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CAPC Palliative Care Discussion Forum
Palliative Care and the ICU

In Reply To: Fentanyl Drip Protocol

Post Re:Fentanyl Drip Protocol
Author: mrabow [CAPC/PCLC Faculty]
Date: Oct 12, 2009 12:02 am
Hi,

Most of the protocols I've seen are for ICU sedation and for compassionate extubation. I'm hopeful readers of this forum will submit fentanyl analgesia protocols from their own institutions. At UCSF, we use fentanyl on our palliative care service, but not by protocol.

As a pharmacist, you are expert in the following, but I will include it in my post for others who may be interested. The applicable principles include boluses starting at 50-100mcg IV, an infusion rate starting at 0.5-1.5 mcg/kg/hour, with frequent re-assessment. With IV medications, Cmax (when the med effect is at its maximum) will be at about 6 minutes. Some published rapid ER protocols call for re-boluses every 5 minutes.

There is an increasing variety of fentanyl formulations, including IV, transdermal, oral transmucosal, buccal tablet, and, most recently, buccal film.

Michael W. Rabow, MD. Professor of Clinical Medicine. Associate Director, UCSF PCLC
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