SAPA Pediatric Drug Dosing SMH

Weight pounds ..... or 20 kg

Age 2 years 2.667
months 8 months 32 20.0 kg <-- wt used for calculations

Airway
ETT size 4.5 uncuffed
ETT at lips 13 cm 14
LMA size #2 LMA
Blade Wis Hipple 1.5 or Mac 2
PreMedication
Versed PO 5.00 mg 0.25-0.75mg/kg (max 20 mg)
Versed IV 2.0 mg 0.1-0.25mg/kg
MSO4 IV 1.0 mg .05 mg/kg

Induction
Propofol 40 mg 2-3 mg/kg
Ketamine IM stun 40 mg 2-3 mg/kg
Ketamine IM induction (add atropine) 100 mg 5-8 mg/kg (+Atropine 10 mcg/kg)
Etomidate IV (> age 10) 6.0 mg 0.3 mg/kg (>10 years old)

Paralytics
Sux IV 40 mg 1.5-2 mg/kg
Sux IM 80 mg 4 mg/kg
Rocuronium 12.0 mg 0.6 mg/kg (1.2 mg/kg for RSI)
Vecuronium IV 2.0 mg 0.1 mg/kg
Atracurium IV 8.0 mg 0.4 mg/kg
Neostigmine IV, reversal w/ Atropine 1.00 mg 30-70mcg/kg+Atropine 20mcg/kg

Analgesics
MSO4 IV 1.00 mg 0.05.-0.1 mg/kg
Fentanyl IV 20 mcg 1 - 2 mcg/kg
Dilaudid 0.30 mg 0.015mg/kg
Ibuprofen PO, PR 120 mg 6-10mg/kg
Tylenol PO, PR 300 mg 15 mg/kg
Ketorolac IV, IM (>2 years) 10.0 mg 0.5-1 mg/kg (30mg max IV)

Misc
Anzemet IV 6.0 mg 0.3 mg/kg (max 12.5 mg)
Zofran 3.00 mg 0.15 mg/kg (max 4 mg)
Decadron IV (PONV) 3.00 mg 0.15 mg/kg (max 8 mg)
Flumazenil IV, IM 20 mcg 1-3 mcg/kg (max 0.2 mg)
Narcan IV,IM,SC, ET (resp arrest) 200 mcg 10 mcg/kg (max 2mg)
Narcan IV (sleepy) 20 mcg 1mcg/kg
Reglan PO, IV 2.0 mg 0.1 mg/kg (max 10 mg)
Benadryl IV 10.0 mg 0.5-1 mg/kg (max 75 mg/dose)
Pepcid 5.00 mg 0.25 mg/kg
Dilantin (for acute seizure loading) 200 mg 10-20 mg/kg

Vasoactive
Atropine IV 200 mcg 10-30 mcg/kg (max 1 mg)
Atropine PO/IM 400 mcg 20-30 mcg/kg (max 2 mg)
Epi IV/ET (vasopressor) 40 mcg 2-10 mcg/kg
Epi IV/ET (arrest) 600 mcg 30-300 mcg/kg (max 1 mg/dose)
Phenylephrine 100 mcg 5-10 mcg/kg (max 100 mcg/dose)
Labetalol 2.0 mg 0.1 -1 mg/kg
Lidocaine (dysrhythmia) 20.0 mg 1 mg/kg, then 30-50mcg/kg/min
Defibrilation (Asynch. Countershock) 40 Joules 2J/kg then 2J/Kg then 3J/Kg

MMW, May 2007

Weight 45 pounds
20 kg

Pre-op Antibiotics / Initial Dose

Amikcin 153 mg/kg 7.5 mg/kg
Ampicillin 511 mg/kg 25 mg/kg
Cefazolin 511 mg/kg 25 mg/kg
Cefotetan 409 mg/kg 20 mg/kg
Ceftazadime 409 mg/kg 20 mg/kg
Cefuroxime 511 mg/kg 25 mg/kg
Clindamycin 20 mg/kg 1 mg/kg
Gentamycin 51 mg/kg 2.5 mg/kg
Metronidazole 307 mg/kg 15 mg/kg
PCN 511 K u/Kg 25 Kunits/Kg
Tobramycin 51 mg/kg 2.5 mg/kg
Vancomycin 205 mg/kg 10 mg/kg

Dental SBE Prophylaxis

Ampicillin 1023 mg/kg 50 mg/kg
or Clindamycin 205 mg/kg 10 mg/kg
High risk add Gent 31 mg/kg 1.5 mg/kg
or only Vanco 409 mg/kg 20 mg/kg

Abd. Surgery SBE Prophylaxis

Ampicillin 1023 mg/kg 50 mg/kg
and Gentamycin 31 mg/kg 1.5 mg/kg
or Vanco 409 mg/kg 20 mg/kg
and Gentamycin 31 mg/kg 1.5 mg/kg
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 Treatment for Malignant Hyperthermia
Signs
Tachycardia, arrhythmias, incr EtCo2, rapid incr Temp, hypoxemia, rigidity, incr K, acidosis,
myoglobinuria
Treatment
1. Hyperventilate with 100%O2
2. Stop Surgery and anesthesia
3. Dantrolene 2mg/kg up to 10 mg/kg in water.
(1 amp= 20 mg + 3 gm mannitol, mix in 60 cc water)
4. Cooling with iced saline, ice bags, iced stomach lavage.
5. Treat arrhythmias with 15mg/kg procainamide, over 10 minutes
6. Check labs: ABG, electrolytes, Ca, glucose, CPK
7. Treat acidosis basd on ABG.
8. Treat hyperkalemia with Insulin/Glucose, CaChloride
9. Keep Urine output greater than 2 cc/hr with lasix (1mg/kg) or manitol (.25mg/kg).

See Malignant Hyperthermia Association of the United States Website