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Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Universal Care Before Surgical Repair: Neuromuscular Blocking Agent — Clinical Pathway: Inpatient and ICU

Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Universal Care for Infants with CDH Before Surgical Repair: Neuromuscular Blocking Agent

Goal

Avoid routine use of neuromuscular blocking agents and if clinically indicated, ensure adequate sedation prior to use of neuromuscular blocking agent.

Consider if:

  • Undergoing procedure
  • Unable to decompress bowel
  • Significant hypoxia or respirations are not in sync with ventilator and are associated with
    clinical decompensation

Side Effects of Repeated Dosing/Infusion

  • Edema
  • Dependent atelectasis
  • Impaired secretion clearance
Medication Infusion Dose PRN/Bolus Dose (IV)
Vecuronium 0.1 mg/kg/hr
  • 0.1-0.2 mg/kg/dose
  • Assess one-time trial dose prior to starting infusion
  • For ECMO, use 0.2 mg/kg/dose

 

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