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Disclaimer to the On-line 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

  • to provide sedation and analgesia

Pharmacology

  • fentanyl is a synthetic, rapid acting, narcotic analgesic which is chemically related to meperidine (Demerol(R))
  • more potent (50 to 100 times) than morphine on a weight basis
  • highly protein bound
  • serum half life is highly variable in neonates (1 to 30 hours)
  • fentanyl is metabolized mainly in the liver. Any condition which decreases hepatic blood flow (eg. abdominal distension, omphalocele, diaphragmatic hernia or a decreased cardiac output) or affects hepatic function can slow the metabolism and thus prolong the effect of the drug
  • fentanyl's action is more rapid and less prolonged than morphine

Side Effects

  • the side effects which are possible are essentially those of any narcotic
  • these include respiratory depression, bradycardia, vomiting, hypotension, apnea: RAPID ADMINISTRATION CAN INCREASE THE POSSIBILITY OF THESE EFFECTS.
  • RESPIRATORY MUSCLE PARALYSIS AND RIGIDITY can also occur if fentanyl is given too quickly
  • this can be overcome with the use of
    1. succinylcholine
    2. pancuronium/vecuronium

Nursing Implications

  • monitor respiratory and cardiovascular status closely; peak respiratory depression may not occur until 5 to 15 minutes after a bolus dose
  • tolerance to analgesic effect may develop with prolonged use
  • stable in both dextrose and saline solutions
  • resuscitation equipment must be readily available

Dose

CONTINUOUS INFUSION

  • consider a loading dose (per "Intermittent Dosing Schedule") before beginning a continuous infusion
  • 1 to 5 mcg/kg/h (usual range)
  • New standard concentrations:
    • Fentanyl 2.5mcg/mL for patients less than 1kg
    • Fentanyl 5mcg/mL for patients greater than 1kg and less than 2.5kg
    • Fentanyl 10mcg/mL for patients greater than 2.5kg

INTERMITTENT DOSING

  • < 1500 g: 1 mcg/kg IV push by physician only over 10 minutes
    (may be given by an RN as a slow infusion over 30 minutes)
  • > 1500 g: 2 mcg/kg IV push by physician only over 10 minutes
    (may be given by an RN as a slow infusion over 30 minutes)

    For MD administration over 10 minutes, follow these preparation and administration guidelines:

    1. Dilute Fentanyl
      0.5 mL Fentanyl (50 mcg/mL) + 9.5 mL Diluent (eg. D5W)
      = 25 mcg/10 mL Fentanyl
      = 2.5 mcg/mL Fentanyl
    2. ADMINISTER REQUIRED DOSE OF DILUTED FENTANYL OVER 10 MINUTES
    3. FLUSH LINE WITH 1 mL D5W OVER 5 MINUTES
  • if the infant is insufficiently sedated after 15 minutes, the dosage may be repeated x 1
  • the effect may last, on average, 2 to 4 hours
  • naloxone (a narcotic antagonist) should be readily available at the bedside, (DOSAGE OF NALOXONE = 10 mcg/kg); this may be repeated as required

Supplied

  • 50 mcg/mL (2 mL and 5 mL ampoules)

References

  1. Bell SG and Ellis LJ: Use of fentanyl for sedation of mechanically ventilated neonates, Neonatal Network 1987 (Oct): 27-31.
  2. Jarvis AP and Arancibia CV: A case of difficult neonatal ventilation (letter), Anesthesia and Analgesia 1987; 66:196.
  3. Billmire DA, Neale HW and Gregory RO: Use of IV fentanyl in the outpatient treatment of pediatric facial trauma, The Journal of Trauma 1985; 25:1079-1080.
  4. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  5. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.
  6. Young TE and Mangum OB: Neofax - A Manual of Drugs Used in Neonatal Care, Columbus, Ohio: Ross Laboratories, 1992.

Updated: 02 August 2002




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