FentaNYL

FentaNYL

Indication

• To provide sedation and analgesia

Pharmacology

• FentaNYL is a synthetic, rapid acting, narcotic analgesic which is chemically related to meperidine (Demerol®)
• 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 (E.G. 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 2.5mcg/mL for patients less than 1kg
  • 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 or = 2.5 mcg/mL Fentanyl
  2. Administer required dose of diluted fentaNYL over 10 minutes
  3. Flush line with 1mL D5W over 5 minutes
• If the infant is insufficiently sedated after 15 minutes, the dosage may be repeated once
• 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 As

• 50 mcg/mL (2 mL and 5 mL ampoules)