Pediatric Anesthesia Worksheet
Version 4.0, 04/24/2012
Copyright 1998, 1999, 2000, 2005, 2012
by Edwin Mathews and Charles Taylor
Introduction:
The Pediatric Anesthesia Worksheet is a tool designed to assist in the anesthetic
management of children. The program makes a number of useful calculations
based on information provided about a specific patient. There is a reference page
containing formulas used in the worksheet computations and other information
useful in pediatric anesthesia.
You may want to print this short READ_ME file; it's the only manual you get. In
spite of the fair amount of instructions that follow, once the Pediatric Anesthesia
Worksheet is installed, everything is extremely simple. Unless your computer is
an antique or you type with fewer than two fingers, it takes less than two minutes
to load the worksheet, fill in the required patient information, and print the twopage report.
Disclaimer:
We have tried our absolute best to ensure that all formulas and computations are
accurate and adhere to accepted pediatric anesthesia practice, but . . .
The Pediatric Anesthesia Worksheet is a tool to aid in the anesthetic
management of children. It is not a substitute for education, training, or
experience in the anesthetic management of children. Clinical judgment must
be exercised when applying the information contained in the worksheet to a
specific clinical situation.
Dosages calculated by the worksheet may not be appropriate to your practice or
to a specific clinical situation. Many drugs are supplied in more than one
concentration. The default concentrations used in the worksheet calculations
may differ from those used in your practice.
Distribution of the Pediatric Anesthesia Worksheet is strictly ‘AS IS.’ No
warranty of any kind is expressed or implied. Under no circumstances will the
authors be responsible for damages of any kind that result from the use or
misuse of the program.
System Requirements:
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Microsoft Windows XP SP2 (or greater) or Microsoft Windows 7
Microsoft Excel 2003 (or greater)
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Mouse or other pointing device
NOTE: The Pediatric Anesthesia Worksheet will work on computers with
screen resolution set to 640x480, but is easiest to view at resolutions of
800x600 or greater
Download or CD-ROM Contents:
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Pediatric Anesthesia Worksheet Program (PEDSHEET.XLS)
This Read Me File (READ_ME.PDF and/or READ_ME.HTM)
Installation:
No installation or setup is REQUIRED to use the worksheet. It can be run in
Microsoft Excel directly from a CD-ROM. However, the worksheet will load and run
faster if you copy it to a hard drive and open it from there. You can open the
worksheet by double-clicking the mouse on the filename (PEDSHEET.XLS) while in
Windows Explorer (Windows 98, Windows NT 4.0, or Windows XP) -- assuming
that *.XLS files have been associated with the Excel program (this task has usually
been done automatically by the Microsoft setup program for Excel). You may also
open the Pediatric Anesthesia Worksheet from within Microsoft Excel. (ONE
CAUTION: You will usually not want to open the Pediatric Anesthesia Worksheet if
you already have the Microsoft Excel application running with other worksheets
open. When you quit the Pediatric Anesthesia Worksheet, it will close the Excel
application along with any other open worksheets.)
You can simplify opening the Pediatric Anesthesia Worksheet by setting up an icon
which is directly associated with the worksheet. The following instructions are for
the moderately computer competent. If you need help, try to find someone who
fits that description (or give it a whirl on your own -- you really can't do much
damage). If you're more than moderately competent, you may not need these
instructions and can skip to the "Instructions for Use" section. Once properly set
up, double-clicking the icon will open the worksheet.
NOTE #1: The following instructions for setting up an icon will not work properly if
the file association mentioned above between Microsoft Excel and *.XLS files has
not been established. It is still possible to set up an icon, but more expertise and
computer knowledge is required. Don't worry much about it, though. If Excel has
been installed normally, the association has almost certainly been made.
NOTE #2: The security provisions in certain enterprise installations may prevent
you from creating a shortcut or program item. If you attempt to follow these
instructions and get error messages such as "Access Denied" or "You do not have
permission . . .", you will need to contact your system administrator for
assistance.
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Windows XP and Windows 7:
 copy all the files from the distribution CD-ROM or download to a suitable
location on the hard drive
 click on the Start/All Programs/Accessories/Windows Explorer
 (here's where you've got to be moderately competent) click on the
appropriate drive and folder icons until you find the files you copied off the
distribution diskette; once you find PEDSHEET.XLS, single click on the file
name and be sure that it is highlighted
 from the drop-down menu of the window you are in, select File/Create
Shortcut; the highlighted file will now be "Shortcut to pedsheet.xls"
 single click the highlighted name "Shortcut to pedsheet.xls"; a box should
appear around the file name, and the entire file name should be highlighted
 type "Pediatric Anesthesia Worksheet" (without the quotes) and press the
ENTER key; the box should go away, and the shortcut should be renamed
"Pediatric Anesthesia Worksheet" and should still be highlighted
 from the drop-down menu of the window you are in, select File/Properties
 you should be done; double click on the shortcut icon and see if it starts the
worksheet; if it does, Congratulations! if not, you can try once more or leave
it for some computer wonk to do.
Instructions for Use:
Start by filling in the blanks for the patient's name, hematocrit, and weight. Press
the ENTER or TAB key after each entry; use the TAB key or the mouse to move
from one box to the next (SHIFT-TAB moves backwards). Then use the mouse (or
other pointing device) to indicate whether the weight entered is in kilograms or
pounds and the patient's sex and age category. Type in the age in months or in
years when prompted.
If the patient's weight is unknown, you may select the option of having the
program provide the 50th percentile weight based on age and sex. This option is
not available for preterm or term babies.
You must enter all of the above information before you can view or print the
worksheet. Based on the age and sex of the patient, the program will display a
warning before printing or displaying the worksheet if you have entered a weight
that is outside of the 10th to 90th percentile range, or if you have entered a
hematocrit that is outside the normal range. These warnings are to help avoid
errors in computations only and will not prevent you from printing or viewing the
worksheet.
You may view or print the worksheet and view or print a reference page that
contains a number of formulas and other useful information. For the most part,
the spreadsheet calculations use the formulas shown on the reference page.
Slight modifications have been made in some instances where there are gaps or
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overlaps in age ranges, etc., but none of these modifications significantly changes
the output. For example, the computation for endotracheal tube size has been
changed slightly to {(age/4.01) + 4} so that it will round down to the
recommended ET tube size instead of up. The program formulas also make a
transition to "standard" adult concentrations at threshold weights to allow for more
practical infusion preparations in larger children.
IMPORTANT: Note that on the printed Pediatric Anesthesia Worksheet, drugs that
have routes of administration OTHER THAN IV have been shaded and put in bold
type for easy identification.
There is also an option to save the worksheet. There should be few instances
where this step will be necessary once the worksheet has been printed since you
can easily re-enter the patient information to print another worksheet. If you do
decide to save a worksheet, you will need to name it something other than
PEDSHEET.XLS. Please be aware that the entire worksheet is quite large and a lot
of saved worksheets will take up a significant chunk of real estate on your drive
(although that has become less of an issue over the years as drives have
dramatically increased in capacity).
The worksheet file as distributed is "read only," and individual sheets are protected
from accidental changes, so don't be afraid to experiment.
For drugs used in dosages that when calculated for a 70 kg child are less than or
equal to the adult dosage, no programmed maximum dose limit is used in the
formula. When the drug dosage used for children results in a calculation that, for
larger children, would exceed the recommended adult (70 kg) dose, a maximum
limit is used in the program (see summary below).
Minimum age limits are based on recommendations in the Physician's Desk
Reference (PDR), package insert, or other credible reference source. Some of the
calculations in the Pediatric Anesthesia Worksheet are made for ages, weights, or
dosages other than recommended in product labeling. The decision to include such
calculations is made based on reports in current peer-reviewed scientific
publications and after consultation with practicing pediatric anesthesiologists.
These calculations are provided with due consideration of the concerns expressed
by the Food and Drug Administration (FDA) about recommendations for "off-label"
use.
Summary of Programmed Limits on Drug Calculations:
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acetaminophen PR, 650 mg max. (*see note below)
acetaminophen IV, 1000 mg max., min. age 2 years
adenosine, 6 mg max.
amiodarone, 300 mg. max, min. age 3 mo.
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atropine IV, 0.1 mg min., and in the Pediatric ACLS table: child < 40 kg = .5
mg max., child > 40 kg 1 mg max.
calcium chloride, 1000 mg max.
cefazolin, 2000 mg max., minimum age 1 month
cisatracurium, min. age 1 month
dexamethasone, 8 mg max.
dextrose in water(D50W), min. age 2 yr.
dolasetron, 12.5 mg max., min. age 2 yr.
droperidol, 1.25 mg max., min. age 2 yr.
glycopyrrolate, 0.1 mg min.
ketorolac, min. age 1 yr.
midazolam IV, min. age 6 mo.
midazolam syrup, 20 mg max., min. age 6 mo.
naloxone, 2 mg max.
ondansetron, 4 mg max., min. age 2 yr.
sodium bicarbonate 8.4%, min. age 2 yr.
succinylcholine IM, 150 mg max.
*NOTE Regarding Acetaminophen Suppositories: It is not recommended to
cut suppositories in half. Therefore, the worksheet calculates the total dose
based on the patient’s weight and the dosing level that you have selected
(default is 30mg/kg). The worksheet then provides a recommended
combination of suppositories (80mg, 120mg, 160mg, 325mg, and 650mg)
that comes closest to providing the computed dose without exceeding it.
Whom to Contact:
Please contact us with your comments and suggestions, especially if you identify
any problems with the worksheet. Be sure to indicate which version of the
Pediatric Anesthesia Worksheet you are using. The version number is on the
distribution CD and on several of the worksheet screens.
Edwin L. Mathews, M.D.
Charles F. Taylor, B.S.
PO Box 904
Brookfield, WI 53008-0904
Thank you to all of the users of the Pediatric Anesthesia Worksheet from around
the world who have taken the time to critique our program and offer helpful,
constructive suggestions for improvement. We appreciate your encouragement
and support.
________________________________
Microsoft Windows, Windows XP, Windows 7, Excel and Notepad are trademarks of the
Microsoft Corporation.
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