BNF for Children 2011-2012

BNFC 2011–2012 15.1.4 Sedative and analgesic peri-operative drugs 641Side-effects section 4.7.2 and notes above; alsohypertension, myoclonic movements; less commonlyarrhythmias, hiccup, laryngospasm; rarely epistaxis;also reported cardiac arrest, cough, convulsions, andpyrexiaIndication and doseTo avoid excessive dosage in obese children, dose mayneed to be calculated on the basis of ideal weight forheightAnalgesia especially during short procedures;enhancement of anaesthesia. By intravenous injection over 30 seconds (withassisted ventilation)Neonate initially 5–20 micrograms/kg; supplementaldoses up to 10 micrograms/kgChild 1 month–18 years initially 10–20 micrograms/kg;supplemental doses up to 10 micrograms/kg. By intravenous infusion (with assisted ventilation)Neonate initially 10–50 micrograms/kg over 10minutes followed by 0.5–1 micrograms/kg/minuteChild 1 month–18 years initially 50–100 micrograms/kgover 10 minutes followed by 0.5–1 micrograms/kg/minuteAdministration for continuous or intermittent intravenousinfusion dilute in Glucose 5% or SodiumChloride 0.9%Alfentanil (Non-proprietary) 2Injection, alfentanil (as hydrochloride) 500 micrograms/mL,net price 2-mL amp = 70p, 10-mL amp =£3.20Intensive care injection, alfentanil (as hydrochloride)5 mg/mL, net price 1-mL amp = £2.50Note To be diluted before useRapifen c (Janssen) 2Injection, alfentanil (as hydrochloride) 500 micrograms/mL,net price 2-mL amp = 64p; 10-mL amp =£2.90Intensive care injection, alfentanil (as hydrochloride)5 mg/mL, net price 1-mL amp = £2.32Note To be diluted before useFENTANYLCautions see Fentanyl, section 4.7.2 and notes aboveContra-indications see notes in section 4.7.2Hepatic impairment see notes in section 4.7.2Renal impairment see notes in section 4.7.2Pregnancy see notes in section 4.7.2Breast-feeding see Fentanyl, section 4.7.2Side-effects see Fentanyl, section 4.7.2 and notesabove; also myoclonic movements; less commonlylaryngospasm; rarely asystole, insomniaLicensed use not licensed for use in children under 2years; infusion not licensed for use in children under12 yearsIndication and doseTo avoid excessive dosage in obese children, dose mayneed to be calculated on the basis of ideal weight forheightSpontaneous respiration: analgesia duringoperation, enhancement of anaesthesia. By intravenous injection over at least 30 secondsChild 1 month–12 years initially 1–3 micrograms/kg,then 1 microgram/kg as requiredChild 12–18 years initially 50–100 micrograms(max. 200 micrograms on specialist advice), then25–50 micrograms as requiredAssisted ventilation: analgesia during operation,enhancement of anaesthesia. By intravenous injection over at least 30 secondsNeonate initially 1–5 micrograms/kg, then 1–3 micrograms/kg as requiredChild 1 month–12 years initially 1–5 micrograms/kg,then 1–3 micrograms/kg as requiredChild 12–18 years initially 1–5 micrograms/kg,then 50–200 micrograms as requiredAssisted ventilation: analgesia and respiratorydepression in intensive care. By intravenous administrationNeonate initially by intravenous injection 1–5 micrograms/kg, then by intravenous infusion,1.5 micrograms/kg/hour adjusted according toresponseChild 1 month–18 years initially by intravenousinjection 1–5 micrograms/kg, then by intravenousinfusion, 1–6 micrograms/kg/hour adjustedaccording to responseAnalgesia in other situations section 4.7.2Administration for intravenous infusion, injectionsolution may be diluted in Glucose 5% or SodiumChloride 0.9%Fentanyl (Non-proprietary) 2Injection, fentanyl (as citrate) 50 micrograms/mL, netprice 2-mL amp = 30p, 10-mL amp = 64pSublimaze c (Janssen) 2Injection, fentanyl (as citrate) 50 micrograms/mL, netprice 10-mL amp = £1.31REMIFENTANILCautions section 4.7.2 and notes aboveContra-indications section 4.7.2 and notes above; leftventricular dysfunction; analgesia in consciouspatientsHepatic impairment section 4.7.2Pregnancy no information available; see also section4.7.2Breast-feeding avoid breast-feeding for 24 hours afteradministration—present in milk in animal studiesSide-effects section 4.7.2 and notes above; alsohypertension; less commonly hypoxia; rarely asystole;AV block and convulsions also reported15 Anaesthesia