Chapter 167. Drug Dosages for Pediatric Anesthesia

Drugs and dosage are intended as general guidelines only. Adjust dosages based on clinical situation: hepatorenal function, cardiopulmonary bypass, ECMO, etc.

• Atropine: 0.01–0.03 mg/kg IM, IV, ET, IC, IO
• Sodium bicarbonate: 1–2 mEq/kg (0.3 × kg × BE) IV, IC, IO
• Calcium chloride 10–30 mg/kg IV, IC slowly (maximum 1 g/dose)
• Calcium gluconate 60–100 mg/kg IV, IC (maximum 2 g/dose)
• Dextrose 0.5–1 g/kg IV = 1–2 mL/kg D50; or 2–4 mL/kg D25W or 5–10 mL/kg D10W or 10–20 mL/kg D5NS
• Diltiazem (Cardizem): 0.25 mg/kg over 2 minutes; may repeat in 15 minutes at 0.35 mg/kg over 2 minutes
• Ephedrine: 0.2–0.3 mg/kg/dose
• Epinephrine 10 μg/kg IV, IC, IO; ET = 100 μg/kg
• Lidocaine: 1 mg/kg IV, IC, ET, IO
• Lipid emulsion (Intralipid) 20%, 1.5 mL/kg over 1 minute × 3 prn, 0.25 mL/kg/min, and then 0.5 mL/kg/min if hypotensive
• Dantrolene: 2.5 mg/kg IV load; repeat until signs of MH are reversed; up to 30 mg/kg may be necessary; maintenance: 1.2 mg/kg IV q6 hours as needed

• V-fib: 2 J/kg, and then 4 J/kg (defibrillation = unsynchronized) using the largest paddles that fit
• Synchronized cardioversion: 0.5–1 J/kg, and then 2 J/kg
• Adenosine: 0.1 mg/kg IV push (maximum 6 mg); repeat 0.2 mg/kg (maximum 12 mg)

• Amiodarone: V-fib—5 mg/kg IV load over 30 seconds (maximum 300 mg); SVT: 5 mg/kg over 10 minutes × 5 doses; non-PVC container
• Digoxin: initial load 4–25 μg/kg IV:
  • Maintenance 5–10 μg/kg/dose BID
  • IV dose = 2/3 PO dose
• Diltiazem: 0.25 mg/kg over 2 minutes; may repeat in 15 minutes at 0.35 mg/kg over 2 minutes
• Dopamine, dobutamine: 2–20 μg/kg/min
• Ephedrine: 0.2–0.3 mg/kg/dose
• Epinephrine, isoproterenol, norepinephrine: 0.05–1 μg/kg/min
• Esmolol: 0.5 mg/kg bolus over 1 minute; maintenance: 50–300 μg/kg/min
• Lidocaine: 1–2 mg/kg/dose IV; 20–50 μg/kg/min (adult dose 1–4 mg/min)
• Magnesium sulfate for torsades de pointes: 25–50 mg/kg (maximum 2 g) over 10–20 minutes
• Milrinone: 20–50 μg/kg load; maintenance: 0.3–0.7 μg/kg/min
• Nitroglycerin: 0.5–5 μg/kg/min
• Nitroprusside: 0.5–10 μg/kg/min
• PGE1 (alprostadil): 0.05–0.1 μg/kg/min
• Phenylephrine: 0.1–0.5 μg/kg/min; 1 μg/kg bolus
• Procainamide: 3–6 mg/kg (maximum 100 mg each dose) over 5 minutes × 3 q5–10 minutes; maintenance: 20–80 μg/kg/min (adult 1–4 mg/min)
• Propranolol: 0.05–0.15 mg/kg IV slowly (maximum 5 mg)
• Vasopressin: mix 10 U in 50 mL, so 1 mL = 0.2 U
  • Hypotension: 0.0005–0.002 U/kg/min
  • GI bleed: 0.002–0.005 U/kg/min
• Verapamil: 0.05–0.2 mg/kg IV over 2 minutes (maximum 5 mg)

• Cisatracurium: 0.1–0.2 mg/kg/dose IV; lasts 15–45 minutes
• Pancuronium: 0.1 mg/kg/dose IV; lasts 1–2 hours
• Rocuronium: 0.4–1.0 mg/kg/dose IV; 0.6 mg/kg/h
• Succinylcholine: 1–2 mg/kg IV; 4 mg/kg IM; consider giving atropine first
• Vecuronium: 0.1 mg/kg/dose IV; lasts 30 minutes

• Chloral hydrate: 30–80 mg/kg/dose PO, PR
• Clonidine: 0.004 mg/kg PO (maximum 0.1 mg)
• Dexmedetomidine: load with 1 μg/kg IV over 5 minutes, and then 0.2–1 μg/kg/h
• Diphenhydramine: 0.2–2 mg/kg/dose IV q4–6 hours; or 1.25 mg/kg/dose q6 hours (maximum 400 mg per day)
• Etomidate: 0.3 mg/kg IV
• Haloperidol: 1–3 ...