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Palliative Care and the ICU

Next Reply: Re:Fentanyl Drip Protocol
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Post Fentanyl Drip Protocol
Author: CMichael
Date: Oct 7, 2009 2:38 pm
Hello All,
I'm new to this discussion group and apologize in advance if this topic has been posted before. We are in the process of developing a Fentanyl Drip protocol for use in pain management as well as palliative care. Does anyone have a protocol they would be willing to share. At this point any and all help will be greatly appreciated.

Thanks in advance,
Crystal Michael
Clinical Pharmacist
Trinity Regional Medical Center
Fort Dodge, IA
michaec@ihs.org
Replies: order by [Date] [Author] [Subject]
Re:Fentanyl Drip Protocol (by mrabow on 10/12/2009)
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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