Heavy Super Complete Finishing ~ Pediatric Sedation and Analgesia (PSA)

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The various forms related to pediatric sedation and analgesia have been arranged in detail for everyone~~ The whole network is the first to remember to bookmark ➕ Follow the new week and have a good work~~♥️Commonly used pediatrics PSA drug route dose (mg/kg) typical maximum dose onset time (min) duration remarks sedative and analgesic morphine intravenous injection, intramuscular injection, subcutaneous injection 0.
1～0.
15mg/kg852～4h diphenhydramine antipruritic Intravenous injection, IN, intramuscular injection of 0.
001~0.
002 [1~2ug/(kg·dose] 0.
01~0.
015ug/kg(kg·dose)] 0.
075 (75ug/dose) 1~23020min produces stiffness (muscle stiffness) during rapid induction.
Stiffness) increased the incidence of vomiting when combined with midazolam, hydromorphone intravenous injection 0.
01-0.
022304-6h hydrocodone oral 0.
210304-6h codeine oral 1-1.
560304-6h, 15% of children could not fully absorb midazole Intravenous injection of IN enema, oral injection of 0.
05～0.
10.
3～0.
50.
5～121225～153030min～2h1～3h60～90min intravenous injection of pentobarbital 2.
0～6.
0200 2～52～4h intravenous injection of thiopental sodium enema 3.
0～5.
015 ～405001200 0.
510～3020min60～90Intubation dose 17% Methorbital Exclusion Methobital Intravenous Enema 1～318.
0～25.
010016～2020min1～2h Sedative Chloral Hydrate Oral 50～75100060～9010-24h Death after discharge, Non-emergency department drug propofol intravenous injection pump 1 ~ 2100ug/(kg·min) 750.
520min 5min egg, soybean allergy (with additional methemoglobinemia with caution) etomidate intravenous injection 0.
3200.
510min Other ketamine intravenous injections should not be used during infection Intramuscular injection Oral 1.
0～1.
54～51060100250253545～90Min1～2h3hN2O inhalation 30%～70%1～2min1～2min Diphenhydramine Oral 1.
0～1.
550152～4h Intravenous injection of dexmedetomidine into nasal cavity ) Oral 1～2ug/kg for at least 10min1.
5ug/(kg·h)1ug/kg4ug/kg5～6 451545～85min 90min30min Hypertension and bradycardia Multi, 1mg15 Past Psychiatric History Ziprasidone Intramuscular Injection, Intramuscular Injection 10mg15 Past Psychiatric History Reversal Drug Naloxone Intravenous, Intramuscular 0.
12mg2min20min Flumazenil Intravenous 0.
010.
2mg2min30min This table: from Strange Pediatric Emergency Medicine (Chinese translation version/4th edition of the original book) Note: The typical maximum dose is the dose that is effective in most children
.

Some children require higher doses due to different responses, and children should be tested as a precaution
.

Any medication may have the risk of complications, and special attention should be paid to the type 1/(2) remarks, and monitoring, airway assessment and tracheal intubation are possible! This editor assumes no medical risk
.

  Guidelines for Administration of the Maximum Allowable Dose of Local Anesthetics Drug Single Dose (mg/kg) Single Dose (mg/kg) Infusion Dose Single Dose [mg/(kg h)] Infusion Dose Single Dose [mg/ (kg·h)] Neonates < 6 months children Neonates < 6 months children Bupivacaine 1.
52.
50.
20.
4 Ropivacaine 1.
530.
2～0.
250.
4～0.
5 Levobupivacaine 1.
52.
50.
20.
4 Ruprocaine 10101818 Lidocaine 350.
81.
6 Modified form: Suresh S, Wheeler M.
pediatric regional anesthesia.
Anesthseiol Clinnorth America.
2002;20:83-113 Epidural opioid and local anesthetic adjuvant administration Medication Guide Drug infusion concentration (ug/ml) Single dose (ug/kg) Infusion rate [ug/(ug h)] Fentanyl 1～30.
5～10.
2～1 Hydromorphone 3～7—1 ～2.
5 morphine——10-30 clonidine 0.
5～11～20.
1～0.
2 ketamine 500～1000 (recommended <1.
0mg/kg or more to reduce adverse reactions) NA sodium bicarbonate 1mg/ml lidocaine, 0.
1mg/ml bupira Caine, Ropivacaine, or Levopivacaine Adapted from: Eck JB, Rose AK.
Pediatric regional anesthsia-what makes a difference? Best Pract Res Clin Anesthesiol.
2002;16(2):159-174 Opioids Application of drugs in children's analgesia Opioid equivalent dose (PO) Equivalent dose (IV) Bioavailability (%) Half-life Remarks Morphine 0.
2 amg/kg (acute) q3～4h0.
1mg/kg 3h poor absorption, neonatal convulsions; histamine release; q2h administration of fentanyl 0.
015mg/kg/dose 0.
001mg/kg q5min ~ q1h NA 20 ~ 30min is suitable for surgical pain, bradycardia; chest wall rigidity and naloxone or muscle relaxant Drug combination methadone 0.
2mg/kgq6～12h 0.
1mg/kgq6～12hb8012～24hIV, SC, IM are acceptable; long half-life; when switching to intravenous administration, reduce the dose of nalbuphine 0.
3mg/kgq3～4h0.
1mg/kgq4h20～304～5hκ-agonists and μ-antagonists ; Less irritability; antagonizing the respiratory depression and analgesic effects of opioid agonists; Oxycodone 0.
1mg/kgq3～4h NA60～802～4h can only be Po Hydrocodone 0.
1mg/kgq3～4hNA60～803.
8～6h can only Po Any opioid agonist can cause urinary retention, Insufficient secretion of diuretic hormones, itching, irritability, excitement, insomnia, dry mouth a study found that 0.
3mg/kg oral administration usually has too many adverse reactions b In some cases, multiple frequency, low-dose administration of NA is recommended, not applicable; h , hour; IV, intravenous; SC, subcutaneous; IM, intramuscular; PO, oral; q, per; CNS, central nervous system; MAO, monoamine oxidase opioid drug intravenous drug load maintenance dose sequential intravenous Dosage <50ug Sequential Intravenous Dosage>50ug Morphine 0.
05～0.
2mg/kg5～40ug/(kg·h)0.
05～0.
02mg/kgq2～4h5～8mgq2～4h Fentanyl 1～3mg/kg0.
25～2ug/ (kg·h)0.
05～1mg/kgq1～2h25～50ug/kgq1～2h Hydromorphine 0.
01～0.
03ug/kg2～6ug/(kg·h) 0.
02mgq2～4h1mgq2～4h Methadone 0.
05mg/kg q 10min until symptoms are relieved (maximum dose 0.
2mg/kg) NA0.
05～0.
1mg/kgq6～12h10mgq6～8h nalbuphine 0.
05～0.
2mg/kg5～40ug/(kg·min)0.
05～0.
2mg/kgq2～4h5～8mgq2～4h Rui Fentanyl 0.
05～0.
2ug/(kg·min) Alfentanil 5～10ug/(kg·min) 1～4ug/(kg·min) Naloxone titration for itching and other adverse reactions of opioids ;0.
25mg～1ug/(kg·h)(10ug/ml), put 1 ampoule of 0.
4mg/ml of naloxone mixed in 39ml of normal saline to alleviate those non-life-threatening adverse reactions, 2ug/kg of naloxone can be injected every 30s until the desired effect is achieved
.

The action time of naloxone is 20min, so in order to counteract the adverse reactions of long-acting opioids, naloxone needs to be titrated.
Hydromorphone exceeding 100ug/kg will reduce the convulsion threshold.
For burst pain, troublesome 0.
03mg can be given /kg or hydromorphone IV q10min, 3 times the dose can be given within 2h
.

The recommended dose is not suitable for children with changes in metabolic function such as liver and kidney insufficiency.
Remarks: Methadone is easy to accumulate due to its long half-life after repeated administration; NA should be dosed at a reduced dose or administered at intervals.
The choice of opioid medication will depend on many factors, including adverse drug effects, route of administration, incidence of allergies, sensitivities, and the child's analgesic needs
.

A passing note about opioids: Switching to another opioid, even when used correctly according to the table, may exacerbate sedation and respiratory depression, especially in children receiving chronic opioids
.

This is now attributed to "incomplete tolerance"
.

Reducing the normal dose by 1/4 to 1/3, or giving large doses can reduce adverse reactions
.

The total dose administered per day can be adjusted by dividing
.

Oral drugs and equivalent conversion of intravenous doses are shown in the table Opioid drug oral dose and morphine efficacy comparison PO equivalent dose: IV morphine 0.
3mg/kgq 3 ~ 4h13:1 chronic/repetitive (pediatric 6:1) fentan Ni 10ug～15ug/kgq 4～6h 50～1001:0.
1 Oxycodone 0.
1～0.
15mg/kgq4～6h1～1.
53:1 Hydrocodone 0.
1～0.
15mg/kgq4～6h5～73:1 Hydromorphine 0.
04～0.
08mgq4 ~6h14: methadone 0.
2mg/kgq6~12h12:1 (acute), 1:1 (chronic) tramadol 1~2mg/kgq4~6h 0.
254:1 codeine (prodrug) 0.
5~1mg/kgq4~6h0 .
1NA hydroxymorphine 0.
03mg/kgq6～8h10NA levorphanol 0.
04mg/kgq6～8h7.
52:1 nalbuphine 0.
3mg/kgq2～4h0.
8～14～5:1 methadone due to its long half-life will be in 2～8h It accumulates after 3 days, so the dose should be appropriately reduced.
The NA can be changed due to the speed of administration.
It cannot be adapted from Tobias J.
pediatric pain Management for Primary Care.
2nd ed.
2005.
Acute pain Management in Infants,Children, and Adolescents: Opearative or Medical Procedures and Trauma (Quick Reference Guide for Clinicians).
Rockville, MD: Agency for Health Care Policy and REsearch, Public Health Service, USDepartment of Health and Human Servvices; February 1992, Publication No.
AHCPR 92-0020.
Recommended doses do not apply to patients with altered metabolism such as in renal or hepatic insuffciency.
Adverse effects common to all opioids include respiratory depression, bronchospasm, muscle spasm, chest wall stiffness, pruritus, immune system suppression, vomiting, nausea, constipation , sedation, hallucinations, dysphoria, tolerance, urinary retention, and hyperalgesia
.

Some patients with these adverse reactions would rather endure pain than use opioid analgesics
.

In all treatment regimens, monitoring medication and preventive treatment is important and throughout
.

Patients can be encouraged and informed that most adverse effects can be reduced over time, with the only exception being constipation
.

  Commonly used intravenous PCA doses required dose (ug/kg) continuous dose (basic) [ug/(kg h)] maximum dose per hour (ug/kg) lock-in time (min) morphine 10～200～201006～8 Hydromorphine Ketone3～50～5206～8Fentanyl0.
25～0.
50.
1516～8Nalbuphine10～200～201006～8Adspted from [1]Yaster M, Kost-Byerly S,Maxwell LG.
Opioid agonists and antagonists.
In： Schechter NL, Berde CB, Yaster M, eds.
pain in Infants, Chlidren and Adolescents.
2nd ed.
Philadelphia, PA: Linppincott Williams & Wilkins; 2003: 620-638.
[2] Greco C, Berde C.
Pain management for the hospitalized pediatrent .
pediatr Clin North Am.
2005;52(4):995-1027.
★If the patient is asleep or hypnotized, the surrogate should not press the PCA pump without authorization to increase the dose
.

Surrogate PCA pump therapy may be a safe and effective analgesic therapy if appropriate protection and monitoring measures are taken
.

Local anesthetics and associated epidural analgesia Bupivacaine or Ropivacaine Fentanyl Hydromorphone Morphine Clonidine Concentration 0.
05%-0.
125% (0.
5-1.
25mg/ml) 1-3ug/ml3-7ug /ml3～10ug/ml0.
5～1ug/ml Recommended dose range (the upper limit is the maximum allowable dose) Age<6 months-0.
2-0.
25mg/(kg h) Age>6 months 0.
2～0.
4mg/(kg ·h) 0.
2～1ug/(kg·h) 1～2.
5ug/(kg·h) 2～2.
5ug/(kg·h) 0.
1～0.
5ug/(kg·h) Guidelines for the maximum allowable dose of local anesthesia Single dose of drug (mg/kg) Neonatal <6 months Single dose (mg/kg) Child infusion dose [mg/(kg h)] Neonatal infusion dose [mg/(kg h)] Child Bupivacaine 1.
52.
50.
20.
4 Ropivacaine 1.
530.
2～0.
250.
4～0.
5 Levobupivacaine 1.
52.
50.
20.
4 Chloroprocaine 10101818 Lidocaine 350.
81.
6 Modified from: Suresh S, Wheeler M.
Practical pediatric regional anesthsia.
Anesthsiol Clin North America.
2002;83-113.
Dosing guidelines for epidural opioids and local anesthetic adjuvants Drug concentration (ug/ml) single-dose (ug/kg) infusion Injection rate [ug/(kg h)] Fentanyl 1～30.
5～10.
2～1 Hydromorphone 3～71-2.
5 Morphine 10～30 Clonidine 0.
5～11～20.
1～0.
2 Ketamine 500～1000 (recommended <1.
0 mg/kg) to reduce adverse reactions NA sodium bicarbonate 1mg lidocaine, 0.
1mg/ml bupivacaine, ropivacaine, or levupivacaine refer to some of the views and usages of the above table in "Pediatric Anesthesia Practice Methods" only For reference, practice or use, please follow the routine and personal experience of your department (to ensure patient safety)