Anesthesiology Resident’s Pocket Reference Guide

Bhavya Venigalla MD, Arvind Chandrashekar MD, Joy Myers

1. RESUSCITATION

ADULT PEDIATRIC

100ug/kg IV(max dose 6 mg) then 200ug/kg IV(max dose

Adenosine 6mg IV then 12mg IV q1 min x 2 prn
12mg)
Atropine 0.5 mg IV q3-5mins; max 3mg 20ug/kg IV q3-5 min; max: child 1mg, adolescent 2mg
Amiodarone 150-300 mg IV followed by 1 mg/min for 6 hrs 5 mg/kg IV(max 300mg) over 30 mins

1-2 mEq/kg IV to be guided by blood gas analysis for <5kg, base excess x Wt/4; for child, base excess x Wt/6; for adult,
Bicarbonate
base excess x Wt/10

Calcium
1-2 gm IV slowly q10mins PRN 10-20 mg/kg IV slowly q10 mins prn
Chloride
Calcium
1-3 gm IV 30-60 mg/kg IV
Gluconate

Hypotension: 0.05 - 0.1 mg IV Arrest: 1mg q3-5 mins Hypotension: 1ug/kg IV Arrest: 10ug/kg q3-5 mins
Epinephrine
prn Racemic: 0.5ml of 2.25% solution in 3ml NS over 15 mins Racemic: 0.05ml/kg of 2.25% sol in 3ml NS over 15 mins

Esmolol 0.5 mg/kg IV prn 0.5 mg/kg IV prn

Lidocaine 1-1.5 mg/kg IV followed by 1-4 mg/min 1mg/kg IV followed by 20-50 ug/kg/min
Magnesium 1-2 mg IV for Torsades 25-50 mg/kg IV for Torsades
Glucose 20-50ml of D50 IV 40-100ml of D25 IV 0.5 ml/kg of D50 2.5 ml/kg of D10

2. VASOACTIVE DRUGS 3. ANTIHYPERTENSIVES/DIURETICS

Dopamine Adrenergic
1-20 ug/kg/min; titrate to effect Dose
Receptor
Furosemide
0.5-2 mg/kg/dose PO/IM/IV
Dobutamine
1-20 µg/kg/min; titrate to effect
Mannitol 0.25-0.5 g/kg IV (slowly to avoid
hypotension)
Epinephrine
0.02-1 µg/kg/min; titrate to effect, 1-10 µg/kg bolus Hydralazine
0.1-0.2 mg/kg IM/IV q4-6h

Esmolol Esmolol
50-300 mcg/kg/min; titrate to effect β1 100-500 µg/kg IV over 1-5 min;
50-300 µg/kg by infusion
Labetalol
Isoproterenol
0.02-1 µg/kg/min; titrate to effect α 1, β 1, and β 2 0.1-0.4 mg/kg IV q10 min until
desired effect
Atenolol
Norepinephrine
β1 1-2 mg/kg/day PO up to 3 mg/kg
0.02-1 µg/kg/min; titrate to effect
0.05-0.1 mg/kg/dose IV every 10

Phenylephrine
Propranolol
β 1 and β 2 min; titrate to effect; max single
0.5-10 µg/kg/min; titrate to effect, 0.5-10 µg/kg bolus dose 10 mg
Nitroprusside &
0.5-10 µg/kg/min by infusion
Milrinone 50-100 µg/kg loading dose followed by 0.25-1 Nitroglycerin
pump; titrate to effect
µg/kg/min infusion

Nitroprusside 0.5-10 µg/kg/min; titrate to effect; observe for signs

of cyanide toxicity 4. CARDIOVERSION/DEFIBRILLATION (EXTERNAL)

Peds: 0.5 joules/kg; repeat up to 2 joules/kg

Nitroglycerine Cardioversion Adult:
1-10 µg/kg/min; titrate to effect
(synchronous) Narrow + Regular: 50-100 joules
Narrow + Irregular: 120-200 joules
Prostaglandin 0.01-0.1 µg/kg/min (Note that apnea may occur and Wide + Regular: 100 joules
E1 intubation is oten required with doses >0.05 Wide + Irregular: Defibrillate
µg/kg/min)
Defibrillation Peds: 1st Shock: 2 joules/kg, 2nd Shock: 4
(asynchronous) joules/kg increase to max dose of 10 joules/kg
Vasopressin Adult: 0.03 - 0.05 units/min Peds: 0.0001 - 0.002 Adult: 120 - 200 joules Biphasic or 360 joules
units/kg/min monophasic

5. ANAPHYLAXIS /ANTIHISTAMINE 6. HYPERKALEMIA TREATMENT

1 µg/kg IV to treat hypotension/bronchospasm; Intervention

Epinephrine Dose
repeat with increasing doses every 3-5 minutes as
needed; may need continuous infusion Calcium chloride 5-10 mg/kg/dose IV; repeat until normal sinus
rhythm
Fluid bolus 20 mL/kg balanced salt solution; repeat as
necessary Calcium
15-30 mg/kg/dose IV; repeat until normal sinus
gluconate
rhythm
Phenylephrine 0.1 µg/kg/min IV; titrate to effect if inadequate
response to epinephrine
Hyperventilation
Hydrocortisone
Peds: 2-3 mg/kg IV ; Adult: 100 mg
Albuterol
By inhalation administered with a spacer
Diphenhydramine
Peds: 1-2 mg/kg IV ; Adult: 25-50 mg IV Salbutamol
5 µg/kg IV over 15 min
Ranitidine
Peds: 1.5 mg/kg IV ; Adult: 50mg IV Glucose + insulin Glucose (0.5-1 g/kg) with insulin (0.1 U/kg) given IV
over 30-60 min
Famotidine Kayexalate
Peds: 0.5 mg/kg IV; Adult: 50mg IV 1 g/kg (up to 40 g) q4h (PO, PR, per gastric tube)

7. Malignant Hyperthermia (Hotline: 1-800-MH-Hyper) 8. LARYNGEAL MASK AIRWAY (CLASSIC)

Cuff Largest ETT that

Dantrolene Size Volume will fit through
2.5 mg/kg IV q5 mins (max dose 10 mg/kg)
Weight (kg) (mL) LMA
<5 1 4 3.5 uncuffed
Hyperkalemia 5-10 1.5 7 4 uncuffed
See box 6 for Hyperkalemia treatment
10-20 2 10 4.5 uncuffed
20-30 2.5 14 5 uncuffed
Cooling
Ice packs + 20-30 ml/kg cold IV fluids
30-50 3 20 6 cuffed
50-70 4 30 6 cuffed
Arrhythmia 70-100 5 40 7 cuffed
Amidoare, Esmolol or Magnesium Sulfate; see box 1 for dosing
>100 6 50 7 cuffed

9. ETT SIZE (mm ID) 10. LARYNGOSCOPE BLADES (APPROXIMATE SIZE)

Age
Uncuffed Cuffed Miler Wis-Hipple Macintosh

Preterm
Preterm(<28 weeks) (<1.5 kg) 0
2.5

Preterm(28-38 weeks) (1.5-3 kg) Full-term neonate

3 0

38 weeks to 5 mo Term-2 years

3 3 1 1

5 mo to 12-18 mo
4 3.5 2-6 years
1.5 1-2
12-18 mo to 20-24 mo
4.5 4
6-10 years
2 N/A 2
>2 years
Age/4 + 4 Age/4 + 3.5
>10 years
2 or 3 N/A 2 or 3
Distance of Insertion (cm): Size of ETT x 3

11. INDUCTION AGENTS Propofol (Diprivan) 12. TIVA

Drug
Bolus Infusion
IV (mg/kg) IM (mg/kg)
Propofol 100-200
1-3 mg/kg
mcg/kg/min
Peds: 2-3
Propofol
Adult: 1-2 Ketamine
0.1-0.3 mg/kg 5-10 mcg/kg/min
Ketamine
1-2 3-12 Dexmedetomidine 0.5-1.5 mcg/kg over 5-10
0.3-1.2 mcg/kg/hr
minutes
Etomidate
0.2-0.3 Fentanyl
.5-1 mcg/kg 0.5-4 mcg/kg/hr

Thiopental Sufentanil 0.05-0.4

4-6 0.05-0.1 mcg/kg
mcg/kg/hr
Methohexital Remifentanil 0.05-0.3
1-3 1-2 mcg/kg
mcg/kg/min

13. NEUROMUSCULAR BLOCKING DRUGS 14. ANTAGONISTS

Neostigmine
0.02-0.05 mg/kg + atropine/glycopyrrolate
Succinylcholine 1-2 mg/kg IV
3-4 mg/kg IM
Edrophonium
0.3-1 mg/kg + atropine/glycopyrrolate

Rocuronium Atropine
0.6-1.2 mg/kg IV 0.02 mg/kg or 20 ug/kg

Glycopyrrolate
0.01 mg/kg or 10 ug/kg

Vecuronium 0.1 mg/kg IV

Sugammadex
Infusion: 0.8 - 1.7 mcg/kg min
**Only for reversal of Rocuronium or TOF count 2: 2 mg/kg, Post Tetanic 1-2: 4 mg/kg, RSI
Vecuronium Reversal: 16 mg/kg

Pancuronium
0.05-0.1 mg/kg IV Physostigmine 0.01-0.03 mg/kg followed by infusion 0.03 mg/kg/hr to
treat cholinergic syndrome
Peds:
Cisatricurium Sedation: 0.25-0.5 ug/kg IV q2 mins
0.1-0.2 mg/kg IV Naloxone Overdose: 10 ug/kg IV/IM q3 mins
Adult:
Sedation: 0.02 - 0.2 mg IV q5 mins
Overdose: 0.1 - 2 mg q3 mins
Atracurium
0.5 mg/kg IV Flumazenil Peds: 10 µg/kg (max 0.2mg) q2 mins Adult: 0.2 mg q2
mins

15. ANALGESICS 16. OPIOID CONVERSTION APPROXIMATIONS Morphine (1 mg) is

equivalent to:
Non-opioids
Acetaminophen Neonate: 7.5 mg/kg IV q6h Peds: 10-15 mg/kg IV/PO
q6h Adult: 500-1000 mg/kg IV/PO q6h IV (mg) PO (mg)

Ibuprofen Peds: 10 mg/kg PO q6h (max 800 mg) Adult: 600-

800 mg q6h
Tramadol
~10 ~15
Ketorolac <50kg: 0.5 mg/kg up to 15 mg; >50kg: 0.5 mg/kg up
to 30 mg, IV, IM, PO every 6 hours
Ketamine Oxycodone (OxyContin)
0.1-1 mg/kg q10-15 mins IV as needed ~2-3

Opioids
Fentanyl 0.5-2 µg/kg; higher doses may be required for Methadone
cardiac cases ~1 ~1.5

Hydromorphone
0.015 mg/kg IV every 3-4 hours
Hydromorphone
Morphine ~0.15 ~0.75
0.05-0.1 mg/kg IV every 3-4 hours

Remifentanil
See TIVA Fentanyl
~0.01 (10 µg) ~0.02 (20 µg)
Tramadol 1-2 mg/kg q6h (max 100 mg); Black box warning in
peds & breastfeeding mothers**
Sufentanil
Methadone ~0.001 (1 µg)
0.05-0.1 mg/kg q8h (max 10 mg)

17. SEDATIVES 18. ANTIEMETICS

Midazolam (Peds IV PO
PO: 0.25-0.75 mg/kg, Rectal: 0.75-1 mg/kg, IV:
only)
0.05-0.15 mg/kg, Max dose of 20mg by any route Dexamethasone 0.0625-0.15 mg/kg (max 15
mg)
Metoclopramide
PO: 1-4 µg/kg; takes 45 mins for full effect, 0.15 mg/kg 0.15 mg/kg
Dexmedetomidine
Intranasal: 1-2 µg/kg; takes 30 mins for full
effect, IV: 0-2 µg/kg over 10 minutes Ondansetron 0.05-0.1 mg/kg; max dose
0.1 mg/kg up to 4 mg
of 4 mg
Tropisetron
Pentobarbital 0.1-0.2 mg/kg
2 mg/kg IV every 10 minutes up to 6 mg/kg
Palonosetron 1.5-20 µg/kg (max 1.5 mg)
(limited data in children)
Ketamine
IM: 2-10 mg/kg IV: 1-2 mg/kg Aprepitant >6mo child to Adults:
Adult Only: 130mg
3 mg/kg (max 125 mg)

19. OBSTETRICS 20. POSTPARTUM HEMORRHAGE

Labor C-section
10-40 units in 1L bag after
0.125% Bupivacaine or 0.2% Oxytocin (Pitocin) baby is delivered, 1-3 unit
Epidural bolus if low risk of
ropivacaine at 6-12 mL/hr +/- 2
Infusion - hypotension
mcg/mL fentanyl PCEA: 3-6 mL
q30min
Lidocaine 2% +/- Epinephrine
Lidocaine 1%: 5-10 mL 5mcg/mL +/- NaHCO3: (20 mL 0.2 mg IM q5-10min; max 2
Methylergonovine
Epidural Bupivacaine 0.125%: 8-10mL Lidocaine 2%) +/- (100 mcg doses Contraindications:
(Methergine)
Bolus Bupivacaine 0.25%: 8-10mL Epinephrine) +/- 1 mL NaHCO3: 20- severe HTN, gHTN,
Fentanyl: 50-100 mcg 30 mL preeclampsia
Sulfentanil: 5-10 mcg 3% Chlorprocaine 20mL + 1 mL
NaHCO3: 20-30mL
Bupivacaine 0.25%: 0.5 mL-0.75 Hemabate/Carboprost 0.25 mg IM q15min; max
mL or Ropivacaine 0.2%: 0.5 mL Bupivacaine 0.75%: 1-1.6 mL + (15-methyl PGF2α) dose 2,000mg
DPE/CSE
- 0.75 mL Fentanyl: 15-25 mcg + Duromorph: Contraindications: asthma
Fentanyl: 15-25 mcg + infusion 150-250 mcg + Epidural
of epidural above
Misoprostol(PGE1) 600-1000 mcg buccal or
*Only do if unable to get an
*Only do if unable to get an rectal administration
Continuous epidural or if wet tap occurs
epidural or wet tap
Spinal 1 mL/hr; can
Bupi 0.125% 0.5% Bupi 1-1.5 mL bolus;
titrate up but Tranexamic Acid/TXA
or or titrate 0.1 mL at a 1g over 10 mins
extremely
Ropi 0.2%: 0.5% Ropi time
carefully

21. LOCAL ANESTHETICS (VOLUME ADJUSTED FOR NERVE BLOCKS) 22. Local Anesthetic Toxicity(LAST)

Lipid Emulsion(20%):
Conversion from percent to mg/mL: concentration (percent) x 10 =
Bolus: 1.5 ml/kg
mg/mL
Infusion: 0.25 ml/kg over 20 mins
Treatment
If unstable; repeat bolus and double infusion
With epinephrine until stable
Maximum doses Plain mg/kg
(1:200,000) mg/kg Max lipid emulsion: 12 ml/kg
Midazolam: 0.05-0.15 mg/kg bolus; max dose 4mg
Lidocaine/Mepivacaine 4.5 7
Seizures Propofol(If hemodynamically stable): 0.2 mg/kg
bolus
Chlorprocaine 10 15
Avoid beta blockers, calcium channel blockers, local
Bupivacaine 2.5 3 anesthetics and negative ionotropes.
Arrhythmia
Follow ACLS or PALS protocol after starting
Levobupivacaine 2.5 3 treatment
Avoid Vasopressin; Consider Epinephrine 0.2-1 mcg/kg
Ropivacaine 2.5 3 Hypotension
IV

23. TRANSFUSION SHORT CUTS 24. FLUID AND BLOOD Maintenance Fluids (balanced salt solution)

Whole blood
6 mL/kg Increases hemoglobin 1g/dL

PRBCs For neonates and infants <6 months: 4mL/kg/h first 10 kg, 2 mL/kg/h
4 mL/kg Increases hemoglobin by 1g/dL 10-20 kg, 1mL/h for each kg above 20 (consider adding glucose to
infusion)
Platelets 5-10 Increases platelet count by 50,000-
mL/kg 100,000/mm3
Fresh frozen
10-15 Factor levels increse by ~15-20
plasma
mL/kg percent
Perioperatively for infants and children >6 months: 10-40 mL/kg over 1-
4 hours
Cryoprecipitate 1-2 Increases fibrinogen by ~60-100
units/kg mg/dL

25. SPECIAL PROBLEMS 26. BLOOD PRODUCTS / TRANSFUSION

Diabetes insipidus EBV x (starting hematocrit - minimum accepted hematocrit)

Dilute polyuria (urine osmolality <250 mOsml/L, >2 mL/kg/h), MABL = ______________________________________________________________
hypernatremia (sodium >145 mEq/L) with serum hyperosmolality (>300 starting hematocrit
mOsm/L)
DDAVP (desmopressin) 1-10 mU/kg/h (0.0025-0.025 µg/kg/h), titrate to
effect (4 µg = 16 IU) Volume of PRBCs =

(desired Hct - present Hct) x estimated blood volume x Weight

_________________________________________________________
von Willebrand Disease (VWD) (Treatment depends on the type)
Hematocrit of PRBCs
Desmopressin (DDAVP) 0.3 µg/kg IV once 30 minutes preoperatively
(avoid in type 2B)
Amicar 100 mg/kg IV or PO 1 hour preoperatively, then q4-6h
MABL = Maximum Allowable Blood Loss
depending on the type of VWD

27. Estimated Blood Volume (ml/kg) 28. NPO Guideline

Premie 100
2 hours Clears
Term 90
<1 year 80 4 hours Breast Milk
1-6 years 75
Male 70 6 hours Formula / Light Meal

Female 65
8 hours Full Meal
Obese 60

29. ANTIBIOTICS (Pediatric Dosing Only**)

AGE
Antibiotic# Repeat intraoperative
1st wk (>2 kg) dosing (h)
1-4 wk (mg/kg) >4 wk (mg/kg)
(mg/kg)
Ampicillin/Sulbactam
# 50 (ampicillin) 50 (ampicillin) max 3g 2

Ampicillin
50 q8h 25-50 q6h 50 q6h max 3g 2

Aztreonam
30 q12h 30 q8-12h 30 q8h max 2g 4

Cefazolin
20 q24h 20 18h 30 q8h max 2g (<120 kg, 3g) 4

Cefuroxime
25-50 q12h 25-50 q12h 25-50 q8h max 1.5g 4

Cefotaxime
50 q8-12h 50 q6-8h 50 q6-8h max 1g 3

Cefoxitin
30 q8h 30-33 q8h 40 q8h max 2g 2

Cefotetan
# 30 q12h 40 q12h max 2g 6

Ceftriaxone
50 q24h 50-75 q24h 50-75 q12-24 max 2g

Cefuroxime
25-50 q12h 25-50 q12h 25-50 q8h max 1g 4

Ciprofloxacin
10 q12h 10 q12h 10 q8h max 0.4g

Clindamycin
5 q12h 5 q8h 10 q6-8h max 900 mg 6

Ertapenem
# 15 q12h 15 q12h max 1g

Fluconazole
3 q72h 3 q24h 6-12 max 0.4g

Gentamicin (over 60
min) 4 q24h 3.5 q24h 2-2.5 q8h Single dose 5 mg/kg

Levofloxacin
# # 10 q12h max 0.5g

Metronidazole
7.5 q12h 15 q12h 7.5-15 q6h max 0.5g

Moxifloxacin
5 q24h 10 q24h 10 q24h max 0.4g

Nafcillin
25 q8h 25 q6h 25-50 q4-6h max 12g/day

Piperacillin/Tazobactam 100 (piperacillin) 100 (piperacillin)

infants 2-9 mon (piperacillin) 80 mg/kg; >9 mon and 40 ≤
kg (piperacillin) 100 mg/kg; >40 kg (piperacillin) max 2
q12h q8h
3.375g
Ticarcillin
75 q12h 50-75 q8h 33-50 q4-6h max 3.1g

Vancomycin (over 60
min) 15 q12h 15 q8h 10-15 q8h max 2g

30. NORMAL HEMODYNAMIC INDICES AND WEIGHT

Mean systolic blood pressure (mmHg) in preterm and term infants

Gestational age at birth Day 1 of life Day 10 of life
24 2-9 52
28 44 62
32 50 69
36 56 76
40 63 83
Mean heart rate Weight range 10-90th
Age Normal blood pressure (mmHg)
(beats/min) percentile
Mean systolic Mean diastolic
Preterm 55-75 35-45 120-170
0-3 months 65-85 45-55 100-150 2.5-7.5
3-6 months 70-90 50-65 90-120 4.8-9.5
6-12 months 80-100 55-65 80-120 6.5-12.5
1-3 years 90-105 55-70 70-110 8.75-17
3-6 years 95-110 60-75 65-110 15.5-25
6-12 years 100-120 60-75 60-95 17-55
12-20 years 110-135 60-75 55-85 30-86
Simple formula to predict weight from age:
Infants 1-11 mo: Wt (kg) = (Age [months] + 9)/2
Children 1-4 yr: Wt (kg) = 2 x (Age [yr] + 5)
Children 5-14 yr: Wt (kg) = 4 x Age (yr)