15 mg/kg IV (>3/12 old, max 60 mg/kg/day)
Max daily dose if <3/12 old, 60 mg/kg/day
For term neonates (>38/40 – 3/12 old), IV dose 10 mg/kg TDS
Under 1 year: 5 mg/kg qds
Local anaesthetics
Calculating concentrations:
1% = 10 mg/ml
0.5% = 5 mg/ml
0.25% = 2.5 mg/ml
0.125% = 1.25 mg/ml
Drug | Maximum dose | Maximum dose with adrenaline | Maximum dose for 70 kg patient | Notes |
---|---|---|---|---|
Lidocaine | 3 mg/kg | 6–7 mg/kg | 210 mg/420 mg (with adrenaline) | 1% or 2% concentration Onset 5–10 min |
Bupivacaine | 2 mg/kg | 2.5 mg/kg | 140 mg/175 mg (with adrenaline) | 0.125% (usually in epidural infusion); 0.25% or 0.5% concentration LSCS spinal dose: 2.2–2.7 ml 0.5% heavy bupivacaine |
Levobupivacaine | 2.5–3 mg/kg | 2.5–3 mg/kg | 210 mg | S-enantiomer of bupivacaine; less cardiotoxic |
Ropivacaine | 3 mg/kg | 4 mg/kg | 210/280 mg (with adrenaline) | |
Prilocaine | 6 mg/kg | 9 mg/kg | 420 mg/630 mg (with adrenaline) | 0.5%, 1% or 2% concentration Onset 5–10 min |
Cocaine | 3 mg/kg | N/A | 210 mg | Generally reserved for ENT |
Intralipid 20%: 1.5 ml/kg bolus; start IV infusion 15 ml/kg/h. Give up to 2 repeat boluses, increase infusion to 30 ml/kg/h up to maximum 12 ml/kg
For 70 kg patient: give 100 ml bolus, start IV infusion at 1000 ml/h. Give up to 2 further doses of 100 ml, then double rate to 2000 ml/h up to a maximum of 840 ml
Emergency drugs
Drug | Concentration | Average dose 70 kg | Paeds/Other | Notes |
---|---|---|---|---|
Adrenaline | 100 mcg/ml (in minijet 1:10 000) | 50–100 mcg boluses = 0.5–1 ml 1:10 000 | 10 mcg/kg (0.1 ml/kg) in paediatric cardiac arrest | IV infusion 2–20 mcg/min (dilute in 5% dextrose) |
Atropine | 600 mcg/ml | 300–600 mcg | 20 mcg/kg | |
Ephedrine | 3 mg/ml | 3–60 mg | Dilute 30 mg in 9 ml 0.9% NaCl | |
Glycopyrrolate | 200 mcg/ml | 200–600 mcg | 4–10 mcg/kg | |
Metaraminol | 0.5 mg/ml | 0.5–1 mg bolus prn | 10 mcg/kg | Dilute 10 mg in 19 ml 0.9% NaCl |
Noradrenaline | 80 mcg/ml (4 mg/50 ml) | Dilute in 5% dextrose Starting rate IV infusion = 0.025 mcg/kg/min | ||
Phenylephrine | 10 mg/ml | 50–100 mcg bolus | Obs: boluses, or run IV infusion (50 mcg/ml) at 30–40 ml/h | 10 mg in 100 ml 0.9% NaCl = 100 mcg/ml Use 10–20 ml in syringes as required |

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