Page 127 - 2026 SMOG

FENTANYL (SUBLIMAZE)
Class/Mechanism of Action
• Analgesic, Opioid (Agonist); General Anesthetic
Binds to opioid receptors within the CNS, increasing pain threshold and altering pain reception; inhibits
ascending pain pathways (blocking painful stimulus); produces CNS depression.
˚ Onset of action—IV: almost immediate; Duration—IV: 0.5–1hr
Indications
• Labeled Indications
Pain relief
˚ Adjunct to general or regional anesthesia
˚
Contraindications
• Hypersensitivity to fentanyl or any component of the formulation
• MAOI taken in the past 14 days
• Hypotension
Adverse Reactions/Precautions
• When using only as a pain medication and not as an adjunct to general anesthesia, ensure a slow IV Push
(3–5min). Rapid infusion may result in chest wall rigidity, impaired ventilation, or respiratory distress/
arrest. Always be prepared for the use of paralytics and intubation (positive control of airway)
• CNS depression, confusion, paradoxical excitation, serotonin syndrome, delirium, drowsiness, apnea/
dyspnea, bradycardia, dysrhythmias (QT-Interval prolongation), hypotension, syncope, nausea/vomiting,
abdominal pain, dehydration, fatigue
• Pregnancy: Use with caution; use the lowest dose needed.
• Lactation: Use with caution; use the lowest dose needed
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Pain Management Pain Management
Note: Patients with prior opioid exposure may • IV (SLOW)
have increased tolerance and require higher dosing 0.5–1mcg/kg/dose q1–2hr prn
• IV (SLOW) ˚ (max: 50mcg/dose)
0.5–1mcg/kg prn for breakout pain q30–60min Pretreatment for RSI
• ˚ IN/IM • IV (SLOW)
1mcg/kg; half dose in each nostril (IN max: 1mcg/kg/dose; may repeat q3min
˚ 100mcg/dose, split 50mcg/nostril) ˚ (max: 50mcg/dose)
Sedation During Mechanical Ventilation
• IV/IO
Initial Bolus: 1–2mcg/kg
˚ Continued Sedation (Infusion): 0.5–1mcg/
˚ kg/hr (see infusion chart on the next page).
Combine with Midazolam for the best effect;
consider dosage reduction.
Continued Sedation (IVP): 0.5–2mcg/kg
˚ q30–60min; 25–50mcg incremental boluses
and titrate to effect
Pretreatment for RSI
• IV (SLOW)
˚ 0.5–1mcg/kg
Non-Traumatic Chest Pain (Cardiac)
• IV
˚ 25–50mcg
2026 Standard Medical Operating Guidelines (SMOG) • 119