fentaNYL

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

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