BNF for Children (BNFC) 2018-2019

Induction of anaesthesia

▶BY SLOW INTRAVENOUS INJECTION

▶Neonate:Initially up to 2 mg/kg, then 1 mg/kg, repeated

if necessary; maximum 4 mg/kg per course.

▶Child:Initially up to 4 mg/kg, then 1 mg/kg, repeated if

necessary; maximum 7 mg/kg per course

lUNLICENSED USENot licensed for use in status

epilepticus. Not licensed for use by intravenous infusion.

IMPORTANT SAFETY INFORMATION

Thiopental sodium should only be administered by, or

under the direct supervision of, personnel experienced

in its use, with adequate training in anaesthesia and

airway management, and when resuscitation equipment

is available.

lCONTRA-INDICATIONSAcute porphyrias p. 603 .myotonic

dystrophy

lCAUTIONSAcute circulatory failure (shock).avoid intra-

arterial injection.cardiovascular disease.fixed cardiac

output.hypovolaemia.reconstituted solution is highly

alkaline (extravasation causes tissue necrosis and severe

pain)

lINTERACTIONS→Appendix 1 : thiopental

lSIDE-EFFECTS

▶Common or very commonArrhythmia.myocardial

contractility decreased

▶Frequency not knownAppetite decreased.circulatory

collapse.cough.electrolyte imbalance.extravasation.

hypotension.respiratory disorders.skin eruption.

sneezing

lPREGNANCYMay depress neonatal respiration when used

during delivery.

lBREAST FEEDINGBreast-feeding can be resumed as soon

as mother has recovered sufficiently from anaesthesia.

lHEPATIC IMPAIRMENT

Dose adjustmentsUse with caution—reduce dose.

lRENAL IMPAIRMENTCaution in severe impairment.

lDIRECTIONS FOR ADMINISTRATIONForintravenous

injection, reconstitute 500 -mg vial with 20 mL Water for

Injections to give 25 mg/mL solution; give over at least

10 – 15 seconds; forintravenous infusionreconstituted

solution may be further diluted with Sodium Chloride

0. 9 %.

lPATIENT AND CARER ADVICE

Driving and skilled tasksPatients given sedatives and

analgesics during minor outpatient procedures should be

very carefully warned about the risk of driving or

undertaking skilled tasks afterwards. For a short general

anaesthetic the risk extends toat least 24 hoursafter

administration. Responsible persons should be available to

take patients home. The dangers of takingalcoholshould

also be emphasised.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug. Forms available from special-order

manufacturers include: solution for injection

Powder for solution for injection

▶Thiopental sodium (Non-proprietary)

Thiopental sodium 500 mgThiopental 500 mg powder for solution

for injection vials| 10 vialP£ 69. 00 | 25 vialP£ 172. 50

HYPNOTICS, SEDATIVES AND

ANXIOLYTICS›BENZODIAZEPINES

eiiiiF 218

Lorazepam

lINDICATIONS AND DOSE

Premedication

▶BY MOUTH

▶Child 1 month–11 years: 50 – 100 micrograms/kg (max. per

dose 4 mg), to be given at least 1 hour before

procedure, same dose may be given the night before

procedure in addition to, or to replace, dose before

procedure

▶Child 12–17 years: 1 – 4 mg, to be given at least 1 hour

before procedure, same dose may be given the night

before procedure in addition to, or to replace, dose

before procedure

▶BY INTRAVENOUS INJECTION

▶Child: 50 – 100 micrograms/kg (max. per dose 4 mg), to

be administered 30 – 45 minutes before procedure

Status epilepticus|Febrile convulsions|Convulsions

caused by poisoning

▶BY SLOW INTRAVENOUS INJECTION

▶Neonate: 100 micrograms/kg for 1 dose, then

100 micrograms/kg after 10 minutes if required for

1 dose, to be administered into a large vein.

▶Child 1 month–11 years: 100 micrograms/kg (max. per

dose 4 mg) for 1 dose, then 100 micrograms/kg after

10 minutes (max. per dose 4 mg) if required for 1 dose,

to be administered into a large vein

▶Child 12–17 years: 4 mg for 1 dose, then 4 mg after

10 minutes if required for 1 dose, to be administered

into a large vein

lUNLICENSED USENot licensed for use in febrile

convulsions. Not licensed for use in convulsions caused by

poisoning. Not licensed for use as intravenous

premedication in children under 12 years. Not licensed for

use as oral premedication in children under 5 years.

IMPORTANT SAFETY INFORMATION

ANAESTHESIA

Benzodiazepines should only be administered for

anaesthesia by, or under the direct supervision of,

personnel experienced in their use, with adequate

training in anaesthesia and airway management.

lCONTRA-INDICATIONSAvoid injections containing benzyl

alcohol in neonates.CNS depression.compromised

airway.hyperkinesis.obsessional states.phobic states.

respiratory depression

lCAUTIONSMuscle weakness.organic brain changes.

parenteral administration

CAUTIONS, FURTHER INFORMATION

▶Paradoxical effectsA paradoxical increase in hostility and

aggression may be reported by patients taking

benzodiazepines. The effects range from talkativeness and

excitement to aggressive and antisocial acts. Adjustment

of the dose (up or down) sometimes attenuates the

impulses. Increased anxiety and perceptual disorders are

other paradoxical effects.

▶Special precautions for parenteral administrationWhen given

parenterally, facilities for managing respiratory depression

with mechanical ventilation must be available. Close

observation required until full recovery from sedation.

lINTERACTIONS→Appendix 1 : lorazepam

222 Epilepsy and other seizure disorders BNFC 2018 – 2019

Nervous system

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