In the preoperative assessment, the patient’s health is evaluated and the type of anesthesia the patient should receive based on the current surgery. The patient is informed in the preoperative conversation about the perioperative course. It is prescribed which premedication the patient should receive and which of the regular medicines to be taken on the day of surgery. The preoperative assessment benefits both the patient and the anesthesiologist as well as determines the design of the anesthesia and the surgical procedure.
The preoperative assessment is usually done one or more days before surgery. Of course, in an emergency, this happens close to the imminent operation. The patient’s health is evaluated in the history of the patient as well as the available journal and other relevant data (lab samples, ECG, X-ray, etc.). The patient’s health is assessed first and foremost regarding cardiovascular function but also the overall health with identification of other possible risk factors for an upcoming anesthesia such as a difficult to access airway, severe obesity, severe patient, increased bleeding tendency, severe allergies, impaired general condition, etc.
The type of anesthesia to be performed regarding airway control, inducers, analgesics, muscle relaxants, anesthesia maintenance and postoperative pain relief should be planned and determined. The anesthetic form to be given is determined; TIVA, TCI, inhalation or combination anesthesia. Airway management is planned with oral intubation, nasal intubation, fiber intubation, video laryngoscopy, mask anesthesia, laryngeal mask or spontaneous breathing (mask, chanterelle or oxygen catheter). It is possible to decide type of regional anesthesia with blockades. It is planned and decided what type of anesthesiologic equipment and monitoring should be used, CVC, arterial line, epidural catheter, ultrasound, etc. Ev. planned for more advanced equipment with cardiac output volume measurement or analysis of the arterial pressure curve, such as Swan-Ganz, LiDCO, Cardio-Q, thermodilution, PiCCO, NiCO, Vigileo, etc. for major surgery or hemodynamically unstable patient.
You plan the arrangement on the operating table and assess the expected size of the bleeding. It is planned to deliver intravenous fluid and order blood products. In the preoperative assessment, ASA grade (I-IV) and intubation assessment should be determined with Malampati grade I-IV, SM distance (sternomental distance), TM distance (thyroid momentum). Prior known intubation problems and other previously known anesthesia complications should be noted. The need for sedation, PONV prophylaxis and postoperative pain relief should be determined.
|Induction Agent||Basic Analgesia||Muscle|
|Anesthesia maintenance||Postoperative Analgesia|
Anesthetic form is determined:
- Induction agent: Propofol, ketamine, thiopentone, Sevorane
- Analgesics: Fentanyl, alfentanil, remifentanil, sufentanil
- Muscle relaxants: rocuronium, succametonium, vecuronium, none
- Anesthesia maintenance: Sevoflurane, Isoflurane, Desflurane, Ketalamine, Propofol, remifentanil, alfentanil.
- Postoperative pain relief
Any allergies are noted, especially for antibiotics, ASA, NSAIDs or local anesthetics. There are special nursing problems. Problems with the layout should be noted, side position, kidney position, abdominal position, bean position, high leg supports etc. Current lab tests are reviewed and the current ECG is evaluated.
After the preoperative assessment, premedication and anesthesia form are determined as well as any additional examinations or investigations needed before the impending surgery. Examples of supplementary examinations may be heart and lung radiographs, cardiac ultrasound (UCG), work tests or spirometry. The scope of the supplementary examination should be as small as possible but still ensure that the patient will be in optimal condition before surgery.
In the preoperative interview, the patient should be given information about the upcoming surgery and anesthesia. The patient usually wants to know when, where and how he or she should be operated. Unfortunately, information is often missing from the preoperative assessment. The patient should be informed in such a way that he or she can feel calm and confident before the upcoming surgery. The same goes for children and their parents. This presupposes that the anesthesiologist is well acquainted with the patient’s health and can evaluate various risk factors as well as the nature of the future procedure and the routines and practices that exist in the operating department.
|ASA PS Classification||Definition||Examples, including, but not limited to:|
|ASA I||A normal healthy patient||Healthy, non-smoking, no or minimal alcohol use|
|ASA II||A patient with mild systemic disease||Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease|
|ASA III||A patient with severe systemic disease||Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents.|
|ASA IV||A patient with severe systemic disease that is a constant threat to life||Examples include (but not limited to): recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis|
|ASA V||A moribund patient who is not expected to survive without the operation||Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction|
|ASA VI||A declared brain-dead patient whose organs are being removed for donor purposes|
Recommendation for which ordinary medication is to be taken or discontinued in situations when anesthesiological intervention is required to carry out surgery, procedure or examination. The purpose is to facilitate the preoperative assessment and make it easier for non-anesthesia staff to follow these recommendations.
Many patients who pass an operating room are on regular medication. Regardless of whether it is a general anesthesia, central blockades, regional blockades or local anesthesia, it is important to know which of the regular medications should be taken or discontinued before an operation, procedure or examination. The anesthesiologist or anesthesia nurse with delegation for preoperative assessment decides which medications should be taken or discontinued.
The responsible anesthetist / nurse must check in the medical record which medications the patient takes regularly. It is of course important that the patient is informed about which medications are to be taken or discontinued. The table below lists a recommendation for the most common medicines. Note, however, that most patients arrive on the morning of the day of surgery and information on how to take the medication on the morning of the day of surgery must therefore be provided in the preoperative assessment. It is important to assess whether the patient needs written information.
|Angiotensin II antagonists||X|
|Alpha-2 receptor antagonist||X|
|Calcium flow inhibitors||X|
|Diuretics (all varieties)||X|
|Nitrates, short and long lasting||X|
|Inhaled drugs for lung disease||X|
|Oral diabetes drugs||X|
|Antipsychotics (dopamine receptor blockers)||X|
|Drugs for treatment of Parkinson||X|
Drugs that are normally discontinued
- ACE inhibitors and Angiotensin II antagonists, according to national guidelines, should be discontinued on the day of surgery. Otherwise, there is a risk of severe hypotension that does not respond adequately to adrenergic agonists. Exceptions: Confirmed heart failure and situations where hypertension must be avoided (eg known aortic aneurysm, aortic dissection), and difficult-to-control malignant hypertension.
- Oral diabetes medications and insulin
- The neuroleptic clozapine should be discontinued, but contact with a psychiatrist for discussion of treatment is recommended.
Discontinuation of anticoagulation prior to spinal anesthesia
|Anticoagulation substance||Medication||Recommended time from drug intake to spinal anesthesia / manipulation||Recommended time from spinal anesthesia / manipulation to ingestion of drugs|
|Dalteparin ≤ 5000 U|
Dalteparin > 5000 U
|6 hours recommended (2-4 hours regular practice)|
|Fondaparinux||Arixtra||36 hours||6 hours|
|Rivaroxaban||Xarelto||2 days according to SSTHS Clinical Advice||6-24 hours (according to risk)|
|Warfarin||Waran||1-4 days dose dependent||Reinsert after epidural catheter removal|
|Acetylsalicylic acid||ASA||12 hours in patients with indication for secondary prevention|
3 days with others
|Resume as soon as possible after surgery|
|Diklofenac||Voltaren||12 hours||Should be avoided - COX2 inhibitors are recommended instead|
|Ketorolac||Toradol||24 hours||Should be avoided - COX2 inhibitors are recommended instead|
|Naproxen||Naproxen||48 hours||Should be avoided - COX2 inhibitors are recommended instead|
|Clopidogrel||Plavix||5 days||After catheter removal|
|Ticlopidin||Ticlide||5 days||After catheter removal|
|Prasurgrel||Efient||7 days according to SSTHS clinical advice||After catheter removal|
|Apixaban||Eliquis||2 days according to SSTHS clinical advice||6-24 hours (according to risk)|
|Dabigadran||Pradaxa||2 days according to SSTHS clinical advice||6-24 hours (according to risk)|
|Tiacagrelor||Brilique||5 days||6 hours|
Fasting before anesthesia during planned surgery
The following time limits apply to oral intake in patients with normal gastric emptying and refer to the time until the start of anesthesia.
- Water (with or without sugar), coffee, tea, clear juice and special preoperative drink – 2 hours
- Other drinks – 6 hours
- All solid foods and semi-solid foods – 6 hours
Fasting before anesthesia in emergency surgery
In principle, the above guidelines also apply to acute surgical procedures. However, the patient’s condition may in some cases lead to the rules being deviated from. The risk of aspiration must then be weighed against the risk of delaying the procedure.
Note increased risk of ventricular retention and aspiration
- mechanical ileus
- intestinal paralysis
- stressed and nervous patient
- pain-affected patient
- large food intake
- alcoholic patient
The premedication usually includes an anaesthesiologic preoperative assessment of a patient prior to a surgical operation as well as prescribing of drugs and possibly. supplementary medical examination prior to surgery. Usually the premedication is given about an hour before the anesthesia start in the care ward, but can also be given if needed in the operating ward, usually as an oral or intravenous treatment. Premedication is usually given per os but if the patient has difficulty swallowing it can also be given intramuscularly or intravenously. The premedication follows regular routines in the care ward/operating department and is usually given according to a predetermined schedule with regard to age and weight. There are a variety of drugs used in premedication, but the main principle is that these should be analgesic and relaxing. In addition, some of the patient’s fixed medications are given, usually as few as possible. The advantage of premedication is that the anesthesia induction will be calmer and the amount of anesthetic agent can be reduced. The disadvantage is that the patient can become very tired after the operation.
There are a variety of drugs used in premedication. The main principle is that these should be analgesic and relaxing. Common combinations often contain paracetamol in combination with a benzodiazepine or benzodiazepine-like drug, sometimes with the addition of an NSAID. Also, opioids can advantageously be used in premedication. Several different combinations exist.
|Paracetamol (acetaminophene) 1-2 g||Oxycontin 5-10 mg||Betametason 8 mg|
|Paracetamol 1-2 g (500 mg x 2 x III)||Zolpidem 5 mg||Etoricoxib 120 mg or similar like diclofenac 50-100 mg||Betametason 8 mg|
|Paracetamol 1-2 g||Diazepam 2,5-5 mg||Betametason 8 mg|
|Paracetamol 1-2 g||Oxazepam 10-15 mg|
|Paracetamol 1-2 g||Flunitrazepam 0,5-1 mg|
|Paracetamol 1-2 g||Oxycontin 10-15 mg||Zolpidem 5 mg|
|Paracetamol 1330 mg (x 3)||Oral syrup Midazolam 5-15 mg||Etoricoxib 120 mg or similar like Diclofenac 50-100 mg||Betametason 8 mg|
|Patients not suitable for selective COX-2 inhibitors can be given:||Tramadol 50 mg|
If sedatives are needed in the operating department: midazolam orally (midazolam for i.v. use, 5 mg/ml) or midazolam 1-2 mg i.v. on the pre-op. or Propofol 10-30 mg i.v. on the pre-op center or operating theatre.
Dosage of Midazolam Orally to Adults
|Age||Dose in mg|
|< 50 years||15 mg|
|50–60 years||10 mg|
|60–70 years||7,5 mg|
|> 70 years||5 mg|
|Blended in apple juice/juice||Given orally 1 hour before operation|
There are a variety of drugs used in premedication for children to get analgesia and anxiolysis. The main principle is that these drugs should be analgesic and relaxing. The general preoperative care of children with parents is essential to gain trust from the patient and parents with a good and safe introduction of anesthesia. Frightened and anxious parents can easily spread their concerns to the child, preoperative information is a and o. During anesthesia induction, it is appropriate if only the calmest parent is present.
Dosage: 2-5 µg/kg orally, provides good sedation in premedication. The disadvantage is that the agent has a long impact time and must be given well in advance, 60-90 minutes in advance. Premedication with oral solution clonidine hydrochloride 20 µg/ml or Tabl Clonidine 75 µg.
Dosage range: 2-4- (6) µg/kg.
Dose: We recommend 3 µg/kg. Children <3 years and all ENT children 2-3 μg/kg. As an example; child weight 15 kg x 3 μg/kg = 45 μg and 2.2 ml (20 μg/ml) of clonidine hydrochloride.
|Dexmedetomidine 100 µg/ml||Clonidine 150 µg/ml (Catapres)|
|1 µg/kg (max 200 µg) in an infusion or by a slow injection||1,5-2 µg/kg |
(MR 4 µg/kg) Max 200 µg
|1-4 µg/kg x 3||1-4 µg/kg x 3||0,1-0,3 µg/kg/tim|
Provides good premedication for young children who come for ear and throat surgery. Dexmedetomidine 100 mg/ml solution for injection can be given both nasally and buccally. Nasal administration is preferred as it provides better absorption and faster effect. The solution has no taste and does not burn in the nose. Dexmedetomidine is a specific alpha2 receptor agonist and its effect is similar to clonidine, but with more pronounced effect. The main effects are sedation and some analgesia. Dexmedetomidine has a shorter half-life, about 2 hours compared to clonidine 5-10 hours. The duration of administration is significantly longer compared to orally administered midazolam, approximately 20-40 minutes.
Children 1-3 years are given 1 µg/kg. Children 3-10 years are given 1-2 µg/kg. Children over 10 years are given 1-3 µg/kg. The dose can be increased with increasing age to a maximum of 3 µg/kg. The easiest way is to use nasal administration with MAD (Mucosal Atomization Device) or MADdy (pediatric variant) coupled to syringe. The prescribed dose of drug is diluted to the desired volume (usually 0.3-0.5 ml) with physiological saline.
Patients must have the presence of parents or staff during the waiting period after application. Peroperative monitoring with blood pressure and ECG. The child may need some extended awakening time compared to patients without premedication.
Alone or in combination. Common combinations of pharmacological premedication in children usually contain paracetamol (30 mg/kg x 1) in combination with benzodiazepines or benzodiazepine-like drugs, sometimes with the addition of an NSAID preparation. Paracetamol is given either as a tablet, oral solution or suppository (Table 6). Children under 6 months are not usually premedicated. Several different drug combinations are common. Various variants of sedative sympathetic stimulant drugs have become more common in recent times, such as clonidine and dexmedetomidine. These are usually given as oral solution but can also be given intravenously.
Routinely, the loading dose of paracetamol (max oral 30 mg/kg) is given in the premedication. Conveniently, the oral solution of paracetamol is 24 mg/ml, 1 ml/kg in the care department before most operations. For more painful interventions, children> 6 months are also given NSAIDs. The youngest children, < 6 months, are usually not premedicated.
|Premedication||Maintenance first 2 days
dosage 20 mg/kg body weight
|Child weight (kg)||Oral solution Paracetamol 24 mg/ml||Supp Paracetamol (mg)||Tablet Paracetamol (mg)||Oral solution Paracetamol 24 mg/ml||Tablet Paracetamol (mg)||Supp Paracetamol (mg)
|6 - 8 kg||8,5 ml||250 mg||-||2,5 ml x 4||-||60 mg x 4|
|8 - 10 kg||12 ml||310 mg||-||3,5 ml x 4||-||125 mg x 3|
|10 - 12 kg||14 ml||375 mg||-||5 ml x 3||-||125 mg x 4|
|12 - 15 kg||17,5 ml||500 mg||-||5 ml x 4||-||185 mg x 4|
|15 - 20 kg||22 ml||625 mg||-||7,5 ml x 4||-||250 mg x 3|
|20 - 25 kg||28 ml||750 mg||500 mg||10 ml x 4||500 mg x 3||250 mg x 4|
|Paracetamol intravenously||10 mg/ml|
|<1 mån||7,5 mg/kg|
|>1 mån||15 mg/kg|
|4 - 10 kg||6 - 15 ml x 4|
|10 - 20 kg||15 - 30 ml x 4|
|20 - 33 kg||30 - 50 ml x 4|
|33 - 50 kg||50 - 75 ml x 4|
|50 - 66 kg||75 - 100 ml x 4|
|>66 kg||100 ml x 4|
|Loading dose||Maintenance dose|
|Weight (kg)||Oral solution 24 mg/ml||Supp.||Weight (kg)||Oral solution 24 mg/ml||Supp.|
|3||2,5 ml||S. 60 mg||3||2,5 ml x 3||S. 60 mg x 3|
|4||3,5 ml||S. 60 mg||4||3,5 ml x 3||S. 60 mg x 4|
|5||5 ml||S. 125 mg||5||4 ml x 4||S. 125 mg x 3|
|6 - 8||7 ml||S. 250 mg||6 - 8||5 ml x 4||S. 125 mg x 4|
|9 - 12||12 ml||S. 310 mg||9 - 12||7,5 ml x 4||S. 185 mg x 4|
|13 - 15||16 ml||13 - 15||11 ml x 4|
|Weight (kg)||Oral solution||Tablet||Weight (kg)||Oral solution||Tablet|
|16 - 19||20 ml||T. 500 mg||16 - 19||13 ml x 4||T. 250 mg x 4|
|20 - 24||25 ml||T. 500 mg||20 - 24||17 ml x 4||T. 500 mg x 3|
|25 - 30||30 ml||T. 750 mg||25 - 30||21 ml x 4||T. 500 mg x 4|
|31 - 34||40 ml||T. 1000 mg||31 - 34||25 ml x 4||T. 750 mg x 3|
|35 - 42||40 ml||T. 1000 mg||35 - 42||30 ml x 4||T. 750 mg x 4|
|43 - 50||50 ml||T. 1250 mg||43 - 50||35 ml x 4||T. 1000 mg x 3|
|50 - 70||60 ml||T. 1500 mg||50 - 70||40 ml x 4||T. 1000 mg x 4|
|>70 kg||80 ml||T. 2000 mg||>70 kg||40 ml x 4||T. 1000 mg x 4|
Alone or in combination. A common standard mixture for children is midazolam + atropine in the oral solution. This mixture is dosed according to schedule by weight. Midazolam often provides trouble-free needle removal if EMLA has been used. Rectally, 0.3 mg/kg (max. 10 mg) is given as nasal spray 0.2 mg/kg (max. 5 mg) and 0.5 mg/kg (max. 15 mg) orally.
Some children, e.g. Those who are very worried or who have previously experienced major problems with anesthesia may be offered a heavier premedication. Flunitrazepam in tablet form 0.05 mg / kg, gives after about 20 minutes heavy sedation lasting at least 1 hour. This premedication can be given in the care department and the time must be coordinated with the surgery department. In some cases, midazolam may be given by anesthesia professionals to facilitate a troublesome induction. The child must not be alone after the administration of flunitrazepam or midazolam. An alternative to midazolam is triazolam. Dosage triazolam 0.125 mg, ½ tablet for children weighing 20-30 kg and 0.125 mg, 1 tablet for children weighing 30-40 kg. Older children may find that waiting for the care department before surgery is long and worrying. Diazepam, tablet or suppository, 0.5 mg/kg rounded down, max. 25 mg rectally, can provide relief.
Atropine is given after medical prescription on surgery, either intravenously, p o, s c, rectally or sublingually.
Premedication with midazolam (children 10-25 kg)
A common standard mixture for children is midazolam + atropine in oral solution given per os. In addition, paracetamol is usually given 30 mg/kg x 1.
Pharmacodynamic properties Midazolam 1 mg/ml + Atropine 0.05 mg/ml. Dosage: 0.4 mg (= 0.4 ml)/kg according to the list below. The maximum dose for the mixture is 10 ml (orange flavor).
|Weight (kg)||Dose in ml Midazolam/Atropine|
Premedication with midazolam (children 10-25 kg).
Midazolam + atropine in a mixture that is mixed clearly in the operating ward. Midazolam 1 mg/ml is mixed with atropine 0.5 mg/ml and add strong juice to a solution of 5-12 ml. Dosage: midazolam 0.4 mg/kg + atropine 0.02 mg/kg orally listed below. In addition, paracetamol is usually given 30 mg/kg x 1.
|Weight (kg)||Volume in ml of the solution||Dose of respective drugs in the solution
Premedication for rectal administration of midazolam (children 5-20 kg).
Midazolam + atropine in oral solution, which is mixed clearly in the surgery department for rectal administration. Midazolam 5 mg/ml is mixed with 2 ml of NaCl to the strength of 3 mg/ml. Dosage 0.3 mg/kg = 0.1 ml/kg. + Atropine 0.5 mg/ml is mixed undiluted in the midazole mixture.
|Weight (kg)||Midazolam 3 mg/ml|
|Midazolam 3 mg/ml|
|Atropine 0,5 mg/ml |
|Atropine 0,5 mg/ml
|0,1 mg/kg (max 5 mg)||0,2-0,3 mg/kg (max 7,5-10 mg)||0,2 mg/kg (max 5 mg)||0,3-0,5 mg/kg (max 10-15 mg)|
|An additional dose can be given according to the schedule below|
|0,05 mg/kg (after 5 minuter)||0,05 mg/kg (after 20 minuter)||0,05 mg/kg (after 10 min)||0,05 mg/kg (after 20 min)|
|At least one hour of monitoring after the last dose||At least one and a half hour of monitoring after the last dose||At least one hour of monitoring after the last dose|
|Flumazenil 0,1 mg/ml iv||Antidote for bensodiazepine overdose|
|5 µg/kg (0,05 ml/kg) intravenously once per minute up to 40 µg/kg (maximum dose 2 mg)||If lack of effect: continous infusion 2-10 µg/kg/hour|
Another alternative, ff.a. For heart disease children aged 1-4 years, ketamine is 7 mg/kg mixed with midazolam 0.3 mg/kg. In cases where the child is not involved at all, ketamine can be given intramuscularly. 3-5 mg/kg, in some cases up to 10 mg/kg, preferably in melteltoideus. If one does not want to give an injection and the child does not cooperate, exceptionally ketamine per os can be given. This induction method is time-consuming, about 20 minutes, until needle can be set. 6 mg/kg are mixed in a little liquid, e.g. Coca Cola.
|Ketamine||10 mg/ml||50 mg/ml|
|Iv bolus:||0,5 mg/kg||Iv infusion 0,02-0,12 mg/kg/hour|
|Esketamin (S-ketamine )||5 mg/ml||25 mg/ml|
|Must be combined with Midazolam or Dexmedetomidine!|
Rectal induction with thiopental (Pentocur – “Pentorect/Sleeping Beauty”) can be given to young children 1-4 years (10-20 kg) if you do not want to insert a needle when the child is awake. This is an older form of anesthesia that is hardly used at all anymore. Pentotal can be given rectally in the dose of 30 mg/kg from a solution of 100 mg/ml. This premedication acts as anesthetic induction and is given in the operating ward. Weight limits are not sharp, this induction often works well for sensitive children weighing 5-30 kg. The maximum dose rectally is 600 mg Pentotal. Pentorect can be used as the only anesthetic form for minor surgical procedures or when you only want the child to lie still, such as for example. during X-ray examinations and certain radiological interventions.
NSAID that can be used for younger children are the ibuprofen and diclofenac suppositories.
|Weight (kg)||Dose (ml)|
|7 kg||2,5 ml x 3|
|8 kg||3,0 ml x 3|
|9 kg||3,5 ml x 3|
|10 kg||4,0 ml x 3|
|Weight (kg)||Dosage of suppositories (number)|
|10 kg||½ supp x 2|
|12,5 kg||½ supp x 2|
|15 kg||½ supp x 3|
|20 kg||1 supp x 2|
|25 kg||1 supp x 3|
|30-40 kg||1½ supp x 3|
|Ibuprofen||Oral suspension 20 mg/ml|
|≥ 6 months 7,5 mg/kg x 4 alt. 10 mg/kg x 3||Max 1200 mg/day|
|0,375 ml/kg x 4 alt. 0,5 ml/kg x 3.||Max 60 ml/day|
|Only to children ≥ 6 months|
|>50 kg||50+50+50 mg||50+50+50 mg|
|8-14 kg||25 mg||25 mg|
|15-19||25+0+25 mg||25+0+25 mg|
|20-24||25+0+25 mg||25+0+25 mg|
|25-27||50+0+25 mg||25+0+25 mg|
|30-34||50+0+25 mg||50+0+25 mg|
|35-40||50+0+50 mg||50+0+50 mg|
|40-50||50+0+50 mg||50+0+50 mg|
Dosage: 2-5 μg/kg per os, provides good sedation in the premedication. The disadvantage is that the product has a long application time and must be given in good time, 60-90 minutes in advance. Premedication with Mixture Clonidine Hydrochloride 20 μg/ml or Tabl Clonidine 75 μg.
Dosage range: 2-4- (6) μg/kg. Dose: We recommend 3 μg/kg. Children <3 years and all ENT children 2-3 μg/kg. Ex; child weight 15 kg x 3 μg/kg = 45 μg and 2.2 ml (20 μg/ml) clonidine hydrochloride.
|Dexmedetomidine 100 µg/ml||Clonidine 150 µg/ml (Catapres)|
|1 µg/kg (max 200 µg) in an infusion or by a slow injection||1,5-2 µg/kg |
(MR 4 µg/kg) Max 200 µg
|1-4 µg/kg x 3||1-4 µg/kg x 3||0,1-0,3 µg/kg/tim|