fentaNYL

fentaNYL

Indication

  • Synthethic narcotic used for sedation and analgesia.
  • Pre-intubation medication used with atropine and succinylcholine

Dosage Guidelines

  • Pre-Minimally Invasive Surfactant Therapy (MIST): 0.5 mcg/kg/dose IV direct slowly over 3-5 minutes by MD/NP or under direct supervision of MD/NP
  • Pre-intubation: Target is 2 mcg/kg/dose IV direct slowly over 3-5 minutes by MD/NP or under direct supervision of MD/NP 
  • Mix fentaNYL 100 mcg (2 mL) with 8 mL normal saline to provide a 10 mcg/mL concentration
  • Consult the Neonatal Premedication for Endotracheal Intubation Standardized Dosing Chart for weight-banded dose and volume found on the NICU Intranet site
  • Continuous analgesia/sedation:
    • Loading dose: 1-2 micrograms/kg IV
    • Continuous infusion: 0.5-5 micrograms/kg/hr IV

Titrate to response as per MD/NP order

Administration

  • IV direct slowly over 3-5 minutes
  • IV continuous infusion 
  • For patients 1 kg or less: Use fentaNYL 2.5 mcg/mL

To make 25 mL of a 2.5 mcg/mL solution:

  1. Add 1.25 mL (62.5 mcg) of fentaNYL [50 mcg/mL] to 23.75 mL of solution
  • For patients over 1 kg to 2.5 kg: Use fentaNYL 6 mcg/mL
  • To make 25 mL of a 6 mcg/mL solution:
  1.  Add 3 mL (150 mcg) of fentaNYL [50 mcg/mL] to 22 mL of solution
  • For patients over 2.5 kg to 10 kg: Use fentaNYL 10 mcg/mL
  • To make 25 mL of a 10 mcg/mL solution:
  1. Add 5 mL (250 mcg) of fentaNYL [50 mcg/mL] to 20 mL of solution

Adverse Effects

  • FentaNYL causes less hypotension and bradycardia than morphine because of minimal or no histamine release
  • Respiratory depression, reduced gut motility and urinary retention
  • CHEST WALL PARALYSIS AND RIGIDITY may occur and is more common if fentanyl is given too quickly

Comments

  • Tolerance may develop following use greater than 5 to 7 days
  • Withdrawal symptoms are reported in neonates with continuous IV infusions greater than 5 days Wean dose slowly (i.e. 10-20% daily if treatment duration greater than 3 days)
  • Monitor NPASS scores during wean
  • Monitor for signs of respiratory and cardiac depression, urinary retention, constipation, and NPASS score as per protocol
  • Antidote: naloxone 0.1 mg/kg should be readily available

Supplied As

  • 50 mcg/mL (2 mL and 5 mL ampoules)
  • At LHSC, standard concentration reference charts are available on the NICU Intranet site

References

LexiComp Sick Kids, Pediatric and Neonatal, Neofax