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
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.
Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC Last Update: April 26, 2021
