Morphine sulfate, 0.05 to 0.10 mg/kg IV over 1 to 2 minutes given 5 minutes before procedure
Fentanyl, 1 to 2 µg/kg (0.001 to 0.002 mg/kg) IV 3 minutes before procedure
Fentanyl Oralet, 5 to 15 µg/kg, maximum to 400 µg, orally 20 to 40 minutes before procedure †
Meperidine (if morphine sulfate or fentanyl is not available), 0.5 to 1.0 mg/kg IV over 1 to 2 minutes given 2 to 5 minutes before procedure or 1.5 mg/kg orally 45 to 60 minutes before procedure.
Diazepam (Valium), 0.2 to 0.3 mg/kg, maximum to 10 mg, orally 45 to 60 minutes before procedure
Midazolam (Versed), 0.2 to 0.4 mg/kg, maximum to 15 mg (IV solution), orally 30 to 45 minutes, or 0.05 mg/kg IV 3 minutes before procedure
Pentobarbital (Nembutal), 1 to 3 mg/kg IV boluses to maximum of 100 mg until asleep
Chloral hydrate, 75 to 100 mg/kg, maximum to 2.0 g, orally or
rectally 60 minutes before procedure
Modified from Zeltzer LK and others: Report of the subcommittee on the management of pain associated with procedures in children with cancer. Pediatrics 86 (suppl): 826-831, 1990; and Coté CJ: Sedation for the pediatric patient, Pediatr Clin North Am 41 (1): 31-58, 1994.
* Provide analgesia and sedation.
† Not recommended for children less than 15 kg. Lozenges should be sucked, not chewed and swallowed. If chewed, drug is less effective because part of it is metabolized by liver before entering bloodstream. Swallowing drug rapidly does not increase risk of respiratory depression during first 15 to 30 minutes, period of greatest risk for decreased respiration.
‡ Provide sedation but no analgesia.
Click here to see a bibliography for conscious sedation
Click here to see notes on meperidine
Click here for a pain FACES rating
scale.
March 15, 2002
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