Paediatric anaesthesia

In Obesity, use Paeds Prescribing Pro.

Weight and Body Mass Index
Normal Physiological Values
SBP mmHg (– mmHg)*
HR – bpm†
RR – bpm†
*50th centile (5th – 95th)
†5th – 95th centile
Airway and Ventilation
Endotracheal tube (ETT)
Laryngoscope
Uncuffed ETT
Cuffed ETT
Depth at lips cm
Supraglottic airway device (SAD)
LMA
i-Gel
Breathing circuits
T-piece 0–20 kg
Infant (Micro) 0–10 kg
Paediatric (Mini) 10–30 kg
Adult >20 kg
Ventilation
Tidal volume (6–8 ml/kg)
Neonates / ARDS (4–6 ml/kg)
Emergency Intubation
Induction
Fentanyl 1–2 mcg/kg mcg
Ketamine 1–2 mg/kg mg
Rocuronium 1 mg/kg mg
Maintenance infusions
Morphine 10–40 mcg/kg/h (0.5–2 ml/h)
Midazolam 1–3 mcg/kg/min (1–3 ml/h)
Propofol 1–4 mg/kg/h (4–10 mg/kg/h in routine anaesthesia)
Emergency Drugs
Atropine 20 mcg/kg mcg
Adrenaline IV 1:10,000
100 mcg/ml 		0.1 mL/kg
10 mcg/kg 		mcg
Suxamethonium IV 1–2 mg/kg mg
Suxamethonium IM 4 mg/kg
(Max 150 mg) 		mg

Other
Fluid bolus 10–20 mL/kg mL
Glucose 10% 2 mL/kg mL
Defibrillation energy 4 J/kg J

For other drugs and infusions, use Paediatric Emergency Tools: Apple / Android.

Premedication & Sedation
Midazolam - PO 0.5 mg/kg mg
Max 20 mg per dose; 6 months - 14 years. Peak effect at 20-30 mins.
Midazolam - NAS 0.2 mg/kg mg
Max 10 mg. Given via short atomiser: 0.1 ml dead space. Peak effect at 10 mins.
Dexmedetomidine - NAS 2–4 mcg/kg mcg
Max 200 mcg per dose. Given 30 mins before intervention.
Routine General Anaesthesia
Induction
Fentanyl 1–2 mcg/kg mcg
Propofol 3–5 mg/kg mg
Rocuronium 0.6 mg/kg mg
Antiemetics
Dexamethasone 0.15 mg/kg mg
Ondansetron 0.15 mg/kg mg
Cyclizine 0.5–1 mg/kg mg
Intraoperative analgesia
Paracetamol IV mg
Ibuprofen IV 5–10 mg/kg mg
Ketorolac IV 0.5–1 mg/kg mg
Diclofenac IV 1 mg/kg mg
Morphine IV 0.05–0.1 mg/kg mg
Reversal of neuromuscular blockade
Neostigmine &
Glycopyrulate
2.5 mg/1mL & 500 mcg/1 mL 		0.02 mL/kg 0.05 mg/kg & 10 mcg/kg ml
Sugammadex 2 mg/kg mg

Moderate block: Return of T2 in response to TOF.
Sugammadex 4 mg/kg mg

Deep block: 1-2 PTCs, no twitch responses to TOF.
Postoperative analgesia
Paracetamol PO mg
Ibuprofen PO 5–10 mg/kg mg
Morphine PO mg
Emergency Drugs
Atropine 20 mcg/kg mcg
Suxamethonium IV 1–2 mg/kg mg
Suxamethonium IM 4 mg/kg
(Max 150 mg) 		mg
Antibiotics - Surgical prophylaxis
Amoxicillin 30 mg/kg (Max 1 g) mg
Cefuroxime 50 mg/kg (Max 1.5g) mg
Co-Amoxiclav 30 mg/kg (Max 1.2 g) mg
Flucloxacillin (Soft tissue) 25 mg/kg (Max 1 g) mg
Flucloxacillin (Open orthopaedic surgery) 50 mg/kg (Max 2 g) mg
Metronidazole 30 mg/kg (Max 500 mg) mg
Teicoplanin mg
Gentamicin 2.5 mg/kg (Max 160 mg) mg
In obesity doses should be calculated based on adjusted body weight.
Gentamicin (high-dose) 5 mg/kg (Max 480 mg) mg
In obesity doses should be calculated based on adjusted body weight.
Lines and Suction catheters
Arterial lines - Radial
Neonates/Infants <10 kg 24 G
Pressure transducer: 150 mmHg (generates a flow rate of 1.5 mL/hr)
Children >10 kg 22 G
Pressure transducer: 300 mmHg (generates a flow rate of 3 mL/hr)
Children >50 kg 20 G
Arterial lines - Femoral
Neonates 22 G, 8cm
Children 20 G, 8cm
Central venous access - Femoral (preferred)
<6 months 4–5 Fr, triple lumen, 6–8cm lines
6 m–5 y 5 Fr triple lumen, 8–12 cm
>5 y 7 fr, triple lumen, 15 cm

Central venous access - Internal jugular
<15 kg 5 cm
16–40 kg 8 cm
>40 kg 13 cm
EZ-IO
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Suction catheters
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Useful Links and Guidelines

Other calculators

Retrieval teams

Specific Emergency Guidelines

Airway Guidelines

Calculations and tables
Weight (kg)
Age 1-12 months

0.5 x Age (months) + 4
Age 1-5 years

2 x Age (years) + 8
Age 6-14 years

2 x Age (years) + 8

3 x Age (years) + 7
Airway and Ventilation
ETT size

Uncuffed ETT size = (Age/4) + 4 [Cole formula]

Cuffed ETT size = (Age/4) + 3.5 [Modified Cole]
ETT depth (oral)

Above 1 year: Depth ≈ Age/2+12

Neonates: Depth ≈ 1.17 × Birth weight (kg) + 5.58 (Tochen / “7-8-9” rule)
ETT depth (nasal)

Above 1 year: Depth ≈ Age/2+15
Circulation
Lowest acceptable SBP

<1 month: ≥60 mmHg

1 month to 1 year: ≥70 mmHg

1–10 years: 2 x Age + 70 mmHg
Lowest acceptable MAP

Age (in years) x 1.5 + 40 mmHg
Premature Neonates

Gestational age ≈ Mean Arterial Pressure