BNF for Children 2011-2012

BNFC 2011–2012 15.1.4 Sedative and analgesic peri-operative drugs 639Premedication (but see notes above). By mouthChild 1 month–18 years 500 micrograms/kg(max. 20 mg) 15–30 minutes before the procedure. By rectumChild 6 months–12 years 300–500 micrograms/kg 15–30 minutes before inductionInduction of anaesthesia (but rarely used). By slow intravenous injectionChild 7–18 years initially 150 micrograms/kg(max. 7.5 mg) given in steps of 50 micrograms/kg(max. 2.5 mg) over 2–5 minutes; wait for 2–5minutes then give additional doses of 50 micrograms/kg(max. 2.5 mg) every 2 minutes ifnecessary; max. total dose 500 micrograms/kg(not exceeding 25 mg)Sedation in intensive care. By intravenous injection and continuous intravenousinfusionNeonate less than 32 weeks gestational age60 micrograms/kg/hour by continuous intravenousinfusion, reduced after 24 hours to30 micrograms/kg/hour; adjusted according toresponse; max. treatment duration 4 daysNeonate over 32 weeks gestational age60 micrograms/kg/hour by continuous intravenousinfusion adjusted according to response;max. treatment duration 4 daysChild 1–6 months 60 micrograms/kg/hour bycontinuous intravenous infusion adjusted accordingto responseChild 6 months–12 years initially 50–200 micrograms/kgby slow intravenous injection over atleast 3 minutes followed by 30–120 micrograms/kg/hour by continuous intravenous infusionadjusted according to responseChild 12–18 years initially 30–300 micrograms/kg by slow intravenous injection given in steps of1–2.5 mg every 2 minutes followed by 30–200 micrograms/kg/hour by continuous intravenousinfusion adjusted according to responseNote Initial dose may not be required and lower maintenancedoses needed if opioid analgesics also used;reduce dose (or reduce or omit initial dose) in hypovolaemia,vasoconstriction, or hypothermiaStatus epilepticus section 4.8.2Administration for administration by mouth, injectionsolution may be diluted with apple or black currantjuice, chocolate sauce, or colaFor buccal administration, administer half of the dosebetween the upper lip and gum on each side of themouth using an oral syringe; retain in the mouth for atleast 5 minutes then swallowFor continuous intravenous infusion, dilute with Glucose5% or Sodium Chloride 0.9%Neonatal intensive care, dilute 15 mg/kg body-weightto a final volume of 50 mL with infusion fluid; anintravenous infusion rate of 0.1 mL/hour provides adose of 30 micrograms/kg/hourFor rectal administration of the injection solution,attach a plastic applicator onto the end of a syringe; ifthe volume to be given rectally is too small, dilute withWater for InjectionsMidazolam (Non-proprietary) 3Oral liquid, midazolam 2.5 mg/mL, 100 mLAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Buccal liquid, midazolam 5 mg/mL, 0.5-mL (2.5 mg)prefilled syringe, 1-mL (5 mg) prefilled syringe, 1.5-mL(7.5 mg) prefilled syringe, 2-mL (10 mg) prefilledsyringe; 10 mg/mL, 5-mL pack and 25-mL packAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Injection, midazolam (as hydrochloride) 1 mg/mL,net price 2-mL amp = 50p, 5-mL amp = 60p, 50-mLvial = £7.87; 2 mg/mL, 5-mL amp = 65p; 5 mg/mL, 2-mL amp = 58p, 10-mL amp = £2.50Hypnovel c (Roche) 3Injection, midazolam (as hydrochloride) 2 mg/mL,net price 5-mL amp = 85p; 5 mg/mL, 2-mL amp =72pTEMAZEPAMCautions see notes above and Diazepam, section4.8.2; interactions: Appendix 1 (anxiolytics and hypnotics)Contra-indications see Diazepam, section 4.8.2Hepatic impairment see Benzodiazepines, section4.8.1Renal impairment see Benzodiazepines, section 4.8.1Pregnancy see Benzodiazepines, section 4.8.1Breast-feeding see Benzodiazepines, section 4.8.1Side-effects see notes above and Diazepam, section4.8.2Licensed use tablets not licensed for use in childrenIndication and dosePremedication. By mouthChild 12–18 years 10–20 mg 1 hour before procedureTemazepam (Non-proprietary) 3Tablets, temazepam 10 mg, net price 28-tab pack =£3.42; 20 mg, 28-tab pack = £2.24. Label: 19Dental prescribing on NHS Temazepam Tablets may beprescribedOral solution, temazepam 10 mg/5 mL, net price300 mL = £33.44. Label: 19Note Sugar-free versions are available and can be ordered byspecifying ‘sugar-free’ on the prescriptionDental prescribing on NHS Temazepam Oral Solution maybe prescribedNote See p. 9 for prescribing requirements of controlled drugs15.1.4.2 Non-opioid analgesicsSince non-steroidal anti-inflammatory drugs (NSAIDs)do not depress respiration, do not impair gastro-intestinalmotility, and do not cause dependence, they maybe useful alternatives or adjuncts to opioids for the reliefof postoperative pain. NSAIDs may be inadequate forthe relief of severe pain.15 Anaesthesia