Hydroxyzine 0.5-1 mg/kg PO, IM 1 hr
(3 h)
Unreliable level of sedation
Not widely used

PREMED PHARMACOLOGY- NONSEDATIVES

Anticholinergics:

Drug Dose/ route Onset
(T½)
Adverse Effects
Atropine 0.02 mg/kg IM, PO
0.01 mg/kg IV
2-4'
30'
(2-3 h)
Can cause fever, extreme dry mouth, flushing, tachycardia
Scopolamine 0.02 mg/kg IM
0.01 mg/kg IV
30'
5'
May cause confusion. Long duration.
Glyco-
pyrrolate
0.01 mg/kg IV
0.01 mg/kg IM
1'
15'
No CNS effects
Long duration

 

H2 Antagonists:

Drug

Dose/ route

Onset
(T½)

Adverse Effects

Cimetidine

7.5 mg/kg PO, IV

60-90'
(1.5-2 h)

Decreases hepatic extraction of propranolol, phenytoin, diazepam
Avoid use in patients with thrombocytopenia, neutropenia

Famotidine

0.25 mg/kg IV
0.5 mg/kg PO

30-60'
(2.5-4 h)

Dilute or infuse slowly, decrease dose in renal failure.

Ranitidine

2mg/kg PO
(given 4 hr preop)
0.5-1 mg/kg IV

30-60'
(2-3 h)

Does not alter hepatic extraction of drugs. Fewer side effects than cimetidine

 

Gastric motility stimulants:

Drug

Dose/ route

Onset
(T½)

Adverse Effects

Meto-
clopramide

0.1 mg/kg PO (given 4 hr preop)
0.1 mg/kg IV

40-120'
15-30'
(2-4 h)

A single recommended dose does not cause extrapyramidal symptoms. 
Contraindicated in GI obstruction & pheochromocytoma

 

Intraoperative fluid requirements:

EFR: Estimated fluid requirement per hour
Maintenance

0-10 kg = 4 ml/kg/hr +
10-20 kg = 2 ml/kg/hr +
>20 kg = 1 ml/kg/hr

EFD: Estimated preoperative fluid
Deficit

Number of hours fasting  EFR
1st hr: infuse ½ EFD + EFR
2nd hr: infuse ¼ EFD + EFR
3rd hr: infuse ¼ EFD + EFR

IL: Insensible Losses

Minimal incision: 3-5 ml/kg/hr
Moderate incision with viscus exposure: 5-10 ml/kg/hr
Large incision with bowel exposure: 8-20 ml/kg/hr

EBL: Estimated blood loss

Replace maximum allowable blood loss (ABL) with crystalloid 3:1

Total intraoperative fluid replacement

EFR + EFD + IL + EBL

Oral airway sizes for children:

Age

Size

Cm

Preterm

000 or 00

3.5 or 4.5

Neonate to 3 mo

0

5.5

3-12 mo

1

6.0

1-5 yr

2

7.0

5 yr

3

8.0

Laryngoscope blades for children:

Blade

Age

Miller 0

Preterm, neonate

Miller 1

Neonate to age 2

Miller 2

Age 3 or >

Wis-Hippel 1½

Age 2-5

Macintosh 2

Age 3-6

Endotracheal tube sizes for children:

Age

ETT Size
(I.D.,  mm)

Premature < 2 kg
> 2 kg

2.5
3.0

Neonate

3.0-3.5

0-6 mo

3.5

6-12 mo

4.0

12-18 mo

4.0-4.5

2 yr

4.5

2-3 yr

4.5-5.0

> 4 yr

(Age[yr]+16) /4
or
(wt[kg]+35) /10

Methods of verification of endotracheal tube depth:

Method

Comment

X-ray

Impractical in the operating room. Useful in the ICU, but assumes child's head and neck position will remain constant

Tube markings

Requires controlled intubation by experienced individual. Average distance from cords to carina in neonate is 5cm; placement of the tube with the first single line at the cords will put the tube midway in the trachea

1234 / 78910 rule for premature infants

Child's weight is used as a guide:

kg

cm at lip

1

7

2

8

3

9

4

10

Age + 10 rule

The centimeter mark at the lip should equal the age (in years) + 10

LMAs:
Descriptions of different sizes of laryngeal mask airways

LMA
size

Pt. wt
(kg)

Int.
Diam.
(ID, mm)

Cuff vol.
(ml)

Largest ETT
(ID, mm)

F.O.
bronch. size
(mm)

1

6.5

5.25

2.5

3.5

2.7

7-10        

2

11-19

7.0

7-10

4.5

3.5

20-30

8.4

14

5.0

4.0

3

30-70

10

15-20

6.0 cuffed

5.0

4

>70

10

25-30

6.5 cuffed

5.0

From Pennant JH, White PF: Anesthesiology 79:144-163, 1993

Treatment of postoperative nausea and vomiting PONV:

Diphenhydramine 0.75-1.0 mg/kg IV
Promethazine 0.25-0.5 mg/kg IV
Metaclopramide 0.10-0.15 mg/kg IV
Ondansetron 0.05-0.10 mg/kg IV up to 4 mg
Dolasetron 1.8 mg/kg up to 100 mg

Muscle Relaxants:

Rocuronium 0.5 mg/kg IV (Rapid Sequence: 1mg/kg)
Vecuronium 0.05-0.1 mg/kg IV
Succinylcholine 1-2 mg/kg IV or 4-5 mg/kg IM
Pancuronium 0.07-0.1 mg/kg IV
Mivacurium 0.2 mg/kg IV over 5-15 sec. 
    -Continuous infusion 10-14 mcg/kg/min
Curare (d-tubocurarine)
    -premature=0.125 mg/kg IV
    -0-2 mo=0.25 mg/kg IV
    ->2  mo=0.3-0.6 mg/kg IV

Atracurium 0.5 mg/kg IV. 
    -Continuous infusion 6-9 mg/kg/min

Metacurine 0.2-0.4 mg/kg/IV

Analgesics:

Acetaminophen 10-15 mg/kg/dose PO or 40 mg/kg PR loading dose; then 20 mg/kg PR Q 4-6 h
Acetominophen IV (NEW):

>50Kg, >13 y/o: 1000mg q6h (max 4000 mg/24 hr)
<50 Kg, >13 y/o: 15mg/kg q 6h (max 75mg/kg/day)
Children 2-12 years: 15mg/kg q 6h (max 75 mg/kg/day)

Ketorolac 0.5 mg/kg IV
Ibuprofen 10 mg/kg/dose PO Q 4-6 hrs PRN
Morphine 0.1- 0.2 mg/kg IV
Meperidine 1-2 mg/kg IV
Fentanyl 1-2 mcg/kg IV
Alfentanil 30-50mcg /kg IV. Maintenance 10-15 mcg /kg IV boluses or infusion of 0.5-1.5 mcg/kg/min
Hydromorphone 0.015mg/kg IV q 4-6h prn

Bronchodilators:

Albuterol Inhaler: 1-2 puffs Q 4-h. 
Albuterol Nebulizer: 0.01-0.03 ml/kg in 2 ml NSS TID-QID. Concentration=5 mg/ml with 1 ml maximum dose.

Aminophyline:
   
Load: 6 mg/kg IV over 20-30'
    Maintenance: 
        Neonate: 0.2 mg/kg/hr
        < 1 yr: 0.2-0.9 mg/kg/hr
        1-9 yr: 1 mg/kg/hr

Ipratropium 200-500 mcg inhaled q 4-6 hrs

Racemic EPI (2.25%) 0.25-0.5 ml in 3 ml NS q 1 hr PRN

SC Epinepherine (1:1000) 0.01 ml/kg or 0.01 mg/kg S(q 30' max 0.5 ml)

Isoproterenol: 
    0.1 mcg/kg/min IV, titrate to effect. 
    Neb:(0.2 mg/ml) mix 0.01 ml/kg in 2 ml NS Q 4

    Metered Dose Inhaler: 1-3 puffs Q 3-4 hrs prn 
   
Keep HR < 200 BPM

Anticholinergics:

Atropine 0.01-0.02 mg/kg IV
Scopolamine 0.005-0.01 mg/kg IV
Glycopyrolate 0.005-0.01 mg/kg IV

Anticonvulsants

Phenobarbital 10 mg/kg IV load X 1-2. 
    Maintenance 2.5 mg/kg IV/BID: 
    Therapeutic level 20-40 mcg/ml

Phenytoin 10 mg/kg IV slow load X 1-2. 
   
Maint. 2.5 mg/kg/BID: 
    Therapeutic level 10-20 mcg/ml

Diazepam 0.1-0.3 mg/kg IV: contraindicated in hyperbilirubinemia

Lorazepam 0.1 mg/kg IV max dose 4 mg

Antihistamines

Diphenhydramine 0.125-0.25 mg/kg IV/PO Q 6 hours

Reversal Agents:
Neostigmine 0.06 mg/kg
Glycopyrolate ) 0.01 mg/kg

Corticosteroids:

Dexamethasone 0.3-1.0 mg/kg IV loading;
    Maintenance: 0.2-0.5 mg/kg/day divided q6h for incr. ICP
Hydrocortisone 2 mg/kg IV Q 6 hours for acute adrenal insufficiency
Methylprednisolone 0.2mg/kg IV load
    Maintenance 1.6 mg/kg/day divided q6h for status asthmaticus

Vasopressors/ Inotropes: (titrate doses as needed)

Epinephrine 0.1 mcg/kg/min
Neosynephrine 0.1 mcg/kg/min
Dopamine 5-20 mcg/kg/min
Dobutamine 5-20 mcg/kg/min
Isoproterenol 0.1 mcg/kg/min
Milrinone 50 mcg/kg loading dose, then 0.5 mcg/kg/min

Diuretics:

Furosemide 1 mg/kg IV/IM/PO q 12h
Mannitol 0.25-1.0 Gm/kg IV

Antihypertensives:

Labetelol 0.125-0.25 mg/kg IV PRN, infusion 0.25-1 mg/kg/hr
Esmolol 100-500 mcg/kg IV loading, followed by infusion of 50-300 mcg/kg/min
Nitroglycerin 1 mcg/kg/min IV, titrate as needed
Nitroprusside 0.25-1 mcg/kg/min IV, titrate as needed

Enalaprilat 5-10 mcg/kg/dose IV Q 8-24 hrs
Hydralazine 0.1-0.5 mg/kg/dose IV Q 4-6 hrs (max 20 mg/dose)           

Induction Agents:

Thiopental 4-6 mg/kg IV (2.5% solution)
Methohexital 1-3 mg/kg IV (make 1% solution)
Propofol 2.5-3 mg/kg IV
Ketamine 0.5-2 mg/kg IV
Etomidate 0.3 mg/kg IV (children > 10 yrs old)

Antagonists:
Naloxone 0.02-0.1 mg/kg IV, infusion 1-2 mcg/kg/hr
Flumazenil 15 mcg/kg IV titrated to effect (½ life is 40-80 min which is shorter than some benzos)