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Child Health Guideline Identifier

Anaesthesia - paediatric cardiac premedication

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Premedication is an important component of the anaesthetic process for patients and is used to smooth the induction of anaesthesia.

The amount and type of premedication required varies with patient age, patient wishes, and clinical condition.

The dose ranges for the commonly used medicines for premedication in children undergoing cardiac surgery at Starship Child Health are different to those found in the New Zealand Formulary for Children (NZFc).

The below medicines and dose ranges have been approved by the Starship Paediatric Anaesthetic Service to be used for these patients.   

There may be instances where a combination of medicines is charted for premedication. These should generally be mixed together for administration rather than administered separately.


Paracetamol is often prescribed as part of premedication both as an analgesic and also to make the co-medicine more palatable.

Midazolam 0.5-0.8 mg/kg to a maximum dose of 20 mg enterally.  Often mixed with paracetamol elixir.
Clonidine 1-4 micrograms/kg enterally.
Dissolve 25 microgram tablet(s) in 5 mL of water and draw up required dose.  Often mixed with paracetamol elixir.
Ketamine 3-5 mg/kg enterally. 
Use IV solution enterally.
Often given in combination with midazolam.
This medication has a bitter taste and needs to be administered with something that masks the taste - usually paracetamol elixir, otherwise use a small amount of clear juice.
Paracetamol 15-30 mg/kg enterally.

Where doses are prescribed outside of these ranges the dose should be checked, as per standard practice, with the prescriber before the medicine is administered. Similarly, check with the prescriber if an unfamiliar medicine is prescribed.

In the exceptional circumstance where a correctly prescribed premedication is not administered, the nurse looking after the patient is required to inform the anaesthetist to enable an alternative plan to be devised to ensure safe and effective anaesthesia.

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Document Control

  • Date last published: 03 April 2019
  • Document type: Clinical Guideline
  • Services responsible: ADHB Pharmacy, Paediatric Anaesthesia
  • Author(s): Dave Buckley, Elaine McCall, Shaheeda Othman
  • Editor: Michael Tan
  • Review frequency: 2 years

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