| Name: |
FENTANYL (SublimazeR) |
| Classification: |
narcotic analgesic
- less cardiovascular depression and sedation than with morphine
- no histamine release, thus preferred narcotic for asthmatic patients
|
| Dose: |
- IV Direct:
- 25-100mcg; titrate to individual response
- IV Infusion
- administer IV bolus doses prn until pain control is achieved, then start infusion to maintain pain control
- 25mcg/hr; titrate to individual response
- Titrate to pain score and target VAMAAS
|
| Administration: |
IV Infusion:
1000mcg/50mL in dextrose 5%, normal saline 0.9% or Ringer's Lactate by syringe pump infusion
- rapid administration may cause muscle rigidity (see adverse effects)
- prolonged continuous infusion may require dose reductions as fentanyl undergoes redistribution
|
| Adverse Effects: |
- respiratory depression which may last longer than analgesic effect; there may also be a biphasic respiratory depression after apparent recovery from general anaesthesia, possibly the result of fentanyl mobilization from tissue stores
- agitation
- bradycardia
- hypotension
- pinpoint pupils
- muscle rigidity; associated with rapid rate of administration
|
| Antidote: |
- naloxone: 0.1-0.4mg IV (see naloxone monograph)
|
| Caution: |
- fentanyl is contraindicated in patients who have received MAO-I within the last 14 - 21 days, due to possible severe and unpredictable potential of fentanyl effect
|
| Monitoring Therapy: |
- blood pressure
- heart rate
- respiratory rate
- analgesic response
- bowel elimination
|
| Adult Critical Care Protocol |
- May be administered IV direct or by IV infusion by a nurse in Adult Critical Care
- Continuous infusions must be administered by infusion device with pump library enabled.
|
