Paeds CAP Drug Calculation

	B	C	D	E	F	G	H	J	K	L	M
1	PAEDIATRIC CARDIAC DRUGS CALCULATION
2	Date: 25/4/2024
3	Baby's Name	Muhammad Rais Nazran
4	Baby's Weight:	6.9	kg
5	Age (years)	1	months	0
6	ETT Size formula	3.5	[Age/4] + 4, and anchor at:	10.5	cm	[3xETT]
7
8	Table 1: Resuscitation Drugs							PAEDIATRICS HAEMODYNAMICS
9	Drug	Dilution	Dose	Calculated dose				Age	RR	HR	MAP
10	Phenylephrine	1 amp in 100mls NS (100mcg/ml)	2-10 mcg/kg	13.8	to	69	mcg	Preterm	<60	140-160	30
11	1 ampoule = 10mg in 1ml	<10kg: 10mcg/ml in 10cc						Term	24-30	130-140	40
12		10-20kg: 50mcg/ml in 10cc						6 months	22-26	130	50
13								1-2 years	20-24	120	50-60
14		Perfusionist: 100mcg/ml						3-4 years	18-22	110	60
15	Atropine	1 ampule in 10mls NS (100mcg/ml)	10 – 20 mcg/kg	69	to	138	mcg	5-6 years	16-20	90-110	60-70
16	1ml ampoule = 1mg							10 years	12-18	80	70
17	Adrenaline	1 ampule in 10mls NS (100mcg/ml)	10 mcg/kg	0.69	mls	(100mcg/ml)
18	(Conc 1:1000)	Dr Maz: Wt <5kg: 1mcg/0.1ml (in 1cc)*						PAEDIATRICS TUBE SIZES
19	1ml ampoule = 1mg	*Take 0.1ml from 100mcg/ml and dilute into 1cc		6.9	mls	(10mcg/ml)		Age	ID (mm)	Depth (cm)
20								Preterm	2.5	6-8
21	Table 2: Induction Drugs							Term	3	9-10
22	Drug	Dilution	Dose	Calculated dose				6 months	3.5	10
23	Midazolam	1mg/ml	0.2mg/kg	1.38	mg			1-2 years	4	10-11
24	Propofol	10mg/ml	2mg/kg	13.8	mg			3-4 years	4.5	12-13
25	Ketamine	10mg/ml	2mg/kg	13.8	mg			5-6 years	5	14-15
26	Rocuronium	10mg/ml	1mg/kg	6.9	mg			10 years	6	16-17
27	Fentanyl	<3kg: 5mcg/ml in 10cc syringe	1. For on pump cases:	Pump cases:
28		>3kg: 10mcg/ml in 10cc syringe	30mcg/kg (*titrating dose)	Total -		207	mcg	CVL size
29			- 15mcg/kg prior to CPB	Prior CPB -		103.5	mcg	- 5.5F size - 3 lumen CVL (length: 5cm, 8cm, 13cm)
30			- 15mcg/kg after CPB	After CPB -		103.5	mcg	- 4/5F – 2 lumens CVL (length: 5cm)
31			2. Non pump cases:	Non pump cases:				- Length: 1/10th of pediatric height (cm)
32		*Dr Maz: 20mcg/kg (PURE)	5-10mcg/kg	34.5	to	69	mcg	- If subclavian approach: +1.5cm
33	Methylprednisolone		30 mg/kg	207	mg
34	Cefuroxime		50 mg/kg	345	mg			ETT suction catheter size		Calculated size
35	Cefazolin		30 mg/kg	207	mg			(formula: 2x the ETT size)		7	Fr
36								- Neonates: 5-8Fr
37	Table 3: Other Drugs							- Pediatrics: 8-12Fr
38	*Tranexamic Acid	1:1	Total: 30mg/kg*	Total:		207	mg	- Adolescent: 12-14Fr
39			-15 mg/kg on Induction	Induction:		103.5	mg			Calculated size
40			-15 mg/kg on Protamine	Protamine:		103.5	mg	CBD size: ETT size x2		7	Fr
41	Heparin	1000u/ml (Red) \| 5000u/ml (Blue)	300-400U/kg	2070	to	2760	U	Chest tube size: ETT size x4		14	Fr
42			100 unit/kg (BT shunt)	BT Shunt -		690	U
43	Recommendation:							Post Bypass Transfusion
44	(1) Maximum recommended tranexamic acid for bolus dose is (30mg/kg)							Non cyanotic heart aim Hct 30%
45	(2) Higher bolus dosage (>30mls/kg) of tranexamic acid is associated with seizure							Cyanotic heart aim Hct 35-40%
46								Target ~ Hb 10
47	Table 4: Inotropes, Vasopressors							Packed cell 4-5ml/kg, increase 1g Hb
48	Drug	Dilution	Dose	Calculated dose
49	Adrenaline	0.3 mg/kg in 50cc	(1ml/h = 0.1mcg/kg/min)	2.07	mg	in 50cc			Current Hb	8	g/dL
50	Adrenaline	0.3 mg/kg in 50cc	Max 0.2 mcg/kg/min						Target Hb	10	g/dL
51	Noradrenaline	0.3 mg/kg in 50cc	(1 ml/h = 0.1 mcg/kg/min)	2.07	mg	in 50cc			How much to tx	55.2	mls
52	Noradrenaline	0.3 mg/kg in 50cc	Max 0.2 mcg/kg/min
53	Milrinone	1.5 mg/kg in 50cc	(1ml/h=0.5mcg/kg/min)	10.35	mg	in 50cc
54	Milrinone	1.5 mg/kg in 50cc	Max 0.75mcg/kg/min
55	Dopamine/Dobutamine	15 mg/kg in 50mls 0.9% NS or 5%Dex	(1 ml/h = 5 mcg/kg/min)	103.5	mg
56	Dopamine/Dobutamine	15 mg/kg in 50mls 0.9% NS or 5%Dex	Max 20mcg/kg/min
57	Vasopressin	3 Unit/kg in 50cc	0.1-1 ml/hr	6.9	to	20.7	u
58			(0.1-1 munit/kg/min) *		in 50cc
59	SNP	50mg dilute in 10cc (1ml = 5mg)	(1ml/h = 1 mcg/kg/min)	20.7	mg	in 50cc
60	50mg powder	3 mg/kg in 50cc	Run at 0.5-4.0ml/hr
61	GTN	3 mg/kg in 50cc	(1ml/h = 1 mcg/kg/min)	20.7	mg	in 50cc
62			Run at 0.5-5.0ml/hr
63
64	Table 5: Pump Drugs
65	Drug	Dilution	Dose	Calculated dose
66	MgSO4	1:1	0.2ml/kg	1.38	ml
67	Lignocaine	1:1	1 ml/kg	6.9	ml
68	NaHCO3	1:1	1-2 ml/kg	6.9	ml
69	Calcium gluconate	1:1	0.5 ml/kg	3.45	ml
70	KCL	(1mls=1.34mmol)	0.4mmol/kg (1:1)	2.76	mmol
71	Insulin	Take 0.1ml using a 1 ml syringe, then dilute it into a 10ml syringe (Conc: 1unit/ml)	0.1U/kg	0.69	U
72
73	Table 6: Heparin Reversal
74	Drug	Dilution	Dose	Calculated dose
75	*Protamine	1:1	0.7-1.2mg/100U heparin	14.49	to	24.84	mg
76	*Recommendation:
77	(1)Based on pharmacokinetics of heparin, a 1:1 ratio could lead to protamine overdose and bleeding(use cautiously)
78	(2)Dose of 80-90% is recommended for Protamine reversal
79
80	Table 7: DIVC
81	Drug	Dilution	Dose	Calculated dose
82	FFP	1Unit = 195 -210mls	10ml/kg	69	ml
83	*Cryoprecipitate	1Unit =35-40mls	1U/10kg	1	Unit
84	*Platelet	1Unit =45-50mls	10ml/kg	69	ml
85	Packed Cell		4ml/kg = increase 1g/dL	27.6	mls 1g/dL increase
86	*Recommendation:
87	(1)Cryoprecipitate only recommended in situation of hypofibrogenaemia or documented CPB time >180 mins
88	(2)Platelet transfusion only recommended in excessive bleeding post CPB after adequate heparin reversal
89	(3)Exclude surgical bleed prior to blood products transfusion
90
91	Table 8: Maximum surgical blood order schedule (MSBOS)
92	Products	Indication	Dose	Bring to OT
93	Packed Cell	CPB Priming (warm 1 pint adult)	Pump Case	2 pint (adult) + 4 pedipack
94			Non Pump Case	2 pedipack
95	FFP	CPB Priming	20mls/kg (Wt <10kg)	138			mls
96
97	To give to perfunionist
98	- Phenylephrine 100mcg/ml in 20 ml syringe
99	- Antibiotics (see table 2)
100