Pediatrics

Pediatric Airway Equipment

Endotracheal Tube (ETT)

Uncuffed ETT size: (age/4) +4; Cuffed ETT size: (age/4) +3.5, ETT depth <1 yr: Wt/2 + 8, > 1 yr: age/2 + 12

The neonatal “1-2-3/6-7-8” Rule (1kg: tape at 6 cm, etc.)

*ALWAYS have available airway equipment one size above and below calculated.


Pediatric Drugs

Emergency Drugs

  • Epinephrine
    • 10 mcg/kg IV; infusion: 0.02-0.5 mcg/kg/min
    • Anaphylaxis: IM: 10 mcg/kg every 5-15 min; IV: 1 mcg/kg, titrate for response
  • Atropine
    • 20 mcg/kg IV (min 0.1 mg)
  • Succ + atropine dart (80 mg/0.4 mg)
    • IM: 4 mg/kg (of succinylcholine); IV: 1 mg/kg
    • (1 cc = sux 16 mg + atropine 80 mcg)
  • Adenosine
    • Initial bolus: 0.1 mg/kg IV Repeat dose: 0.2 mg/kg IV (max 12 mg)
  • Amiodarone
    • 5 mg/kg IV
  • Calcium Chloride
    • 5-20 mg/kg IV (usual dose 10 mg/kg) For central line administration
  • Calcium Gluconate
    • 15-100 mg/kg IV (usual dose 30 mg/kg) Can be given via PIV
  • Dantrolene
    • 2.5 mg/kg IV (max 10 mg/kg)
  • Dexamethasone
    • 0.1-0.5 mg/kg IV
  • Dextrose (D25W/D50W)
    • 0.5-1 gr/kg IV
  • Diphenhydramine
    • 0.5-1 mg/kg IV, IM, or PO
  • Dopamine
    • 2-20 mcg/kg/min IV infusion
  • Ephedrine
    • 0.1-0.3 mg/kg IV
  • Racemic epi 2.25%
    • 0.05 mL/kg in NaCl 0.9% 3 cc (nebulized)
  • Flumazenil
    • 10 mcg/kg IV
  • Naloxone
    • 10 mcg/kg IV (give divided doses)
  • Phenylephrine
    • 1-10 mcg/kg IV
    • For TOF hypercyanotic spells, NOT for routine tx of hypotension in children
  • Sodium Bicarbonate
    • 1 mEq/kg IV
  • Magnesium Sulfate
    • 25-50 mg/kg IV (max 2 gr)

Premedication

  • Midazolam
    • PO: 0.5 mg/kg (max 20 mg); IV: 0.05-0.1 mg/kg (max 2 mg)
  • Ketamine
    • PO: 6-10 mg/kg; IV 0.5-1 mg/kg; IM: 3 mg/kg
  • Dexmedetomidine
    • Intranasal: 1 mcg/kg (undiluted, 100 mcg/cc solution)

Induction Agents

  • Propofol
    • 2-3 mg/kg IV Maintenance: ~250 mcg/kg/min
  • Ketamine
    • 1-3 mg/kg IV
  • Etomidate
    • 0.3 mg/kg IV
  • Thiopental
    • 5-6 mg/kg IV (currently not available in the US)
  • Methohexital
    • 1 mg/kg IV

Muscle Relaxants

  • Rocuronium
    • 0.6-1.2 mg/kg IV
  • Vecuronium
    • 0.1 mg/kg
  • Succinylcholine
    • 1-3 mg/kg (neonates require doses at the higher end)
  • Cisatracurium
    • 0.15 mg/kg

Opioids

  • Fentanyl
    • IV: 1-5 mcg/kg
    • Intranasal: 2 mcg/kg
    • If used as main anesthetic (e.g., CDH repair in NICU): 25-50 mcg/kg
  • Morphine
    • 0.05-0.1 mg/kg IV
  • Remifentanil
    • Bolus: 0.25-1 mcg/kg IV
    • Infusion: 0.05-0.2 mcg/kg/min IV
  • Sufentanil
    • 0.5-1 mcg/kg IV
    • Infusion: 0.05-0.2 mcg/kg/hr IV
  • Hydromorphone
    • 0.005-0.01 mg/kg IV
  • Oxycodone
    • 0.1 mg/kg PO

Analgesics

  • Acetaminophen
    • Neonates: 20-30 mg/kg PR
    • Children 3-25 kg: 30-40 mg/kg PR; 10-20 mg/kg PO
    • Children >25 kg: 15 mg/kg IV. Maximum per day: 60 mg/kg
  • Ketorolac
    • 0.5 mg/kg IV (max 30 mg)
  • Ibuprofen
    • 10 mg/kg

Antiemetics

  • Ondansetron
    • 0.1-0.15 mg/kg IV (up to 4 mg)
  • Dexamethasone
    • 0.5 mg/kg IV (up to 8 mg)
  • Metoclopramide
    • 0.1 mg/kg IV (up to 10 mg)

Common Antibiotics

  • Ampicillin
    • 50 mg/kg IV
  • Ampi/sulbactam (unasyn)
    • 25-50 mg/kg IV
  • Cefazolin
    • 25-30 mg/kg IV
  • Cefotaxime
    • 25-50 mg/kg IV
  • Ciprofloxacin
    • 7.5-10 mg/kg IV
  • Ceftriaxone
    • 25-50 mg/kg IV
  • Clindamycin
    • 15 mg/kg IV
  • Gentamicin
    • 2 mg/kg IV
  • Metronidazole
    • 7.5 mg/kg IV
  • Zosyn
    • 50-100 mg/kg IV (usual dose: 75 mg/kg)
  • Vancomycin
    • 15 mg/kg IV

Source: Dr. Shaik and Dr. Gonzalez