Peri-op  

THE BELLFLOWER PERIOPERATIVE POCKET MANUAL
Maracus Magallanes, MD 2002

15.  PEDIATRIC SECTION

FLUIDS

After appropriate correction for hypovolemia with 10-15 ml/kg NS, routine maintenance is started as follows:

It is easier for the nurses to run a number divisible by 24; therefore, the following table is offered:
Kg mL/24h mL/h Kg mL/24h mL/h
4 384 16 17 1344 56
5 480 20 18 1392 58
6 600 25 19 1461 61
7 696 29 20 1488 62
8 792 33 25 1584 66
9 888 37 30 1680 70
10 984 41 35 1800 75
11 1056 44 40 1896 79
12 1104 46 45 1992 83
13 1152 48 50 2088 87
14 1200 50 55 2184 91
15 1248 52 60 2280 95
16 1296 54

Initial bolus of crystalloid is NS 10-20 ml/kg; then D5NS, D5½NS, NS, or ½NS with maintenance volumes as above + replacement as necessary as NS or ½NS. Once voiding well, routine maintenance fluid can be D5Isolyte M, which is similar to D5¼NS but with potassium and acetate.


ANTIBIOTICS            Peri-op  

For intra-abdominal infection (e.g. appy, GI perforation), usual antibiotic doses for over one week of age:

OR

P.O. regimen for post discharge (only for patients with resolving infectious complications of appendicitis):

For treatment of Staph aureus infection:

For treatment of UTI:

*If patient remains symptomatic 24 hours after start of treatment for UTI, a repeat urinalysis and urine culture and change of antibiotics is warranted.

Generally contraindicated antibiotics in pediatrics are the floxacins because of cartilage damage in the growing child, tetracyclines because of tooth staining, chloramphenicol in infants because of gray baby syndrome and in older children because of idiosyncratic bone marrow suppression. Other than allergies, the remainder of the antibiotic armamentarium is not contraindicated.

Antibiotic Suspensions and Chewables for Pediatrics

Antibiotic Type Preparation Sizes (ml)


PAIN MEDS            Peri-op  

Parenteral:

· First choice PCA pump-parent or nurse may adjust dosage for patients 7 years of age or older using the standard PCA orders.

· Second choice Demerol 1mg/kg IV, 2mg/kg IM q4h

Oral:

· First choice Tylenol (per dosing chart)

· Second choice Tylenol with codeine (120mg acetaminophen/ 12mg codeine). Based on codeine dose of 0.5-1 mg/kg/dose q4h, approximate doses:

· Alternative is Ibuprofen Suspension (100mg/ 5ml)


ANTIEMETICS             Peri-op  

ANTIPYRETICS

Acetaminophen (Tylenol) Dosage Chart
Age

Weight

Drops

0.8 ml

0.9 ml

Elixir

160 mg/5 mL

Chew Tab

80 mg

Jr. Size Tab

160 mg

Adult Size Tab

325 mg

0-3 mos

6-11 lbs

0.4 1/4 tsp 1/2 tab
4-11 mos

12-17 lbs

0.8 1/2 tsp 1 tab
12-23 mos

18-23 lbs

1.5 droperful
(1/2 ml)
1/2 tsp 1.5 tabs
2-3 yrs

24-35 lbs

1 tsp 2 tabs
4-5 yrs

36-47 lbs

1.5 tsp 3 tab
6-8 yrs

48-59 lbs

2 tsp 4 tabs 2 tabs 1 tab
9-11 yrs

60-95 lbs

2.5 - 3 tsp 5-6 tabs 2.5 - 3 tabs 1.5 - 2 tabs
12-14 yrs

96+ lbs

4 tabs 2 tabs

*Kaiser Permanente does not endorse a brand name-any similar product may be used.


STIMULANT LAXATIVES          Peri-op  

· Dulcolax (bisacodyl) tablets: (results within 6-8h)

· Dulcolax (bisacodyl) suppositories:

· Colace (docusate) 20mg per 5ml:

ANTACIDS

* Pediatrics section contributed by Dr. Alan Alter (Pediatrics)
   Reviewed by Dr. John  Crabtree (General Surgery)

       Peri-op  

2002