Pediatric Emergency Medicine

ANALGESIA AND SEDATION DOSAGES

Propofol (Diprivan®):         

  • Bolus: 5 mcg/kg/min (0.3 mg/kg/hr) IV infusion for 5 min

  • Infusion: Titrate in 5 to 10 mcg/kg/min (0.3 to 0.6 mg/kg/hr) increments to achieve desired level of sedation; allow minimum of 5 min between dose adjustments; usual maintenance rates 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/hr) or higher

  • A/E: Hypotension, respiratory depression

 

Midazolam (Versed®):       

  • Bolus: 0.01 to 0.05 mg/kg IV administered over several minutes; may repeat at 10- to 15-minute intervals until adequate sedation is achieved        

  • Infusion: Initiated at a rate of 0.02 to 0.1 mg/kg/hr; may adjust rate up or down by 25% to 50% of initial infusion rate to achieve adequate sedation

  • A/E: Hypotension, respiratory depression

 

Dexmedetomidine (Precedex®):   

  • Bolus: Loading infusion of 1 mcg/kg IV over 10 minutes; no loading dose required when converting from alternate sedative therapy        

  • Infusion: Maintenance, 0.2 to 0.7 mcg/kg/hr continuous IV infusion titrated to desired clinical effect

  • A/E: Hypotension, bradycardia      

 

Fentanyl citrate:                   

  • Infusion: Continuous infusion, 0.7 to 10 mcg/kg/hr IV

  • A/E: Hypotension, accumulates in fatty tissue     

  • Intermittent Dosing: 0.35 to 1.5 mcg/kg IV every 0.5 to 1 hour, if inadequate pain relief consider bolus and increasing drip by 25-50%

Ketamine: Based on general anesthesia/procedural sedation dosages 

  • Bolus: Induction, 1 to 2 mg/kg IV over 1 to 2 min, may be followed by 0.25 to 0.5 mg/kg IV every 5 to 10 min as needed

  • Infusion: 0.01to 0.03 mg/kg/min continuous IV infusion          

  • A/E: Sympathomimetic effects, laryngospasm

Haloperidol (Haldol®):       

  • Bolus: Bolus with infusion: 0.5 mg bolus followed by 0.1 mg/hr infusion                 

  • A/E: Prolonged QT, Extrapyramidal Symptoms   

  • Intermittent Dosing: 2.5 mg every 8 hours, can have added boluses of 2.5 mg – 5 mg with daily max of 10 mg

 

Remifentanil (Ultiva®):     

  • Bolus: Continuous infusion, 0.1 to 0.15 mcg/kg/min IV initially (using ideal body weight)   

  • Infusion: Titration to a MAX dose of 0.2 to 0.4 mcg/kg/min IV    

  • A/E: Hypotension, bradycardia  

Morphine sulfate:                

  • Infusion: 0.07 to 0.5 mg/kg/hr IV

  • A/E: Hypotension, respiratory depression

  • Intermittent Dosing: 0.01 to 0.15 mg/kg IV every 1 to 2 hours, if inadequate pain relief consider bolus and increasing infusion


   

WYCKOFF HEIGHTS MEDICAL CENTER

EMERGENCY MEDICINE RESIDENCY

374 Stockholm St, Brooklyn, NY 11237, USA

©2019 WYCKOFF EMERGENCY MEDICINE RESIDENCY.