rare eS Tarte) erry Spina Ee Ropivacaine 0 Breer acie a_i ipa O07 | HS | 515 Rae us Sees elaminophen| ree IN Merphine Morphine oo, DA mpg IV q3 hr Fentanyl Otmgiv ‘tmcokgWqitr Hepaidne | 78mqlV tng 0) [nota Waeh Hrsonartore [4 snglV@6ma PO) 00% mevaivastr ehadere_|0raIV 0m) l00Smanaiv ashe Hygrecadone! 30mg PO) [1 mong POq she Gryeodone |20mgPO Si TotmhgPOaann Codeine }200'mg PO. Peyes myhkg POq 3 br maikg PO 9 tr oy torr ro oD ey 2 4 Tite |e Soar: | Snr | lta Scammtas | es ear | arian | eee SS a ee item og te Bea ese ena ver, [mest 0. ramsey CaCl, 1-800-MHHYPER « ~ oan ea Kean | ica a Acetaminophen $25 + | Rescion analysis. ay - ee a iia [Peoupalamtiie ase | aero memes bite lane antes sere ee STEROIDS Hydrocorts Metylre opscle res Peripheral Nerve Block | [Bupivacame 01%] @ @ mL +2 ml. q30 min PRN iy Wentanyl | t8meu gin 9 1Omeahr) WHysromerphone | 0.2maq ini [v- 04 mart) Epil {Feranytioginl» Bupveceine 0.1%) @ 6 mLUtr 2m 20min FR Beaters cna OR pinepini ng 93-5 | vasomessn 400 xt | consider NaHOOs Cat &voi hyperheriahyperventatond ‘yncorized erdowesen S020 usable Novow compl adaosne 112mg, esa metcpoldibazon rapa motto tpi 0 Sng (3g an), opamie pep fe, sopoteolarsodangousrennenes ©; osarn Bede, NTS, rin | exlogy saan fr posse tverton ae comprare 50mg, MSO 129 | Ge paring IABP, BPAP ‘seis, laing epinephrine, MgSO. PAP, vate anstetes fuosende maphng, NIG, NTP, mimnene! | Or, teathypergycamia & severe hyper, | rerloycesut er CT scan and medial | sui terventon dain prenion. GA NgSOs(x ecu) FLUD MANAGEMENT oar Aen Tis 0 nhs : Dexmopeon [03 eoKg Rowena | Ponce [na ro $e BFP, Abo) jean J Aminocaproic Acid | 180 mgfkg—+15 mfgihr Insensible Loss| 3.9 mLighr Uineout [054 nAaW fants [moon mais] as amc a Tao i [Fudcompostion PT onemOSKS MyzaGuamae || Heparin 0 Uhg + 15 Ung ssa | il [ceoaneboe|t02snua m7 T= MICRA outsgt _—— Giuisine (SC) Rac ton | ete xe81/07 Vane 40.20% 8Preacten wih NTP neapine abt uber at evel ot sal new needle to 17cm dept het be 0-60 mitesAnesthesiology Quick Reference (Adult) Etomidate Ketamine Soconnal ery 05-1 mgikg 12mg 025-05 mgikg 1 mgfig PO | Dexmedetomidine opolamine Dipheah ram Pres ey -Aropine |Ephectine ine [05 mgkg mach Maintenance (M)_ Iv OPIOIDS rr Cea) | Phenylephrine Dopamine (60203 9) | moa 20mg GOmeyimi) [014 Omegialnin Disha 400 mg (16maimL) | 2-20mephgimin Norepineptvine opt 911050 mex) Tots. ipa (16 mogim.) [00505 megiginin’ | | | Epinephrine ca [psig ae (100 mea) [4g (tS egiml) _ [001-05 megan | Vasorvessin [teva 9108 UA H(0520) 40U(0 (8 uimi) [00204 Uigine f seo ar) fica efor June 2014 [Debetamne je 2307001 maint) 9) ‘Miimone | POEL ap 30g (200moginl) [0375075 menkoln ‘Isoproterenol | [Ostia (200men) [2ma(@melty 7 [pcto Labetal [Bat |01025mahy [imetoproil [B12 — |BIPB2 [Prepranai |e Teo. mala (5-19) rysesigmne | 001-008 mph Niroglyeeri| [5-15 Feat (25-100men) Tomy one [ossrepomm TT, cen cane Tete a Nope TES ncahg G5 HO re [Sra AOL) [O5Sncnkginn _ |Waynesun Sule | 1625799 | | Niceripine | (6250.39 Bg (100 megimL) |5-15 maine D6 pkg yee eal |Phercinine [a 40-70 meofig (15 m9) 30 mogikgin jo z Pt ae 054 meqyig 7 ACE [0625425 mg | 4 ae a i zag 6112 tng | Binnie Terbuang 025 mg SC ‘Amioderne (COBB | 15020n9 0 mph 30: Digoun SPA [05 025-025 mg , :$612 ANEST o . Relerenc WI SNESTHESIA § CRITICAL a Inpuction MAINTENANCE (me é 3 (wegikgme®* LOADING DOSE (mee kg) MAINTENANCE (meg igimin)’ LOADING DOSE (meeikg) Mamnin (Preceder) an alpha; ndresccpen apoels NPR Tapa over 10 min Tmepag over 10 min 2 (Amudare* } 02-06 Werage > 10) LR os 2 i (Lusendira” ) 10- 1Sageniaion as ee cape kee } ~ 2mpitg (S-10 1wPR) 1000 - 2000 200 - 1000 i | {Brevital® }%) ee 1000 - 2000 500 - 1000 10- 50 i 0.15 - aes 50-150 25 20 - 100 (10 rye cement 02: 1000 - 2000 100 - 200 100 - 150/minuntisetitea ten 25-75 2000-4000 500 - 2000 30 - & 50-150 10-25 025-1 5-15 1-6 0.01 - 0.05 05-2 oe 1 fovtused over 30-60 sec) 0.025 - 0. Ol Fused in combination with aes Sa eT ae. "2 ion doses when drugs used asthe single agent after induction dose (usualy for cardiac surges) 3. Ate 2 GNET INtuSion rate should be used intially to compensete for distribution into penpheral tissues. 4. Agents used as ajuvants to anesthesia with alow cose inhalational agent and/or narcotic, muscle relaxant, amnestc, anoxiolytic, analgesk as needed ‘Gest given afer induction with another agent. 5. Approved for only short procedures due to inhibition of corticosteroid synthesis, N/R = not recommended. ia Protocol (Acute Phase Treatmeny Neuromuscular Blockers (doses in mg/kg V) 1. Get Help. Get Dantrolene. Stop succinylcholine and all inhalational : IV Intubating Child Intubating RS! = ED; Maintenance” anesthetics. Hyperventilate with 100% Oy at max flows (>10 Lime) succinylcholine (Anectine™) 0.6 (03 - 1.1) 1-2G4™ 1-1.5 03-05 30-150 mgikgimin 2. Dantrolene (Dantrium") 2.5 mg/kg bolus rapidly. Titrate for control of 0.1-0.2 MH Sx’s, Max dose = 10 mgikg but sometimes up to 30 me'ks if \ ~O4fage<2) 023 “15 megike/min necessary. Continue IV dantrolene for at least 24 hours after cisatracurium! (Nimbex”) 0.15 (0.15-0.2) _0.1 (age 2-12) 4 0 i! control of the episode (approx. I me'ke q6h) {Nieromax®) eae 0.08) 0.03 - “005 3, Treat acidosis with NaHCO; guided by ABG’s, otherwise use 1-2 mists é-tubocurarine’ (curare) . 06 oe Neonate) . in 4. Start cooling techniques: Give cold NS IV (15:mitz q]5min x 3) (Metubine*) 0. i Lavage stomach, bladder, rectum and wound with cold NS. Surface ! (Mivacron® } . . r i! cooling with ice and hypothermia blanket. Monitor for overtretment é panceronium (Pavulon") ———«0.08 - 0. ( “S mepikg 5. Dysthythmias usually respond to Rx of acidosis and hyperkalemis ( } 0.07-0.1 0,04 - 0.06 (age 1-14) r If not, administer standard antiarrhythmic with exception of Ca: (Zenuron®) 0.6(045-1.2) 06-0808) 0612 03 channel blockers (may cause hyperkalemia and CV collapse) 'Norcuron®) 0.1(0.08-02) _O.l(age 1-10) _ 03-04 0.057 08-12 in__ 6. Determine and monitor end-tidal CO,, arterial, central or venous BC K’‘/lytes, urine output, PT PTT and Ca* for baseline. Repeat p: 7. is or pe perkalemia: hyperventilate, NaHCO,, Insulin ]0\ in SO cc and titrate to serum K’. If needed add 2-5 mete of CaCl, -detesicuating doses use 15% of ED, 3-5 min prior to induction. 2. infusion dases Fox maintenance bolus dosing use 20-40% of ED. 8 es urine output of > 2 m/kg’hr with IV’ fluids and or mannite! (0.25 gikg) or furosemide (1 mp%ks). Consider CVP or PA monitors of Neuromuscular Blockade E 0.0) 5.0.03 melts and (¢ Te eae 0.5-1 mike IV and ‘ni smun®)0.04-0.08 mp/kg 1V & 9. Sudden cardiac arrest in children after succinylcholine should be (Analgesics, Antiemetics, Reversa) treated as acute hyperkalemia first. Give CaCl, with above Rx 7 20-40 ae PR, 5-15 mgikg PO. 650-1000 mg (15 me'kg) 16 Presume subclinical muscular dystrophy and consult neurologis: AV; 1Amg IM (MH Emergency HOTLINE: (800) 644-9737 or (17-315-404-7078 Web: weneimesen Inhalational pennies MAC (voi) Vapor Pres. Partition Coefficients T Adi Child InfantNeoanic mm Hy Blood Ges fiw Bie’ Fe Sn:atropine glycopyrtolate (Robin) 0.01-0.02 melkg and 3 butorphanol (SxiaoF’) 2 ketorolac (Toradol*) * natbuphine ¢Nibubr Postoperative Medications (Anaigesics, Amiemetics, Reversal) treated as acute hyperkalemia first. C « acetaminophen (Tylenol) 20-40 mpikg PR. 5-15 me'ke PO. 650-1000 mg (1.5 me's) 1V Prestme subclinical muscolar dys 0.5-2 mg (0.01-0:04 mgikg) 1V;, 14-mg IM MH Emergency HOTLINE: (200) 4 0 30 mg (0.5 mg/kg) 1V ; 60 meg (1 mg/kg) IM 5-10 mg (0.1-0.3 me'kg) 1VAMISC HERAG Inhalational Anesthetics MAC (vo!) dexamethasone (Decadron”) 8 mg 1v (0.25 me/ke child) dolasetron (Anzemef*) z i granisetron (Kytril”) ei” metoclopramide (Reglan®) 5-20 mg (0.1 mg/kg) POM (SV given over 1-2 min) 6, Determine and monitor es K/iytes, urine output, PT/PTT 7. For hyperkalemia: hypervemilace, NaHCO, Insutin DSO and titrate fo serum K-. If needed add 2-5 m 8, Ensure urine output of > 2 mbigine with IV 8 (0.25 gig) oF furosemide (1 ogi 9. Sudden cardiac arrest in childre 0.015-0.03 mgike and soe 12.5mpv (0.35 metee child age 2-16 yrs. to max 125mg) 0.625-2.5 me (10-20 megikg) IM/IV 0.1-1 meV over = 30 sec. (10 mepiks child > age 2) _4 mp IViIM over > 30 sec. (0.1 mplkg child < 40k) (0.2 meV q min (up to 1 mg max Smin, 3 me maxi Thr) 7 For no movement to noxious stimulin 95% ps use __Einalmefene (Reve 0.1-0.25 megikg 1V q 2-5 min to max of I megike 5-13 MAC For blocking ateneric sponse (MAC-BAR) =| ‘waloxons (Nara 0.1-0.4 mg IMiIV/sQ q3min (1-10 meg’ke child) For eye opening on command (MAC-awake) use 0.5 MAC Autonomic / Cardiovascular Drugs Mixture/Concentration Clinical Adrenergic Receptor Activity Hemodynamic Effects’ TV Push IV INFusion Di-ution 1. Muripuie® Duration Direc: ind ‘pha Alpha Alpha Beta Betz CO Inotrop HR MA ee Loading Dose __(mes/kg/in) (in 250 ml) x Wt=Rate (IV) Tar 1 ver 2 = phenylephrine (Neosvnephrine® }50-200 meg 0.15-0.75 20m BO megim! 0.075=0.1 a 0.03-0.15 Ime 4meqimi 0.45=0.03 are eS = a+ 0.15-0.5 tte Sette estes tee tett ttee TO TET TT ot E ephedrine 5-10 me NR SA0ma ee ee 2 Pt S dopamine (iIniropin®) N/R renaldose 0.5-3 200 me 800 megimi O375=5 <10main vere 0 tere Oourmnegcmsmian | 0 0 0.4 2 B dose 3-10 400mg 1.6 mpm! 0.1875=5 eee ett = +p 10-20 800mg 3.2 mpm _0.09375=5 ee eet dees 0A} tt A | Bdobutamine (Doburex*) NiR 230 250mg lig’ 9 03=5 << UOmm tees 20a ett _Bisoproterenol (/suprel") 20-GOme _0.01-0.5 2mg_ Begin! 0.1875-0.025 1-5 min +++ 0 0 0 vereseate ft Tt ttt | = vasopressin (Pivressin®) N/R 0.01-0,06 Umin 100U___ 400 mb/ai NIA. 10-20 rnin sive Hormone (ADH). HemodymanicetensiiSentcSck =f = inamrinone (Inocor*) 0.75 me'ke 5-20 100mg 400 megim! 0.75=5 .S2br 0 a a ae Ree at at |= milrinone (Primacor 50 megikg siowls 0375-075 50mg 200 mepimi 0.15505 O5-2br 0 CRU Soleo i (Apresoline®} 25-5 me qiSmia: max 20-40 me (or 0.2-0.5 me'ks) 24h 0 sacion 00 {0 fein trie 11 0 ine "25-50me 01-7 50mg 200 megim! O3=1 BSmin 0 + moxiyvrostiain fo tetecitetc | dd ° O5-Imeke 01-10 50mg 200 meg! 0.3=1 12min 0 dieses aks ye D0) Ot theta tele 144 1 ot 85 250mg mpm 0325 SAO min —— 0. | dameinteis iemcomnintiode) 100 me 400 meeim 0.15=1 desir ss (ee Oss VO! 0) 25me 100 megimt O.6=1 10-15 mind 0 50mg 200 megimt 0.3=1 ite ue 00 50mg 200 mg/m) 03=1 46m 0 0 0 oO a 3 25¢ 10mem 0.3=50 10mm 0 © 0 0 O J labetall Normodync*) 0.1-0.25 mete 2-8 meimin ager eRe ay ‘metoprolol (Lopressor*) 2-15 me O00 00 : RTT EI eT OTE ig ae ee eae \ (Cordarone®) 150 mg ist 10 min, 360 mg nex 6 hours. 540 mg remaining 18 hours ‘nig: Cs K+ hanna tae kwocawie*) 1-3 mpike 20-60 lg 4mm —-0.3=20 15-30 min Anidysnythmic Cassin: Na+ blockade | 4 depolarization) iide (Pronesty!®) 500 me over 30 min 15-60 TeinD5W4memi _03=20 24hr ypaLiose omsesisonm: jena 00 _t_04 OL i “Sb tai Ee ese ety ow ov snes COCarda Output notrop=niy, Her Ra MAP=Mean Aiea Presi VR eos Re pat fling pes), SHR= Seni Vsaa ssn eon ss ‘Wascaka Resetance, RBFResal 2. Madtigher (1st) xpts wt in Ko. {set pump fo infusion rate of (2nd #) in mca at con of drug on tha line (Example. nitroglycerine 50 ra/250 m= 200 uaimi For ane BB vasopressors f/Nasodilators WilLoco! Anesthetics WlBenzodiazepines MB Muscle Relaxants /,Anticholinesterases Ach Antagonists BEE Frans”Extremities, Intrathoracic: (Noncardiac), 6-10 mig ‘Gilopental(Peniothal") 20-30 ings. TURP: 3-6 mig "watch for sudden expansion from irigant Pep IM CocKTAaIL: midazolam 0.15 mets ‘Trauma: Mild - 4 aig, Moderate - 6 mitpse Severe -8 niltge REPO Cin. Gee ee hoe, Urme QuTeUT: Adjust fluids to maintain at 5-1 mip ir, 2 mite’ infant eee alnate Local Anesthetics Relat! K, Endotracheal Tubes/ Airway Rae se Howie Doser’ tmp AGE Size(mm ID) BLave Disr@Lir LMA; InruaTe: 1 Ol rapid 05-1" ws = Premature (/-25ig) 7253.0 OMil 810 2 rapid NR - ‘Term-6 moi? 5-4ig) *3.0 1 Mil 10-41 I 89 mpid 05-| 5 0. 612 mo.(5-7igh #3530 1 Mil u 8 86 slow 1446) . 12-20 mo.(7-10%;) *4035 15Mil 12 S81 mod 15-25 35 2 years (/24¢) “4535 15M 1B 6 77 rapid NR s 4 years (/4 i) *5.040 2Mil 14 = 79 rapid 1-15 45 a | 6 years (/8%s) *5545° 2MilMac | 15-16 #2:2-14m = mepivacaine (Cuybocaire) 2 7.6 mod NR 4 | 8 years (24:e) *6.05.0 2 Mil/Mac #2)3,2-14m _peilocaine (Citonest") 2 6 pRe aes 14m ropivacaine (Naropin”) 8 25 ares 3Mil/Mac 18-20 #3; 20m! 7. Duration prolonged with epinephrine (200-300 mcg intrathecal) or phenylephri 2. th epneprine 2 x i yes eee Seabee: me Soo 31 Tein dependent upon ste ofnjcion:V > intercostal > caudal > epidural > brachial lens topic N/R =p 657.0 34Mac 2022 NR Hemodynamic Formulas Adult Nasal Intub. 6.5.7.5 _3-4Mil/Mac_add2-3 N/A Variable Equation Norra values ETT Size (mm) = (age = 4) +4or [height (em) +20] *uncuffed Cardiac index (C1) COMBSA, 2.84.2 bmin'm* Distance at lip (cm) = 3 x Size (mm), Nasal = 4 x Size ae eee COT 1000, 50-90 me beat stroke index (S! SV/BSA 40-60 mb-beat in Loss Mean arterial pressure (MAP) Diastolic pres. + 1/3 Pulse pres. 80-120 mm Hg SUCTION Losses: Blood in suction canister minus irigation. __ Systemic vascular resistance (SVR) [(MAP-CVP) + CO] x80 900-1400 dynes'secem* Sronce Losses, Boon SoakeD: Raytec = 15: Lap =80mi Systeme vascular resistance index (SVRI)__[(MAP-CVP) = Cl] s 80 1900-2400 dynes sec-cm Teme RESTO VOLORE: Pulmonary vascular resistance (PVR) [PAB - PCWP) + CO] x 80 dynes-sec-cm* Obese 60 milks. aes 90-100 milks. Pulmonary vascular resistance index (PVRI) —_|(PAP - PCWP) = Cl] x 80 ThinFemale 65 ait Term 80-90 mite Right ventricular stroke work index (RVSWI) 0.0136 (PAP - CVP) x SI ‘Adult Male 70. Left ventricular stroke work index (LVSWI) 0.0136 (MAP - PCWP) x SI 45-60 g-mr beat m lke <1Yr. 75-80 mike |__Museular __75lkg 1-6 Yr. 70-75 mits Respiratory Formulas aa ens Atom Hh tera) EB Ate Variable/Equation Normal Values Tan = (Hetaearear HCtpreent) ‘Hetrsestwot Hoot Alveolar oxygen tension 110 mm Hg (FIO, = 0.21) Basal Metabolic Rae “PAO; = FiO, (PB - P30) - PaCOy0.8 CaO, terial xygen contre ar CeO, Pulmonary apilay 0, corte | diuzepam (Vulium®, Dizac*) ‘5-20 mg PO, 2-10.mg IV -arterial oxygen gradient &mal=(age/4)+6 < 10 mm Hg (FIO, = 0.21) a ii a -< 60 mm Hig (FiO) CO” Griacoupt inllaaiam (Verse) Coe 0.5-S mg iv ae — (@/A ratio) §— > 0.75 oe etree content temazepam: Restoril®) 00> 4 ‘Mean central venous presue Sse eee! tise Sn ¢ as a fraction of TV 033 Bo, ecrnseste: (PaCO, - PECO,)/PaCO. Doll i (Demeror) 50-150 mg Mv O. 2) 2 ta j morphine (Duramorph ) ae (0.05-0.1 mgks) IMiIV © 136% S00,/ none or aot a 0,100 mi BO: glycopyrrolate (Robinul”) 0:1-0.3 metvinisg Mit eisai 15 mlO, 100 ml MAP banca: expbae waaay C¥O, = (Hb x 1.36 x S¥Oy 100) + (PRO, x 0.0031) Pe P age iene cone eee (extraction) 4-55 ml 0100 ml! 1-2 mg MV, 0.5 mg q8h PO PAP - 50-200 mg POIM a-¥0; = CaO, - CVO: Bie H,Ovaportensn (mS ) 25-50 mg PONV Inirapulmonary (or physiologic) shunt fraction <5% Atel ese hydroxyzine (Vistaril®, Atarax*) 25-100 mg (0.6 mers) POU Qs Or = (CCO, - CaO.)(Cc'O, - CVO) ar PCA ~ a)Oy + 20 (fred, > ?Sora 0} PADS cone uy ©C'O, = (Hb x 1.36) + PAO: (0.0031) (ie 0,="0) peceeeiee Tarot 12.5-50 mg (0.05-0.1 mgikg) POPRIMIV Cage SRG toreo Ss rt Oy kg min! (@BMIR) PRO; et me PCWP. Rleanary aneary neice Sine Cit nee ine CO (CaO, - CVO,) x 10 or CO = VO (CaO, - CVO.) x 10 eee ton Gree, cro i 110-140 mb-min m2 ae ee ul or transpo % 3 150-300eqr0,50-t0DmuW REST Go (Ga0,) 10 1000 mi min | Sa, Ane Swen BOxL= CI (Ca0,) x 10 430-350 min SHO, Maes Smtr 22.30% No batgeran eo Vr extraction ratio QAER =(VO,DO,) x 100 or [(Cad, - CVO)/CaDg| x 100 aoe esate breve ane icone igecoite sorte on teat perm, Wok wrwncers.com forefoot a orden, Px se TADPediatric Code Further Dosing « Indications adenosine O.T meg Vi pmsh Double and repeate dose if no effect. adenosine amiodarone — Smeg iVitloal give over 20-60 min for SV amiodarone xiropine QI meas VA —-Emg MAN, O.L ng min. May repeat x 1 Defibrillation 214s initial then 4ikg x 2. Repeat after each med. atropine Lig for cardioversion, CaChy gpinephiine — QOL meg WHO gB-Sinin, 0.1 milky OF 1:10,000. diltiazem glucose gkelWIO ——-J-tmbkg of DISW, Give slowly. epinephrine Tidocaine Ag WHO ‘may repeat x Later [Own isoproterenol magnesium Dmg kev io for torsdes de pointes or hypomagnesemia lidocaine NaHCO, tweaks Use only with ventilation, Give slowly, Volume 10-20 ows isotonic (crystalloid), magnesium. NaHCO, NPO Practice Guidelines’ (ait ages, neniny patients, elective procedurms) Clear Liquids': NPO x 2his Breast Milky NPO x + his procainamide Infant Formulas NPO x 6 hes Nonshuman Milk: NPO x 6 his Light Meal®: NPO x 6 brs Medications: Should be taken with <30 ml of water > L hr before su “T. Not mead for women in aboe 2, Includes water, Mult juices without pulp carbonated bewerages, clear tea, ‘lack coffer. 3. fypeally coms of toast ant clea iquds Fried arty foods, oe et mary pratong gastric emptying tie Adult ACLS vasopressin WAVEL (Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine) may be quen vin ETT in 1OCC NS Pediatric Prooperative/Sedative Medications (aye > 41) diazepam ( Viulivin”) midazolani (Verseie”) Further Dosing « Indications Ging then 12mg lV push 1" drug for PSVT, Does nor convert atrial fib Mlutter or Vt 300 mg IWiOthen 150mg LV push for cardiac arrest. Max cumulative dose 2.2 24h, 130 melv over 0 min x 2for stable wide complex VT. Maintaince Lingmin vb hy L mg Vi10.q 3-5 for asystole/bradycardiae PEA. For bradycardia 0,5 mg. 3 mg max 2-f mgiky qLO min pr for cardiac arrest with fK’, |Ca, or Ca ehan block OD. 0.25 mgkg iV over2 min after 15 min, 0.35 mgikg; infuse at 5-15 mghr, titrate to FIR. Ling vito qa-5 min for VE pulseless VT, and PEA 2-10 meginin Not indicated for cardiag arrest. Titrate to adequate HR Tel Soke VtOinitial —0,5:0,75 mgrkg after 5-10 min; for persistant VEV'T 40-50 inogikyimin infusion Max total doxe 3 mp ks 1-21 in 100m DSW — infuse at 0.5-1 gir (lor torsades, | M, 1 otk V initial ABG, 0.3 x we (kg) x base defle then 0.5 ntqkeqlO min catecholamines or calcium salts, helplul with TK 20 maimintV infusion —— maximum 17 mg/kg, 100 mg ive q3en if refractory VIVE JOU IOUT | \ ternative prossor to epinephrine in Cardiae A 0.3-0.4 mp ky PouPHUIM (90-120 min pre-op) 0.5¢1 inaike PO} 0,2 -0.3 ng/kg IN; Os1-0,2 mngik tM Od ivy LPR Fluid Management Fentanyl Oralet® S15 mowke OF (S mowby adults) (2040 min pre-op) MAINTENANCE? 4 mnl/kethr=/! JOKg, 2 inlikghe-2™ JOKg, L ellkgihe= remainder, miorphine: 0.1-0.2 me/ke IneCHS-60 min pre-op) (For Pis > 20 kg body weight, take We in kg +40 = maintenance in mii) sufentanil (Silent) 1.5-3 mow ka intranasal (IN) Dertcr7: Maintenance Auids per hour x hrs NPO without hydration, chloral hydrate (Nofec®) 65-100 mg/kg POU Replace '2of deficit in 1 br ain 2" and Vain 3" Bioop Loss: Replace with LR: 3 to 1; blood, colloid, oF Hespan® wix.0nifatiy: Eto 1 THIRD-SPACE or INSENSIBLE Losses: Intraubdominal, Hip: 12-15 miky hr I" hr, 6-10 mi/ky hr therealter Extremities, Intrathoracte: (Noncardiac), 6-10 mi/kgihe TURP: 3-6 mlkg/ir “watch for sudden expansion from irrigant ‘Trauma: Mild - 4 miikg/he, Moderate - 6 milkgihr, Severe - 8 m/ke/he Urine Ourpur: Adjust fluids to maintain at 0.5-1 mi/kg/he; 2 mike/he infant clonidine (Catapress®) Pep IM Cockrat: natal 0S ate Singkg, glycopyrrolate [0 inp kg for drying Pep PO CockTait: midazolam 0.4-0.5 mg 4-5 mykg, glycopyrrolate 20 meg/ks for drying 2.5 mgikg PRAY, -b mew’he PO (105-120 min pre-op) (Ketalar®) 3-S mg/kg IM; 6 PO; 8-10 PR; 0.25-0.75 1V5 3 IN (Brevital”) 25-30 mg/kg PR (2-10% In), 3% sin) (Nembutal®) 2 ngkg PORIM (or Seeobarbital Seconal®) 2h pre-op (Pentothal®) 20-30 mg’hy PR (2.5-10% sln); 1-2 mek tv Local Anesthetics Relative pK, Onset Duration (hrs) Toxic Doses! (mg/ka) Endotracheal Tubes/Airway Management Potency SPINAL Eenunat Iwenicreari Nor EXcbuD PLAIN Wi1iL Age Size(mmiD) Babe —_Disr@Lir LMA; Innate -ehlonoprocaine (Neueame) 1 OT rapid Eis Tooomg tf 14 Premature (/-2.54¢) *2.5-3.0 0Mil 8-10 NIA 2 cocaine 2 rapid 200mg 15-3 NR Term-6 mo(2.5-44s) *3.0 1 Mil 10-1 #1; 2b iNaoLaiHY 189% impict BOG eee 6-12 mo. (5-7 kg) #3.5/3.0 1 Mil A #12; 2-7 stracaine (Poniocuine” ) 8 Omg 1-15 25 12-20 mo. (7-105) *4.0/3.5 1.5 Mil 12 #1'lz;2-7mt— bupivachine (Marcaine®) 8 175/225 mg 2.5 3 ‘2 years (12 kx) #4535 1.5Mil 13 #2;2-10ml —_etidocaine | Duranesr’) 6 4oomg 6 8 4 years (/4 1) 5.0/4.0 2 Mil 4 10m! $ lidoeaine ( Xyiveain 2 S00mg 45° 7 Seesciae) a as a eee & mepivacaine (Curbocaine®) 2 somg 4+ 7 years (24 ke) = 2 Mil/Mac - 2'/2;2-14mi_prilocaine (Ciionest) 2 mi 6 9. 10 years (301s) 65 2-3.Mil/Mac 17-18 #2/s;,2-14mi ropteactine (Minor i 8 LS. ee (>30 kg) 70 3MilMac 18-20 #5; 20m! . (50-70 s)7.0-8.0\ 3 MiliMac 20-22 “Duration prolonged with epinephrine (200-300 mcg intrathecal or phenylephrine (2-Smg intrathecal). 2. With epinephrine j.200,000 3. Toxctys dependent upon ite of injection: I> intercostal > caudal > epidural > brachial plexus > subcutaneous > ropcal N/R = notre ft Large (70-1001) 8.0-9.0 3-4MillMac 22-24 #5; 40 mi 657.0 34Mac 20-22 NIR Hemodynamic Formulas Nasal Intub. _6.5-7.5_ 3-4 Mil/Mac_add 2-3 N/A Variable Equation Normal Values ‘Size (mm) = (age = 4) + 4 or [height (em) = 20] *uncuffed Cardiac index (CD CO/BSA 28-42 bmin im? Distance at lip (cm) = 3 x Size (mm), Nasal = 4x Size Stroke volume (SV) COVHR x 1000 60-90 ml: beat ‘Stroke index (ST) SV/BSA 40-60 mb: beat Ss weet tone : Mean arterial pressure (MAP) Diastolic pres. + 1/3 Pulse pres. 80-120 mm Hg i {UCTION Losses: Blood in suction canister minus irrigation ‘Systemic vascular resistance (SVR) [(MAP- CVP) + CO] x 80 900-1400 dynes-secem* SPONGE Losses, BLOOD SoaKED: Raytec = 15m; Lap=80mi Systemic vascular resistance index (SVRD) {(MAP - CVP) + Cl] x 80 1909-2400 dynes'sec-em uME (EBV) 5 [(PAB-PCWR) +CO}xB0 100-250 dynessec cm Ms ate ea he Riera Me (45-225 dynes secem