Fentanyl

Indications

  • Pain

Pharmacology

  • Opioid Receptor Agonist (see Opiates, [[Opiates]])

Metabolism

  • xxx

Administration

  • IV Bolus: 12.5-25 ug bolus
  • IV Drip: start 12.5-25 ug/hr
  • Transdermal: start 25 ug/hr

Dose Adjustment

  • Hepatic
  • Renal

Adverse Effects

Gastrointestinal Adverse Effects

Neurologic Adverse Effects

Myoclonus (see Myoclonus, [[Myoclonus]]) [MEDLINE]

  • Epidemiology:
  • Physiology: may involve opioid receptors in the brainstem and basal ganglia
  • Clinical: may resemble seizure activity

Tonic Muscle Rigidity [MEDLINE]

  • Epidemiology: usually associated with high fentanyl doses during cardiothoracic surgery (however, may be seen at lower doses and with other opiates)
  • Physiology: may involve opioid receptors in the brainstem and basal ganglia
  • Clinical: may involve chest and abdominal wall
    • Decreased Compliance/Increased Peak Inspiratory Pressures (PIP) on Mechanical Ventilation (see Ventilator Troubleshooting, [[Ventilator Troubleshooting]])
  • Treatment
    • Naloxone (Narcan) (see Naloxone, [[Naloxone]]): may be used in cases where reversal of the effect of the opiate would not be detrimental
    • Pharmacologic Paralysis: may be required in cases where reversal of the effect of the opiate would be deterimental

Pulmonary Adverse Effects


References

  • Postoperative rigidity following fentanyl anesthesia. Anesthesiology 1983;58: 275-7
  • Seizure-like movements during a fentanyl infusion with absence of seizure activity in a simultaneous EEG recording. Anesthesiology 1985;62:8124
  • Post-operative rigidity after fentanyl administration. Eur J Anaesthesiol 1986;3:4134
  • Generalized grand ma1 seizure after recovery from uncomplicated fentanyl-etomidate anesthesia. Anesth Analg 1986;65:979-81
  • Delayed muscular rigidity and respiratory depression following fentanyl anesthesia. Arch Surg 1988;123:66-7
  • Postoperative myoclonus and rigidity after anesthesia with opioids.  Anesth Analg 1994; 78:783-786 [MEDLINE]