Although paediatric services have become increasingly centralised over the last twenty years, Macclesfield DGH has an A+E department that sees children, an acute paediatric ward, paediatric out-patients and we do regular elective paediatric ENT and dental surgery. Children often present for elective surgery on other lists. We occasionally have to stabilise sick children prior to transfer to a paediatric ICU at another hospital.

The Age Rules

No child under 2 years, under 2 stone (12.7kg) or over ASA 2 should be anaesthetised at MDGH, except for lifesaving intervention. Remember, even if you and the surgeon have anaesthetised small children recently, the safety of the service also depends on the recovery staff, the Children’s ward nurses and the acute care facilities.

Trainees must discuss with the on-call Consultant anaesthetist any child under 3 years of age requiring anaesthesia out of hours. The on-call Consultant anaesthetist must be informed of any seriously ill child requiring an anaesthetic, regardless of age.

  • All childen over 8 years of age are welcome at MDGH for common, minor, elective and emergency surgery.
  • All children over 2 years of age are welcome for elective ENT, Orthopaedic and Dental surgery.
  • All acute paediatric emergencies of any age will continue to be assessed and managed to the best of our abilities.
  • Children under 8 with abdominal pain may referred to the Paediatricians for assessment, some of whom will be transferred to specialist hospitals if they require surgery.
  • Children under 2 years old definitely requiring surgery should be referred directly to a Specialist Childrens Hospital

All anaesthetists employed by East Cheshire NHS Trust have separate study leave and funding over and above their normal allowance, to remain current in Advanced Paediatric Life Support.

For consultants who undertake anaesthetics in children under 12, there is a notional target of 21 anaesthetics in children under 12 per calendar year.

Paediatric dose calculator

Enter the child’s weight: Kg and age: years
and then press

APLS “WETFLAG”
Weight Kg  
Energy J (4J/Kg)
Tube size mm (age/4+4)
Fluid bolus ml (20ml/Kg)
Lorazepam mg (0.1mg/Kg)
Adrenaline ml of 1:10,000 (0.1ml/Kg)
Glucose ml of 10% (2ml/Kg)
General anaesthesia
Propofol mg (4mg/Kg maximum 200mg)
ondansetron mg (0.1mg/Kg maximum 4mg)
dexamethasone mg (0.20mg/Kg maximum 6.6mg)
paracetamol mg (15mg/Kg maximum 1g)
diclofenac mg (1.5mg/Kg maximum 50mg)
morphine mg (0.1mg/Kg maximum 10mg)
saline 0.9% ml (10ml/Kg)
Post-op analgesia
paracetamol syrup mg qds (mls of 120mg/5ml)
      (mls of 250mg/5ml)
ibuprofen syrup mg qds (mls of 100mg/5ml)
oramorph syrup to mg qds (0.2-0.3mg/Kg maximum 20mg)
ondansetron mg qds (0.1mg/Kg maximum 4mg)

 

NB: the dose of all syrups is rounded to the nearest 0.2ml.

 

Paediatric Critical Care Infusions
These dilutions are recommended by Alder Hey, North Staffs and the Royal Manchester Children’s Hospital. They are identical to those at www.crashcall.net which NEWTS will ask you to use. You’ll need to enter the child’s weight at the top of the calculator.

 

drug dilution dose pump rate
morphine
(up to 50Kg)		 1mg/Kg (mg) in 50mls
5% dextrose or 0.9% saline.		 5-60mcg/kg/hr 0.25-3ml/hr
midazolam* 3mg/Kg (mg) in 50ml
5% dextrose or 0.9% saline		 60-300mcg/kg/hr 1-5ml/hr
adrenaline/
noradrenaline		 0.3mg/Kg (mg) in 50ml
5% dextrose or 0.9% saline		 0.05-2mcg/kg/min 0.5-20ml/hr
dobutamine
(up to 16Kg)		 15mg/Kg (mg) in 50ml
5% dextrose or 0.9% saline		 3-20mcg/kg/min 0.6-4ml/hr
prostaglandin 10mcg/ml (neat) 2-40ng/kg/min –
ml/hr

 

*NB: if the child weighs more than 16.6Kg, you will need “high strength” midazolam. (5mg/ml) This is available from pharmacy or Ward 4.

If anyone thinks there should be any other drugs here please email the webmaster.

Child protection

who to call:
consultant paediatrician available by switchboard 24/7

  • Named doctor: Dave Wright phone 1759
  • Named Nurse: Melanie Barker Bleep 3342 phone 1770

Information about what to do if you’re worried a child is being abused:

NICE guidance CG89: When to suspect child maltreatment
Local policy: ECNHST Safeguarding Children Policy
GMC: 0-18 years: guidance for all doctors