1st line: |
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Metoclopramide LOAD (if NOT given intraoperatively) 0.5 mg/kg IV (over 10 minutes) (Maximum dose 20 mg)
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IF EFFECTIVE, CONTINUE: Metoclopramide 0.2 mg/kg IV/PO q6h PRN (Maximum dose 20 mg) |
If ineffective: |
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 |
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2nd line: |
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Dexamethasone (if not contraindicated and NOT given already) 0.15 mg/kg IV for ONE dose (Maximum dose 8 mg)
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NB this agent is commonly used intraoperatively. If this is the case it should be given as a single dose on Day 2 only |
If ineffective: |
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 |
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3rd line: |
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Granisetron 40 microgram/kg IV daily PRN (Maximum dose 1mg) OR Ondansetron0.1 mg/kg sublingualwafer q8h PRN (Maximum dose 4 mg)
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IF EFFECTIVE, CONTINUE: Granisetron 40 microgram/kg IV daily PRN (Maximum dose 1mg) OR Ondansetron 0.1 mg/kg sublingual wafer q8h PRN (Maximum dose 4mg)
for 72 hours ONLY
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These 'trons' can ONLY be prescribed by CPMS, Anaesthesia Consultants OR after approval from Drug Usage Committee (DUC) |
If ineffective: |
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 |
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4th line [over 10 years]: |
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Droperidol10 microgram/kg IV q8h PRN (Maximum dose 0.625 mg)
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IF EFFECTIVE, CONTINUE: Droperidol 10 microgram/kg IV q8h PRN (Maximum dose 0.625 mg) |
4th line [under 10 years]: |
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Promethazine 0.5mg/kg IV q8h PRN (Maximum dose 25mg) |
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IF EFFECTIVE, CONTINUE: Promethazine 0.5mg/kg IV q8h PRN (Maximum dose 25mg) |
If ineffective: |
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 |
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5th line [over 10 years]: |
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Promethazine 0.5mg/kg IV q8h PRN (Maximum dose 25mg) |
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IF EFFECTIVE, CONTINUE Promethazine 0.5mg/kg IV q8h PRN (Maximum dose 25mg) |
5th line [under 10 years]: |
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Droperidol10 microgram/kg IV q8h PRN (Maximum dose 0.625 mg)
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IF EFFECTIVE, CONTINUE: Droperidol 10 microgram/kg IV q8h PRN (Maximum dose 0.625 mg) |
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Continued PONV? |
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CONTACT Children's Pain Management Service PAGER 5773 |
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Continued PONV?
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