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

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

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

 

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. 

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 

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

 

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.