eTable. Drug preparation*1.
| Preparation | Pediatric dosage | Effect onset (minutes) | Effect duration (minutes) | Analgesia/Remarks |
| Midazolam | Intravenously (0.5 to 5 years): initially 0.05 to 0.1 mg/kg, | IV: 2 to 3 | IV: 45 to 60 | – Effects: anxiolytic, amnestic, anticonvulsant, sedative, central muscle relaxation |
| then titrate to effect up to a maximum of 0.6 mg/kg | PO: 15 to 30 | PO: 60 to 90 | ||
| Intravenous (6 to 12 years): initially 0.025 to 0.05 mg/kg, | IN: 10 to 15 | IN: 60 | – Wide therapeutic spectrum (as single substance) | |
| then titrate to effect up to a maximum of 0.4 mg/kg; | – Reduced dose when combined with opioids | |||
| Orally: 0.5 to 0.75 mg/kg | – Paradoxical reactions possible (avoid underdosing) | |||
| Intranasally: 0.2 to 0.5 mg/kg | – Respiratory depression possible with rapid IV administration or in combination with opioids | |||
| – Intranasal use unpleasant | ||||
| – ANTAGONIST: flumazenil 0.005 to 0.01 mg/kg IV | ||||
| Propofol | Intravenously: | IV:<1 | IV: 5 to 15 | No |
| initially 1.0 to 2.0 mg/kg, | – Narrow therapeutic spectrum | |||
| then 0.5 to 1.0 mg/kg titrated to effect | – License: general anesthesia > 1 month of age | |||
| Via a perfusor: 3 to 6 mg/kg/h | – Typical: injection pain [avoid: e.g., 1 mL lidocaine 1% per 20 mL propofol 1% or lower concentration 5 mg/mL (0.5%) instead of 10 mg/mL (1 %)] | |||
| – Absolute contraindications: allergy (egg, soya, and peanut allergy), sedation of pediatric intensive care patients < 16 years (risk of PRIS) | ||||
| – Relative contraindications: children < 3 years with acute airway infection (risk of PRIS) | ||||
| – Frequent side effects: airway obstruction, apnea, hypotension, bradycardia, flushing | ||||
| – Rare side effects: rhabdomyolysis, pancreatitis, myoclonia, hyperlipidemia (1 mL propofol 1% contains 0.1 g/mL fat; max. rate: 2 mL/kg per hour) | ||||
| Fentanyl | Intravenously: 0.5 to 1.0 ìg/kg (up to 50 ìg/dose), | IV: 3 to 5 | IV: 15 to 30 | Yes |
| may be repeated every 3 to 5 minutes until effective | – Narrow therapeutic spectrum | |||
| – Side effects: respiratory depression, bradycardia, thorax rigidity, low histamine liberation | ||||
| – ANTAGONIST: naloxone 0.01–0.04 mg/kg IV | ||||
| Ketamine | IV: 1 to 2 | IV: 30 to 60 | Yes | |
| Racemate | Intravenously: 1.0 to 2.0 mg/kg | – Not hypnosis but “dissociative anesthesia” | ||
| slowly over 30 to 60 seconds, | – Wide therapeutic spectrum | |||
| may be repeated every 10 minutes according to effect | – Relative contraindications: raised ICP, perforating eye injury, pulmonary and arterial hypertonia, aortic and mitral stenosis, hyperthyreosis, epilepsy and psychiatric illness | |||
| S(+)-Ketamine | Intravenously: 0.5 to 2.0 mg/kg | IV: 1 to 2 | IV: 30 to 60 | – Side effects: nightmares (therefore: combine with benzodiazepines), hypersalivation (atropine or glycopyrrolate), nausea and vomiting |
| slowly over 30 to 60 seconds, | ||||
| may be repeated every 10 minutes according to effect | ||||
| – almost no respiratory depression (as single substance), protective reflexes are generally preserved | ||||
| – Cardiovascular stimulation, bronchodilation | ||||
| EMLA | Neonates/infants: 0.5 g (max. 1 to (2) g) | 45 to 90 | 60 to 120 | – 1 g cream contains 25 mg lidocaine and 25 g prilocaine |
| Young children: 1 g (max. 10 g) | ||||
| School-age children: 1 g (max. 20 g) | – Relative contraindications: neonates and premature infants < 3 months old (risk of methemoglobinemia) | |||
| Adolescents: 1.5 to 2 g | – Application time: 30–45 minutes (risk of vein maceration) |
*1 Modified from (5); IV, intravenously; PO, orally; IN, intranasally; ICP, intracranial pressure; PRIS, propofol infusion syndrome.