BNF for Children 2011-2012

644 15.1.5 Neuromuscular blocking drugs BNFC 2011–201215 AnaesthesiaIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightNeuromuscular blockade (intermediate duration)during surgery. By intravenous injectionChild 1 month–2 years initially 150 micrograms/kg, then 30 micrograms/kg repeated approx. every20 minutes as necessaryChild 2–12 years initially 150 micrograms/kg(80–100 micrograms/kg if not for intubation), then20 micrograms/kg repeated approx. every 10minutes as necessaryChild 12–18 years initially 150 micrograms/kg,then 30 micrograms/kg repeated approx. every 20minutes as necessary. By intravenous administrationChild 2–18 years initially 150 micrograms/kg byintravenous injection, then by intravenous infusion180 micrograms/kg/hour, reduced to 60–120 micrograms/kg/hour according to responseAdministration for continuous intravenous infusion,dilute to a concentration of 0.1–2 mg/mL with Glucose5% or Sodium Chloride 0.9%; solutions of 2 mg/mL and 5 mg/mL may be infused undilutedNimbex c (GSK) AInjection, cisatracurium (as besilate) 2 mg/mL, netprice 10-mL amp = £7.55Forte injection, cisatracurium (as besilate) 5 mg/mL,net price 30-mL vial = £31.09MIVACURIUMCautions see notes above; low plasma cholinesteraseactivityHepatic impairment reduce dose in severe impairmentRenal impairment clinical effect prolonged in renalfailure—reduce dose according to responsePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes aboveIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightNeuromuscular blockade (short duration) duringsurgery. By intravenous administrationChild 2–6 months by intravenous injection initially150 micrograms/kg, then either by intravenousinjection 100 micrograms/kg repeatedevery 6–9 minutes as necessary or by intravenousinfusion, 8–10 micrograms/kg/minute, adjusted ifnecessary every 3 minutes by 1 microgram/kg/minute to usual dose 11–14 micrograms/kg/minuteChild 6 months–12 years by intravenous injectioninitially 200 micrograms/kg, then either byintravenous injection 100 micrograms/kgrepeated every 6–9 minutes as necessary or byintravenous infusion, 8–10 micrograms/kg/minute,adjusted if necessary every 3 minutes by1 microgram/kg/minute to usual dose 11–14 micrograms/kg/minuteChild 12–18 years by intravenous injection initially70–250 micrograms/kg, then either by intravenousinjection 100 micrograms/kg repeatedevery 15 minutes as necessary or by intravenousinfusion, 8–10 micrograms/kg/minute, adjusted ifnecessary every 3 minutes by 1 microgram/kg/minute to usual dose of 6–7 micrograms/kg/minuteAdministration for intravenous injection, give undilutedor dilute in Glucose 5% or Sodium Chloride0.9%. Doses up to 150 micrograms/kg may be givenover 5–15 seconds, higher doses should be given over30 seconds. In asthma, cardiovascular disease or inthose sensitive to reduced arterial blood pressure,give over 60 seconds.Mivacron c (GSK) AInjection, mivacurium (as chloride) 2 mg/mL, netprice 5-mL amp = £2.79; 10-mL amp = £4.51PANCURONIUM BROMIDECautions see notes aboveHepatic impairment possibly slower onset, higherdose requirement, and prolonged recovery timeRenal impairment use with caution; prolonged durationof blockPregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes aboveIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightNeuromuscular blockade (long duration) duringsurgery. By intravenous injectionNeonate initially 100 micrograms/kg, then50 micrograms/kg repeated as necessaryChild 1 month–18 years initially 100 micrograms/kg,then 20 micrograms/kg repeated asnecessaryAdministration for intravenous injection, give undilutedor dilute in Glucose 5% or Sodium Chloride0.9%Pancuronium (Non-proprietary) AInjection, pancuronium bromide 2 mg/mL, net price2-mL amp = £1.20ROCURONIUM BROMIDECautions see notes aboveHepatic impairment reduce doseRenal impairment reduce maintenance dose; prolongedparalysisPregnancy see notes aboveBreast-feeding see notes above