Page 140 - 2023 SMOG Digital

FENTANYL Lactation Yes (Not recommended) Trade Name: Sublimaze
Class / Mechanism of Action
Opioid Analgesic; 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: IV almost immediate, Duration: IV 0.5-1 hour
Indications
Labeled Indications:
• Pain relief
• Adjunct to general or regional anesthesia
Contraindications
• Hypersensitivity to fentanyl or any component of the formulation
Adverse Reactions / Precautions
• When using only as pain med and not adjunct to general anesthesia, ensure Slow IV Push (3-5 min).
Rapid infusion may result in chest wall rigidity, impaired ventilation, or respiratory distress/arrest Always be
prepared for use of paralytic and intubation (positive control of airway).
• Head trauma: Use with extreme caution in head injury, or suspected increased ICP; exaggerated
increase in ICP may occur if patient management is inadequate.
• May worsen Bradycardia
• May cause life-threatening hypoventilation and Reparatory depression
• CNS depression: Impairs physical and mental abilities
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Pain Management: Pain Management:
IV: Slow (Unlabeled) IV: Slow (Unlabeled)
• 0.5-1mcg/kg prn for breakout pain q30-60min • 0.5-1mcg/kg prn for breakout pain q30-60min
IN:
• 100mcg Sedation during mechanical ventilation:
Note: Patients with prior opioid exposure may have IV:
increased tolerance and require higher dosing • Initial Bolus: 1-2mcg/kg
• Continued Sedation: 0.5-2mcg/kg q30-60min or
Sedation during mechanical ventilation: 0.5-2mcg/kg/hr infusion
IV: (Combine with 0.05-0.1mg/kg Midazolam for best
• Initial Bolus: 1-2mcg/kg effect)
Continued Sedation:
• 0.5-1mcg/kg/hr infusion (See Infusion chart next
page)
(Combine with 0.05-0.1mg/kg Midazolam for best
effect)
• 0.5-2mcg/kg IVP q30-60min Note: Titrate doses and intervals to pain
relief/prevention. Monitor vital signs.
Pretreatment for RSI: • Single IV doses last 0.5-1 hour
3-5 min prior to RSI in pt's with Head injuries,
Increased ICP, Cardiac Ischemia or Aortic Dissection
(if situation allows):
• 3mcg/kg slow IV push
Non-Traumatic Chest Pain (Cardiac)
• 25-50mcg IV

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