Medications Administered to Critically Ill Pediatric Patients and Recommendations for Time Interval to Testing After Discontinuation
| Medication . | Infants/Children Elimination ½ life . | Neonates Elimination ½ life . |
|---|---|---|
| Intravenous induction, anesthetic, and sedative agents | ||
| Thiopental | Adults: 3–11.5 hours (shorter ½ life in children) | |
| Ketamine | 2.5 hours | |
| Etomidate | 2.6–3.5 hours | |
| Midazolam | 2.9–4.5 hours | 4–12 hours77,–,80 |
| Propofol | 2–8 minutes, Terminal ½ life 200 minutes (range 300–700 minutes) | |
| Dexmedetomidine | Terminal ½ life 83–159 minutes79,–,81 | Infants have faster clearance81,–,83 |
| Antiepileptic drugs | ||
| Phenobarbital | Infants: 20–133 hours* | 45–500 hours*79,84,85 |
| Children: 37–73 hours* | ||
| Pentobarbital | 25 hours* | |
| Phenytoin | 11–55 hours* | 63–88 hours* |
| Diazepam | 1 month–2 years: 40–50 hours | 50–95 hours79,86,87 |
| 2 years–12 years: 15–21 hours | ||
| 12–16 years: 18–20 hours | ||
| Lorazepam | Infants: 40.2 hours (range 18–73 hours) | 40 hours86 |
| Children: 10.5 hours (range 6–17 hours) | ||
| Clonazepam | 22–33 hours | |
| Valproic Acid | Children > 2 months: 7–13 hours* | 10–67 hours* |
| Children 2–14 years: Mean 9 hours; range 3.5–20 hours | ||
| Levetiracetam | Children 4–12 years: 5 hours | |
| Intravenous narcotics | ||
| Morphine sulfate | Infants 1–3 months: 6.2 hours (5–10 hours) | 7.6 hours (range 4.5–13.3 hours)79,89,–,91 |
| 6 months–2.5 years: 2.9 hours (1.4–7.8 hours) | ||
| Children: 1–2 hours | ||
| Meperidine | Infants < 3 months: 8.2–10.7 hours (range 4.9–31.7 hours) | 23 hours (range 12–39 hours) |
| Infants 3–18 months: 2.3 hours | ||
| Children 5–8 years: 3 hours | ||
| Fentanyl | 5 months–4.5 years: 2.4 hours (mean) 0.5–14 years: 21 hours (range 11–36 hours for long term infusions) | 1–15 hours |
| Sufentanil | Children 2–8 years: 97 ± 42 minutes | 382–1162 minutes |
| Muscle relaxants | ||
| Succinylcholine | 5–10 minutes | |
| Prolonged duration of action in patients with pseudocholinesterase deficiency or mutation | ||
| Pancuronium | 110 minutes | |
| Vecuronium | 41 minutes | 65 minutes |
| Atracurium | 17 minutes | 20 minutes |
| Rocuronium | 3–12 months: 1.3 ± 0.5 hours | |
| 1 to < 3 years: 1.1 ± 0.7 hours | ||
| 3 to < 8 years: 0.8 ± 0.3 hours | ||
| Adults: 1.4–2.4 hours |
| Medication . | Infants/Children Elimination ½ life . | Neonates Elimination ½ life . |
|---|---|---|
| Intravenous induction, anesthetic, and sedative agents | ||
| Thiopental | Adults: 3–11.5 hours (shorter ½ life in children) | |
| Ketamine | 2.5 hours | |
| Etomidate | 2.6–3.5 hours | |
| Midazolam | 2.9–4.5 hours | 4–12 hours77,–,80 |
| Propofol | 2–8 minutes, Terminal ½ life 200 minutes (range 300–700 minutes) | |
| Dexmedetomidine | Terminal ½ life 83–159 minutes79,–,81 | Infants have faster clearance81,–,83 |
| Antiepileptic drugs | ||
| Phenobarbital | Infants: 20–133 hours* | 45–500 hours*79,84,85 |
| Children: 37–73 hours* | ||
| Pentobarbital | 25 hours* | |
| Phenytoin | 11–55 hours* | 63–88 hours* |
| Diazepam | 1 month–2 years: 40–50 hours | 50–95 hours79,86,87 |
| 2 years–12 years: 15–21 hours | ||
| 12–16 years: 18–20 hours | ||
| Lorazepam | Infants: 40.2 hours (range 18–73 hours) | 40 hours86 |
| Children: 10.5 hours (range 6–17 hours) | ||
| Clonazepam | 22–33 hours | |
| Valproic Acid | Children > 2 months: 7–13 hours* | 10–67 hours* |
| Children 2–14 years: Mean 9 hours; range 3.5–20 hours | ||
| Levetiracetam | Children 4–12 years: 5 hours | |
| Intravenous narcotics | ||
| Morphine sulfate | Infants 1–3 months: 6.2 hours (5–10 hours) | 7.6 hours (range 4.5–13.3 hours)79,89,–,91 |
| 6 months–2.5 years: 2.9 hours (1.4–7.8 hours) | ||
| Children: 1–2 hours | ||
| Meperidine | Infants < 3 months: 8.2–10.7 hours (range 4.9–31.7 hours) | 23 hours (range 12–39 hours) |
| Infants 3–18 months: 2.3 hours | ||
| Children 5–8 years: 3 hours | ||
| Fentanyl | 5 months–4.5 years: 2.4 hours (mean) 0.5–14 years: 21 hours (range 11–36 hours for long term infusions) | 1–15 hours |
| Sufentanil | Children 2–8 years: 97 ± 42 minutes | 382–1162 minutes |
| Muscle relaxants | ||
| Succinylcholine | 5–10 minutes | |
| Prolonged duration of action in patients with pseudocholinesterase deficiency or mutation | ||
| Pancuronium | 110 minutes | |
| Vecuronium | 41 minutes | 65 minutes |
| Atracurium | 17 minutes | 20 minutes |
| Rocuronium | 3–12 months: 1.3 ± 0.5 hours | |
| 1 to < 3 years: 1.1 ± 0.7 hours | ||
| 3 to < 8 years: 0.8 ± 0.3 hours | ||
| Adults: 1.4–2.4 hours |
Modified from Ashwal and Schneider.57
Metabolism of pharmacologic agents may be affected by organ dysfunction and hypothermia.
Physicians should be aware of total amounts of administered medication that can affect drug metabolism and levels.
Elimination ½ life does not guarantee therapeutic drug levels for longer acting medications or medications with active metabolites. Drug levels should be obtained to ensure that levels are in a low to mid therapeutic range prior to neurologic examination to determine brain death. In some instances this may require waiting several half-lives and rechecking serum levels of the medication before conducting the brain death examination.