Presentation
100 mcg in 2 mL glass ampoule
250 mcg in 1 mL glass ampoule or cartridge (IN use only)
Pharmacology
CNS effects:
- Depression – leading to analgesia
- Respiratory depression – leading to apnoea - Dependence (addiction)
Cardiovascular effects:
- Decreases conduction velocity through the A-V node
Metabolism
By the liver; excreted by the kidneys
Primary Emergency Indications
- Sedation to facilitate intubation
- Sedation to maintain intubation
- Sedation to facilitate transthoracic pacing
- Sedation to facilitate synchronised cardioversion
- CPR interfering patient - ALS
- Analgesia – IV/IN
- History of hypersensitivity or allergy to morphine - Known renal impairment / failure
- Short duration of action desirable
- Hypotension
- Nausea and/or vomiting - Severe headache
Contraindications
- History of hypersensitivity
2. Late second stage of labour
Precautions
- Elderly/frail patients
- Impaired hepatic function
- Respiratory depression, e.g. COPD
- Current asthma
- Patients on monoamine oxidase inhibitors
- Known addiction to opioids
- Rhinitis, rhinorrhea or facial trauma (IN route)
ROA
IV
IN
IV infusion
Side effects
Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles Bradycardia
Special notes
Fentanyl is a Schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility
Respiratory depression can be reversed with Naloxone
100 mcg Fentanyl is equivalent in analgesic activity to 10 mg Morphine
IV effects:
Onset: Immediate Peak: < 5 minutes Duration: 30 - 60 minutes
IN effects:
Peak: 2 minutes
Dose
IV: 50mcg, repeat 50mcg every 5 minutes (max 200mcg)
IN: 200mcg loading dose, repeat 50mcg every 5 minutes (max 400mcg)
Old, frail, <60kg: 100mcg loading dose, repeat dose of 50mcg (maximum 200mcg)
Paed:
10-17kg 25mcg IN
18-39kg 25mcg or 50mcg IN
Repeat initial dose at 5-10 minute intervals (max 3 doses).
