Fentanyl

[spartacus007]

Dear Colleagues

 

I am writing to you about your dose range and experiences of using fentanyl infusions for sedation. What is your range and what side effects have you seen. 

 

Alok

[JMari]

Hi Alok,

We use Fentanyl infusion on our unit, we start with 1 ug/kg/h and titrate depending on the effect. No major side effect experienced (apart from respiratory depression), but we see withdrawal if used for longer period. Most frequently given for postop pain/PPHN etc.

Judit

[frvg666]

We USE clonidine infusion (1.5microgr) 2 - 3 days before we stopp fentanyl infusion if duration of fentanyl was longer than 4-5 days. Almost no withdrawl problems, reduction of clonidine 2-3 days after fentanyl was stopped

 

[bimalc]

1-4 ug/kg/h infusions, usually the lower end of that spectrum, titrating by 0.5 to 1 to effect.  Obviously respiratory depression is an issue, but these drips are almost exclusively used in intubated patients so less of a concern.  Less uniform practice in my group, historically have used methadone or morphine to come off high dose infusions, but we're increasingly using dexmedetomidine for much the same reason/effect as @frvg666 uses clonidine when coming off larger exposures. 

[rehman_naveed]

Can share any evidence about use of dexmet use in newborns. I am currently in the process of making guidelines but didn’t find any robust evidence about its use in newborns but still I know many nicu use it. Thanks 

[Pototo]

Very interesting. I´m worry abaut this item.

This is very novel aprox

Pharmacologic Analgesia
and Sedation in Neonates
Christopher McPherson, PharmDa,b,*, Ruth E. Grunau, PhDc,d

Clin Perinatol 49 (2022) 243–265
https://doi.org/10.1016/j.clp.2021.11.014 perinatology.theclinics.com
0095-5108/22/ª 2021 Elsevier Inc. All rights reserved.

 

About  ***sorry

 

[Flavio Martins]

Hi.

I work in 3 NICU. One of than is only for surgical babys and we use mechanical ventilation for long times. In this unit, we use 0,5 to 4 mcg/kg/hour of Fentanyl in continuous infusion. When we use for more than 7 days, we usually tape off about 20% each 2 days. 

Some babys, especially term babys with prolonged intubation, need adiccional drugs. We use midazolam or dexmetomedine.