FENTANYL
Introduction:
- Is a pure opioid agonist.
- Given by IM, IV, transmucosal, transdermal (fentanyl patch), intrathecal & epidural routes.
- Order of potency (in decreasing order): Sufentanil > Fentanyl = Remifentanil > Alfentanil.
Uses:
As agent of choice in:
- TIVA (Total intravenous anesthesia – propofol supplemented by fentanyl.
- Daycare surgery.
- Conscious sedation.
Most common uses:
- Preferrable induction agent for CVS surgeries.
- For patient-controlled epidural analgesia.
- Useful for chronic pain.
- As a premedication agent – Mainly analgesia.
- As neurolept analgesia – Along with droperidol.
- As neurolept anesthesia – Used with N2O (adding O2).
Advantages:
- Prevents rise in IOT during induction.
- Maintains coronary perfusion pressure along with etomidate.
- Produce stress-free anesthesia.
Adverse effects:
- “Biphasic/delayed/recurrent respiratory depression” –
- Respiratory depressant effect of fentanyl outlasts analgesic duration & recurs after dissipation.
- Truncal rigidity on rapid i.v. injection:
- All fentanyl genres can produce increased chest muscles tone with rapid fentanyl injection.
- Cause bradycardia.
Exam Important
- A patient after undergoing thoracotomy with severe pain can be managed by I.V fentanyl
- Chest wall rigidly is the common side effect seen with fentanyl
- A 25 year old overweight female was given fentanyl-pancuronium anesthesia for surgery. After surgery and extubation she was observed to have limited movement of the upper body and chest wall in the recovery room. She was conscious and alert but voluntary respiratory effort was limited. Her blood pressure and heart rate were normal. The likely diagnosis is “Incomplete reversal of pancuronium”.
- Propofol, fentanyl, isoflurane are the most preferred for short day care surgeries .
- Drug used for Epidural Analgesic is Fentanyl.
- Management of chronic pain includes Epidural fentanyl.
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