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:
- 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:
- 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:
- 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