BNF for Children 2011-2012

632 15.1.2 Inhalational anaesthetics BNFC 2011–201215 AnaesthesiaMaintenance of sedation for surgical and diagnosticprocedures using 1% injection. By intravenous infusionChild 1 month–18 years dose and rate ofadministration adjusted according to desired levelof sedation and response; usual dose in child1 month–17 years 1.5–9 mg/kg/hour (additionally,if rapid increase in sedation required, by slowintravenous injection, max. 1 mg/kg); usual dosein child 17–18 years 1.5–4.5 mg/kg/hour (additionally,if rapid increase in sedation required, byslow intravenous injection, 10–20 mg)Maintenance of sedation for surgical and diagnosticprocedures using 2% injection. By intravenous infusionChild 3–18 years dose and rate of administrationadjusted according to desired level of sedation andresponse; usual dose in child 3–17 years 1.5–9 mg/kg/hour; usual dose in child 17–18 years 1.5–4.5 mg/kg/hour (additionally, if rapid increase insedation required, by slow intravenous injectionusing 0.5% or 1% injection, 10–20 mg)Administration for continuous intravenous infusion;microbiological filter not recommended; 0.5% or 1%emulsion may be infused undiluted using a suitableinfusion pump; may also be administered via a Y-piece close to injection site co-administered withGlucose 5% or Sodium Chloride 0.9%; alternativelydilute to a concentration not less than 2 mg/mL(1 mg/mL for 0.5% injection) with Glucose 5% (orSodium Chloride 0.9% for Propofol-Lipuro c ,Propoven c , Braun, and Fresenius Kabi brands); useglass or PVC containers (if PVC bag used, it should befull—withdraw volume of infusion fluid equal to thatof propofol to be added); give within 6 hours ofpreparation2% emulsion do not dilute; may be administered via aY-piece close to injection site co-administered withGlucose 5% or Sodium Chloride 0.9%Propofol (Non-proprietary) A0.5% injection (emulsion), propofol 5 mg/mL, netprice 20-mL amp = £3.46Brands include Propofol-Lipuro c1% injection (emulsion), propofol 10 mg/mL, netprice 20-mL amp = £4.18, 50-mL bottle = £10.10, 100-mL bottle = £19.40Brands include Propofol-Lipuro c , Propoven c2% injection (emulsion), propofol 20 mg/mL, netprice 50-mL vial = £21.30Brands include Propofol-Lipuro c , Propoven cDiprivan c (AstraZeneca) A1% injection (emulsion), propofol 10 mg/mL, netprice 20-mL amp = £1.07, 50-mL prefilled syringe (foruse with Diprifusor c TCI system) = £4.722% injection (emulsion), propofol 20 mg/mL, netprice 50-mL prefilled syringe (for use withDiprifusor c TCI system) = £5.27THIOPENTAL SODIUM(Thiopentone sodium)Cautions see notes above; cardiovascular disease;reconstituted solution is highly alkaline—extravasationcauses tissue necrosis and severe pain; avoidintra-arterial injection; interactions: Appendix 1(anaesthetics, general)Contra-indications see notes above; acute porphyria(section 9.8.2); myotonic dystrophyHepatic impairment use with caution—reduce doseRenal impairment caution in severe impairmentPregnancy may depress neonatal respiration if usedduring delivery; dose should not exceed 250 mgBreast-feeding breast-feeding can be resumed assoon as mother has recovered sufficiently fromanaesthesiaSide-effects hypotension, arrhythmias, myocardialdepression, laryngeal spasm, cough, headache,sneezing, hypersensitivity reactions, rashLicensed use not licensed for use in status epilepticus;not licensed for use by intravenous infusionIndication and doseInduction of anaesthesia. By slow intravenous injectionNeonate initially up to 2 mg/kg, then 1 mg/kgrepeated as necessary (max. total dose 4 mg/kg)Child 1 month–18 years initially up to 4 mg/kg,then 1 mg/kg repeated as necessary (max. totaldose 7 mg/kg)Prolonged status epilepticus. By slow intravenous injection and intravenousinfusionNeonate initially up to 2 mg/kg by intravenousinjection, then up to 8 mg/kg/hour by continuousintravenous infusion, adjusted according toresponseChild 1 month–18 years initially up to 4 mg/kgby intravenous injection, then up to 8 mg/kg/hourby continuous intravenous infusion, adjustedaccording to responseAdministration For intravenous injection, dilute to aconcentration of 25 mg/mL with Water for Injections,and give over at least 10–15 seconds; for intravenousinfusion dilute to a concentration of 2.5 mg/mL withSodium Chloride 0.9%Thiopental (Archimedes) AInjection, powder for reconstitution, thiopental sodium,net price 500-mg vial = £3.6815.1.2 Inhalational anaestheticsImportantThe drugs in this section should be used by experiencedpersonnel only and when resuscitation equipmentis available.Inhalational anaesthetics include gases and volatileliquids. Gaseous anaesthetics require suitable equipmentfor administration. Volatile liquid anaestheticsare administered using calibrated vaporisers, using air,oxygen, or nitrous oxide-oxygen mixtures as the carrier