Pediatric Cardiovascular Anesthesia Drug Sheet (September 2022)


Appendix: Pediatric Cardiovascular Anesthesia Drug Sheet (September 2022)


Lisa A. Caplan1 and Erin A. Gottlieb2


1 Arthur S. Keats Division of Pediatric Cardiovascular Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA


2 Division of Pediatric Cardiac Anesthesiology, Department of Surgery and Perioperative Care, The University of Texas at Austin, Dell Children’s Medical Center of Central Texas, Associate Professor of Surgery and Perioperative Care Dell Medical School, Austin, TX, USA


Drug doses and treatments are those commonly recommended; each patient’s treatment must be individualized, drug doses double‐checked for accuracy, and drug concentrations and modes of administration used according to local guidelines. The information here is current at the time of publication; however, the practitioner must always be aware of new recommendations and remains responsible for determining the best course of treatment. Consult the textbook, hospital formulary, or authoritative internet resources for a complete listing of indications, contraindications, interval dosing schedules, and side‐effects of these drugs and treatments. All drugs are intravenous, unless otherwise noted. Drugs denoted with an asterisk (*) are not approved by the US Food and Drug Administration (FDA) as of May 2021. Many drugs are not specifically labeled for pediatric use by the US FDA; however, the physician may choose to administer these drugs for specific indications, if in their judgment the drug will be safe and effective. The source for dosing information is the Texas Children’s Hospital formulary, current as of May 2021, except as otherwise noted in the references.
























































































































































































































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May 17, 2023 | Posted by in ANESTHESIA | Comments Off on Pediatric Cardiovascular Anesthesia Drug Sheet (September 2022)

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Vasoactive infusions
Clevidipine [1] 0.5–7 μg/kg/min Loading: 10–15 μg/kg
Dobutamine 2–20 μg/kg/min
Dopamine 2–20 μg/kg/min
Epinephrine 0.03–1 μg/kg/min
Esmolol 200–1000 μg/kg/min Loading: 100–500 μg/kg
Fenoldopam 0.1–0.8 μg/kg/min
Isoproterenol 0.03–1 μg/kg/min Maximum dose 2 μg/kg/min
Levosimendan [2]* 0.05–0.1 μg/kg/min Loading: 6–12 μg/kg over 1 hour
Liothyronine (Triostat®,T3) [3, 4] 0.05–0.15 μg/kg/hour
Milrinone 0.25–0.75 μg/kg/min Loading: 50 μg/kg over 10–60 minutes
Nesiritide 0.01 μg/kg/min; at intervals of 3 hours, dosage may be increased by 0.005 μg/kg/min to the maximum of 0.03 μg/kg/min
Nicardipine 0.5–2 μg/kg/min
Nitroglycerine 0.25–3 μg/kg/min
Nitroprusside 0.3–3 μg/kg/min
Norepinephrine 0.03–1 μg/kg/min
Phenylephrine 0.05–0.5 μg/kg/min
Prostaglandin E1 0.01–0.1 μg/kg/min
Vasopressin 0.01–0.04 units/kg/hour
Vasoactive bolus drugs
Atropine IV: 0.01–0.02 mg/kg
IM: 0.02 mg/kg
Calcium chloride 10 mg/kg IV
Calcium gluconate 30 mg/kg IV
Enalaprilat 5–10 μg/kg/dose IV Q8–24H; max. 5 mg/dose
Ephedrine 0.1 mg/kg IV max. 5 mg
Epinephrine 0.5–10 μg/kg IV
Hydralazine 0.1–0.2 mg/kg IV
Labetalol 0.2–1 mg/kg IV
Methylene blue [5–7] 1–2 mg/kg IV
Phenoxybenzamine 0.25–1 mg/kg IV
Phentolamine 0.05–0.2 mg/kg IV
Phenylephrine 0.5–3 μg/kg IV
Antiarrhythmic agents
Adenosine First dose: 0.1 mg/kg IV (max 6 mg)

Second dose: 0.2 mg/kg IV (max dose 12 mg)
Amiodarone 10–15 mg/kg/day Loading: 2.5–5 mg/kg or a maximum of 300 mg IV over 5–10 minutes. Additional boluses of 5 mg/kg or a maximum of 150 mg IV push may be given with a maximum total dose not to exceed 25 mg/kg or 2.2 g in 24 hours
Lidocaine 20–50 μg/kg/min Loading: 1 mg/kg; repeat if the dose infusion is initiated more than 15 minutes after initial bolus
Procainamide 20–80 μg/kg/min (max 2 g/day) Loading: 3–6 mg/kg/dose over 5 minutes, not to exceed 100 mg/dose; may repeat every 5–10 minutes to the maximum total loading dose of 15 mg/kg; do not exceed 500 mg in 30 minutes
Verapamil 0.1–0.3 mg/kg/dose (max. 5 mg) Repeat dose 30 minutes after the initial dose as needed (max second dose 10 mg)
Pulmonary hypertension medications
Inhaled nitric oxide 1–20 PPM
Epoprostenol [8]



Iloprost [9]

Sildenafil [10, 11]
Treprostinil		 Intravenous: 1–2 ng/kg/min initial infusion; increase by 1–2 ng/kg/min every 4–8 hours to 25–40 ng/kg/min; must be given in dedicated intravenous line
Inhaled: 20–50 ng?kg/min continuous infusion
Inhaled: Initial: 0.5 mcg/kg over 10 minutes
Subsequent Dosing: 1–2 mcg/kg over 10 minutes
0.067 mg/kg/hour; loading: 0.4 mg/kg over 3 hours
0.625–1.25 ng/kg/minute; must be given in dedicated intravenous
line
Anesthetic/analgesia agents
Acetaminophen 10–15 mg/kg IV Q6 H
Dexmedetomidine 0.25–0.75 μg/kg/hour Loading: 0.25–1.0 μg/kg over 10 minutes
Etomidate 0.2–0.3 mg/kg
Fentanyl 1–10 μg/kg Infusion: 1–10 μg/kg/hour
Hydromorphone 0.005–0.015 mg/kg Maximum single dose: 2 mg
Ibuprofen 10 mg/kg IV Q6–8H
Ketamine IV: 1–2 mg/kg

IM: 5–10 mg/kg
Ketorolac 0.5–1 mg/kg IV; 0.5 mg/kg/dose every 6 hours (max 30 mg/dose; 120 mg/day)
Midazolam 0.03–0.1 mg/kg IV
Morphine 0.05–0.2 mg/kg IV
Remifentanil 0.025–2 μg/kg/min Loading: 0.5–1 μg/kg IV
Sufentanil 0.1–0.3 μg/kg/hour Loading: 1–2 μg/kg IV