Appendix II: Perioperative Pedatric Care

Fluids & Electrolytes

• 4-2-1 Rule
  4 ml/kg/h for 0 - 10 kg (100 ml/kg/24 hr)
  2 ml/kg/hr for 10 - 20 kg (50 ml/kg/24 hr)
  1 ml/kg/hr for >20 kg (20 ml/kg/24 hr)
• Na+ maintenance: 2 - 5 meq/kg/24 hr
• K+ maintenance: 1 - 3 meq/kg/24 hr
• 2/3 - 1/3 is fluid of choice for maintenance
• Add 50 ml D50W to each 500 ml of 2/3 - 1/3 for age < 3 months

Blood Transfusion

Estimated Blood volume

• 85 ml/kg for infants
• 80 ml/kg/for toddlers & young children
• 75 ml/kg for older children

Transfusion

10 ml/kg packed RBC ~ 1 unit in adults

> 30 ml transfusion requires clotting factors also

Shock

Bowel preparation

Golytely - 100 cc/kg @ 25 - 35 cc/kg/hr PO or NG

Analgesia

Acetaminophen

• 15 mg/kg/dose q4 - 6 hr PO
• 20 mg/kg/dose q4 - 6 hr PR suppository

Codeine

• 0.5 - 1 mg/kg/dose q4 - 6 hr IM or PO (4 mg/kg/24 hr max. in divided doses)

Meperidine (Demerol)

• 1 - 2 mg/kg/dose q3 - 4 hr IM

Morphine

• 0.1 - 0.2 mg/kg/dose q2 - 4 hr IM
• 0.01 - 0.05 mg/kg/hr IV maintenance (i.e., 1.25 mg/kg in 500 ml D5W at 5 - 10 ml/hr)

Naloxone (Narcan)

• 0.01 mg/kg/dose IV or IM - for narcotic overdose

Diazepam (Valium)

• 0.05 mg/kg IV or PO

Lidocaine

• 3 - 4 mg/kg max. without epinephrine
• 7 mg/kg max. with epinephrine

Antibiotics

Cefazolin (Ancef)

• 30 mg/kg q8h

Metronidazole (Flagyl)

• 10 mg/kg q8h

Penicillin G

• 100,000 IU/kg/24 hr q6h IV for moderate infections
• 250,000 IU/kg/24 hr q2 - 6 hr IV for severe infections

Penicillin V

• 25 - 50 mg/kg/24 hr q6 - 8 h IV

Cloxacillin

• 50 - 100 mg/kg/24 hr q6h IV or PO for moderate infections
• 200 mg/kg/24 hr q6h IV for severe infections

Amoxicillin

• 25 - 50 mg/kg/24 hr q8h PO

Ampicillin