Pharm Peds Flashcards by Magda S

Protein binding in neonates

Albumin and alpha 1 acid glycoprotein are found in lower concentration than in adults, same level at 5 months

Inc free active drug in neonatal

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What substances found in neonate can reduce protein binding

Bilirubin
Free fatty acid
Maternal steroids

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Volume distribution

Larger in infants and children due to inc tbw

Decrease FAT: need lower doses of fat soluble meds: Propofol

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What med doses need to be increased in neonates

Sux, abx

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Neonatal kidney receives only ?% of CO

5-6% of CO

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Term infant GFR is

40% of adult

Preterm 20-30% of adult
Increases over 1st year of life

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Who has the highest cardiovascular complication durning induction

<1 year old

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Uptake of inhalation in infants & small children

Faster, greater ratio of alveolar ventilation to FRC

Faster RR in infant

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Fe: Fi of 1.0
Infant
Child
Adult

Infants 25 min
Child 30 min
Adult 60 min

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Shunt

Right to left

Slower rise in blood concentration

Slower inhalation induction

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Shunt left to right

Effect on FE: FI depends on size
Large shunts speed induction
Small little effect

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Isoflurane

Infants MAC 1.6
Less myocardial depression than halothane, but dec SVR more
Pungent

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Desflurane MAC

Neonate 9.16
Infant 1-6 months 9.4
Infant >6 mon 9.9
Toddler 8.72
Child = 8.0-8.3
Adult = 6.6

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What is des associated with

Pungent
Cough, laryngospasm
Good for maintainence not induction

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Sevoflurane

MAC

Neonate = 3
Infant 1-6 months = 3.2
Infant >6mon= 2.6
Child 1-12= 2.5
Adult 1.7
Elderly 1.5

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Second facts about Sevo

Ideal for inhalation
Low incidence of myocardial depression even with overpressure
Avoid low flows due to toxic renal metabolites, esp in neonates
Emergence delirium

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Why children require larger dose of induction IV meds

Inc met rate
Inc cerebral O2 consumption
Inc cerebral blood flow
Inc vd

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Propofol

Induction 2-3 mg/kg IV, not common to use

Sedation 60-300 mcq/kg/min

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Etomidate

Induction .2-.3 mg/kg IV

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Ketamine

Induction
IV 1-3 mg/kg
IM 5-10 mg/kg

Sedation
IV .5-1 mg/kg intermittent boluses or
Load 1-2 mcq/kg, then gtts 15-75 mcq/kg/hr

Robinul + Versed dose

Robinul 10 mcq/kg + versed 0.1 mg/kg

Midazolam

IV 0.1 mg/kg
PO= 0.3-05 mg/kg, up to 20 mg
O: 10 min pre op sedation

Intranasal: 0.2-03 mg/kg
May prolong emergence in short cases

No need before 8-10 months, no separation anxiety

Dexmedetomidine

Selective alpha agonist w/sed/ analgesic properties

Resp stability w/no ventilatory depression

Dexmedetomidine contraindicated

In pts with heart block or bradycardia

Dexmedetomidine used for

``` Procedural sed Supplement to GA Premedication Emergence .1-.2 mcq/kg Post op shivering .1-.25 mcq/kg ```

Dexmedetomidine Sed or supplement to GA Premedication

``` Sed/supplement Load: 1 mcq/kg IV Gtts: .5-1 mcq/kg/hr Premedication 1-2mcq/kg intranasal, give 30-45 min prior to procedure ```

Dexmedetomidine Emergence Post op shivering

.1-.5 mcq/kg IV give 30 min prior to end of procedure Post op shivers .1-.5 mcq/kg IV

Fentanyl | Doses for various procedures

``` 1-2 mcq/kg for small procedures 5-10 mod to highly 50 mcq/kg cardiac surgery Intranasal 1-2 mcq/kg Gtts 1-2mcq/kg/hr, turn off 1 hr ```

Morphine

0.025-0.1 mg/kg | Prolong clear end win neonates(liver not 100%).....best to avoid if planning to extubation

Demerol

Uncommon 0.25-0.5mg/kg IV Post op shivers Contra: seizure, renal disorder

Sufentanil

Load slowly .2-1mcq/kg | Infusion .01-1 mcq/kg/hr

Remifentanil

Load 0.5-1mcq/kg: May omit load & use fentanyl on induction Gtts: 0.1-0.2 mcq/kg/min, titrate to BP/HR Supplement to GA

Sux

``` Dose higher in neonates d/t inc VD Induction: 2mg/kg onset within 1 min Laryngospasm IM: 4 mg/kg onset 1-2 min duration: up to 20 min IV 0.2 mg/kg ```

What med would u give with sux to decrease fasiculation & dose

Atropine 10-20 mcq/kg

Glycopyrrolate dose

10 mcq/kg

Why NDMR dose in peds is the same as in adults

Inc VD but immature neuromuscular junction: sensitive to NDMR Duration might be slightly longer in peds

NDMR | Which meds have a dose of 0.1 mg/kg

Vecuronium Pancuronium Cisatracurium

Rocuronium dose

0.6-1.2 mg/kg

Endrophonium dose

0.5-1 mg/kg

Neostigmine dose

50-70 mcq/kg Give with atropine or robinual or atropine Anti cholinesterase

Ketorolac

0.5 mg /kg up to 30 mg/kg Avoid: renal, bleeding esp ENT, platelet inhibition, dec narcotics

Decadron

PONV prophylaxis 0.1 mg/kg Airway edema prophylaxis 0.5-1 mg/kg up to 20 mg ENT Post-op stridor

What steroid would u use for adrenal insufficiency and what dose

Hydrocortisone | 2 mg/kg IV pre op, then q 6 hrs the day do surgery

Zofran dose

0.1mg/kg up to 4 mg

Reglan

0.15 mg/kg up to 10 mg

Dramamine

0.5 mg/kg up to 25 mg/IV

Bupivicane foe tissue infiltration dose

2.5 mg/kg plain | 3 mg/kg with epi

Lidocaine

4 mg/kg plain | 7 mg/kg with epi

What meds can u use to prevent emergence delirium

Precedex | Narcotics