Clinical Guidelines | Luton Hospital Nairobi

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OPD Guidelines

Outpatient protocols, clinical pathways, and common condition references. Select a file below to open — all documents open in a new tab.

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Emergency Department Guidelines

Emergency care algorithms, triage notes, and acute management references. Select a file below to open — all documents open in a new tab.

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Anti-microbial Guidelines

Antibiotic use, infection protocols, and antimicrobial stewardship references. Select a file below to open — all documents open in a new tab.

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Maternal and Child Health

Maternal, paediatric, neonatal, ANC, PNC, and child health guidelines. Select a file below to open — all documents open in a new tab.

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Patient Leaflets

Patient education materials and condition-specific advice leaflets. Select a file below to open — all documents open in a new tab.

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Anaesthesia Handbook

Luton Hospital – Anaesthesia Handbook. For clinical reference only; verify with approved Luton Hospital protocols.

Internal Resource

About This Site

Anaesthesia clinical and teaching resources adapted for Luton Hospital clinical reference. These notes support quick access to protocols, dose references, theatre preparation, and calculator tools.

Training Programme

This handbook section supports Luton Hospital clinical reference, anaesthesia teaching, dose checks, theatre preparation, and quick protocol review. Content should be reviewed and approved by the clinical team before use.

Disclaimer

This is NOT medical advice — it is an educational guide only for those providing anaesthesia at Luton Hospital. Much content is abbreviated for rapid access. Always apply clinical judgment.

Direct Questions & Support

For queries contact Dr. Kemunto or Dr Chege.

Dr. Kemunto Phil Yao

Pre-Induction & Induction

Medication	Induction Dose	Duration	Comment
Thiopental	2.5–5 mg/kg	60 min	Decreases BP, SVR, CO; resp. depression
Fentanyl	50–250 mcg	30–60 min	Blunts hemodynamic response to laryngoscopy
Ketamine	1–2 mg/kg IV	15–30 min	Maintains ventilation; salivation; releases catecholamines
Lidocaine	1 mg/kg	90–120 min	Blunts laryngoscopy response; eases propofol "burn"
Midazolam	1–2 mg pre-op	2–6 h	Anterograde amnesia; avoid in elderly
Propofol	1–2.5 mg/kg	5–10 min	"Burns" in IV; decreases SVR

Muscle Relaxants

Medication	Dose	Duration (Onset)	Comment
Rocuronium	0.6–1.2 mg/kg	55–80 min (1–2 min)	RSI dose 0.9–1.2 mg/kg
Suxamethonium	1–2 mg/kg	10–12 min (30 sec)	Avoid in hyperkalemia; RSI of choice
Vecuronium	0.1 mg/kg	50–80 min (2–3 min)	3 min to take effect
Cisatracurium	0.15 mg/kg	60–90 min (3–4 min)	Hoffman degradation
Atracurium	0.5 mg/kg	30–45 min (3–5 min)	Hoffman degradation; histamine release

Inhalational Anesthetics

Agent	MAC	Comment
Halothane	0.76%	Least pungent; risk hepatotoxicity
Isoflurane	1.2%	May take longer off after 2–4 h; coronary steal
Nitrous Oxide	104%	Avoid: air embolism, PTX, bowel obstruction, pulm. HTN
Sevoflurane	1.85%	Least pungent; best for peds inhalational induction

Age-adjusted MAC: subtract 6–10% per 10 yrs after age 40 | MAC-Aware: 0.3–0.5 | MAC-Bar: 1.5–2.0

Vasopressors

Drug	MOA	Effect	Bolus	Comment
Phenylephrine	Pure α1	Vasoconstricts	50–200 mcg	Reflex bradycardia
Ephedrine	α1>β1	↑ contractility & HR	5–10 mg	Tachyphylaxis
Norepinephrine	α1>β1	↑ contractility	3–6 mcg	Vasopressor of choice in sepsis
Epinephrine	α β	↑ HR, vasoconstricts	"Baby Epi" 5–10 mcg	Also bronchodilator
Vasopressin	V1	Vasoconstricts	0.5–1 unit	Effective for ACEi/ARB-induced hypotension

Anti-Hypertensives

Drug	MOA	Bolus	Duration (Onset)	Comment
Esmolol	β1 selective	10–30 mg	10–30 min (1 min)	Esterase degradation
Labetalol	α1 < β1=β2	5–10 mg	6 h (2–5 min)	Alpha:beta 1:7
Nitroglycerin	Venous dilation	10–50 mcg	3–5 min (1–2 min)	Dilute 1cc in 9cc → 0.5 mg/mL
Hydralazine	Arterial	5–10 mg	6–12 h (5–15 min)	Rebound tachycardia

Common Infusions

Drug	Rate	Loading Dose	Comment
Fentanyl	25–300 mcg/hr	—	Context-sensitive half time
Ketamine	0.3 mg/kg/hr	0.5 mg/kg bolus	Reduce in elderly (>65)
Propofol	5–200 mcg/kg/min	1–2 mg/kg	May accumulate
Norepinephrine	2–25 mcg/min	—	Central line recommended
Phenylephrine	20–300 mcg/min	—	Reflex bradycardia; OK through PIV
Vasopressin	0.03–0.04 U/min	—
Lidocaine	1–4 mg/min	1–1.5 mg/kg	Caution with hepatic impairment
Amiodarone	0.5–1 mg/min	150 mg over 10 min	Peripheral up to 3 mg/mL

Peri-operative Antibiotics

Antibiotic	Dose	Infusion	Redose
Cefazolin	2 g; 3 g if >120 kg	5 min	4 h, redose 8 h
Ampicillin-Sulbactam	3 g	15–30 min	2 h, redose 6 h
Clindamycin	600–900 mg	10–60 min	6 h, redose 8 h
Gentamicin	1.5 mg/kg	30–60 min	24 h
Vancomycin	10–15 mg/kg (max 2 g)	60 min/g	24 h

Give within 60 minutes before incision. Redose after every 1.5 L blood loss.

Pediatric Sedation

Medication	Dose	Comment
Ketamine IM	3–7 mg/kg
Ketamine IV (Induction)	1–2 mg/kg
Propofol Bolus (Induction)	2–4 mg/kg	Higher doses at younger ages
Midazolam PO	0.5–0.7 mg/kg	Max 20 mg
Midazolam IV	0.05–0.1 mg/kg

Pediatric Analgesics

Medication	Dose	Comment
Fentanyl IV	1–2 mcg/kg	Induction dose
Morphine IV	0.1 mg/kg	Avoid in neonates
Paracetamol IV/PO	10–15 mg/kg	Q6h
Paracetamol Rectal	30–40 mg/kg PR	×1 loading

Pediatric Muscle Relaxants

Medication	Dose	Comment
Suxamethonium	1.5–2 mg/kg
Rocuronium (Standard)	0.45–0.6 mg/kg
Rocuronium (RSI)	1.2 mg/kg
Atracurium	0.3–0.4 mg/kg
Vecuronium	0.1 mg/kg

Pediatric Vasoactives

Medication	Dose	Comment
Atropine IV	10–20 mcg/kg	No minimum dose
Epinephrine (resus)	10 mcg/kg
Adenosine	0.1 mg/kg (1st); 0.2 mg/kg (2nd)	Max 6 mg / 12 mg
Dantrolene	2.5 mg/kg

ETT Size

(Age/4) + 4 = uncuffed
−0.5 for cuffed ETT

Ex: 8 yr → 6, use 5.5 cuffed

Blood Volume

Neonate: 90 ml/kg
Infant <1 yr: 80 ml/kg
>1 yr: 70 ml/kg

Hypotension

SBP = 70 + (Age × 2)

Fluid: 10–20 cc/kg × 2–3

4-2-1 Fluid Rule

4 ml/kg for first 10 kg
2 ml/kg for second 10 kg
1 ml/kg for remaining kg

Normal Pediatric Vital Signs

Age	HR	RR	SBP	DBP
<1	120–160	30–60	60–95	35–69
1–3	90–140	24–40	95–105	50–65
3–5	75–110	18–30	95–110	50–65
5–12	75–110	18–30	90–110	57–71
12–16	60–90	12–16	112–130	60–80

Local Anesthetics

Medication	Onset	Duration (Epidural)	Duration (Spinal)	Max Dose
Bupivacaine 0.125–0.75%	Moderate	2–5 h	1–4 h	2.5 mg/kg plain; 3 mg/kg with epi
Lidocaine 1–2%	Fast	1–2 h	0.5–1 h	4.5 mg/kg plain; 7 mg/kg with epi

Block Dosing Guides

Lumbar Epidural: 5–10 cc bupivacaine 0.125%, or 1% lidocaine for rapid onset

Thoracic Epidural: 3–5 cc bupivacaine 0.125%, or 1% lidocaine

Epidural C-Section: 10–15 cc 2% lidocaine with epi + 1 cc bicarb

Spinal C-Section: 10 mg bupivacaine 0.5% with 8% dextrose ± 15–20 mcg fentanyl or 150 mcg IT morphine

Spinal Ortho: 15 mg bupivacaine 0.5% (PF)

Calculating mg dose

Move decimal right 1 place:

2% lidocaine = 20 mg/cc
0.25% bupivacaine = 2.5 mg/cc

"3–5–7" Rule

3 mg/kg bupivacaine, ropivacaine
5 mg/kg lidocaine
7 mg/kg lidocaine + epi

"IT ICEBALLS" Absorption

IV › Tracheal › Intercostal › Caudal › Epidural › Brachial › Axillary › Leg › SubQ

Local Anesthetic Systemic Toxicity (LAST)

Symptoms

Oral numbness / ear ringing → CNS agitation / seizure → cardiac arrest

ACLS

Standard ACLS with decreased epinephrine (1 mcg/kg boluses)

Intralipid 20%

1.5 cc/kg bolus then 0.25 cc/kg/min — acts as lipid sink

Room Setup — "MS MAIDS"

Machine
Suction
Monitors: EKG, SpO2, BP, ETCO2, temp
Airway: blade, ETT, oral airway, bougie, LMA, Ambu
IV: full setup
Drugs: induction, drips
Special: fluid warmer, A-line, etc.

Drug Box Contents

IV Induction: Propofol, Lidocaine, Ketamine
NMB: Suxamethonium, Rocuronium, Atracurium
Pressors: Phenylephrine, Ephedrine
Code: Epinephrine, Atropine
Antihypertensives: Labetalol, Hydralazine, Esmolol
Antiemetics: Dexamethasone, Ondansetron
Analgesia: Paracetamol, Diclofenac, Fentanyl, Morphine

Pharmacy: Vasopressin, Calcium gluconate, Insulin, TXA

Machine Check Protocol

1
Ambu Bag: Should be in the box on the wall.
2
O2 Alarm: Turn on machine, unplug green O2 hose, listen for alarm, replug.
3
O2 Tank: Open key, check >1000 PSI, close key.
4
Flowmeters: No hypoxic mixture; Nitrous:O2 at 3:1.
5
Calibrate O2 Sensor: Unscrew knob → 21% room air → Setup/Calibration → O2 sensor → Start.
6
CO2 Sensor: Breathe into unconnected CO2 tubing, confirm ETCO2 on monitor.
7
CO2 Absorber: Check color change; capnography should return to baseline.
8
Leak Test: Occlude circuit, close APL, ensure no pressure drop for 10 sec. Repeat with each new circuit.
9
Bellows: Remove bag, attach to circuit, flip ventilator on, verify tidal volumes match.
10
Suction: Must be strong enough to hold to your thumb.

Pre-op Assessment

NPO Fasting

Food	Time
Clear liquids	2 h (peds: until surgery)
Breast milk	3 h
Infant formula	4 h
Light meal	6 h
Normal diet	8 h

Airway Exam

Face: Beard, trauma, excess tissue?

Mouth: Opening, Mallampati, dentition, jaw subluxation

Neck: Thyromental distance, mobility

ASA Classification

1: Normal healthy
2: Mild systemic disease
3: Severe systemic disease
4: Constant threat to life
5: Moribund without surgery
E: Emergent modifier

Dynamic Patient Dosage Calculator

Enter weight and age — all doses update instantly.

Weight (kg)

Age (yrs)

Adult Dosages

70 kg

Drug	Formula	Calculated

Pediatric Dosages

35 yrs

Drug / Formula	Rule	Calculated

LAST — Intralipid 20% Emergency Dosing

1.5 cc/kg Bolus:105.0 cc

0.25 cc/kg/min Infusion:17.50 cc/min

Epi Bolus (1 mcg/kg):70.0 mcg

Pharmacy Guidelines

Drug references, pharmacy protocols, dispensing notes, and medicine safety documents. Select a file below to open — all documents open in a new tab.

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Radiology Protocols

Imaging preparation, radiology workflows, MRI/CT protocols, and reporting references. Select a file below to open — all documents open in a new tab.

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Other

General clinical documents and supporting files. Select a file below to open — all documents open in a new tab.

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Clinical Calculators

Lightweight calculators built directly into the page. Drug formulas are loaded from public/guidelines/calculators/drugs.json.

0 approved drugs

Patient Weight KG

Approved Drug

How to add calculator drugs: Create this file in File Manager: public/guidelines/calculators/drugs.json

[
  {
    "name": "Approved Drug Name",
    "category": "Antibiotic / Analgesic / Emergency",
    "dose_per_kg": 0,
    "unit": "mg",
    "max_single_dose": 0,
    "frequency": "Every 0 hours",
    "concentration_mg": 0,
    "concentration_ml": 0,
    "notes": "Add Luton-approved clinical notes here."
  }
]

Weight KG

Height CM

Quick access to approved clinical documents, patient leaflets, pharmacy references, emergency guidelines, and calculator tools.

Available Categories

Luton Contact

0111003400

info@lutonhospital.co.ke

China Centre, Ngong Road, Nairobi

For use by qualified healthcare professionals. Always verify with the current Luton Hospital approved protocol before applying any guideline or dose calculation.

Luton Hospital Clinical Guidelines

OPD Guidelines

Emergency Department Guidelines

Anti-microbial Guidelines

Maternal and Child Health

Patient Leaflets

Anaesthesia Handbook

About This Site

Training Programme

Disclaimer

Direct Questions & Support

ETT Size

Blood Volume

Hypotension

4-2-1 Fluid Rule

Calculating mg dose

"3–5–7" Rule

"IT ICEBALLS" Absorption

Local Anesthetic Systemic Toxicity (LAST)

Symptoms

ACLS

Intralipid 20%

Room Setup — "MS MAIDS"

Drug Box Contents

NPO Fasting

Airway Exam

ASA Classification

Dynamic Patient Dosage Calculator

Adult Dosages

Pediatric Dosages

LAST — Intralipid 20% Emergency Dosing

Pharmacy Guidelines

Radiology Protocols

Other

Clinical Calculators

Luton Hospital
Clinical Guidelines