Fentyl IV Injection is indicated for:
- Analgesic action of short duration during anaesthetic periods, premedication, induction and maintenance, and in the immediate post-operative period (recovery room) as the need arises.
- Use as a narcotic analgesic supplement in general and regional anaesthesia.
- Administration with a neuroleptic such as droperidol injection as an anaesthetic premedication, for the induction of anaesthesia, and as an adjunct in the maintenance of general and regional anaesthesia.
Dosage & Administration
Dosage should be individualised. Some of the factors to be considered in determining the dose are: age, body weight, physical status, underlying pathological condition, use of other medicines, type of anaesthesia to be used, and the surgical procedure involved. The initial dose should be reduced in the elderly and in debilitated patients. The effect of the initial dose should be taken into account in determining supplemental doses. Vital signs should be monitored routinely.
Usual Dosage in Adult: Premedication (To be appropriately modified in the elderly, debilitated and those who have received other depressant medicines) 50 to 100 micrograms (1 to 2 ml) may be administered intramuscularly 30 to 60 minutes prior to surgery. Adjunct to general anaethesia: Induction - 50 to 100 micrograms (1 to 2 ml) may be administered initially intravenously and may be repeated at 2 to 3 minute intervals until the desired effect is achieved. A reduced dose as low as 25 to 50 micrograms (0.5 to 1 mL) is recommended in elderly and poor-risk patients. Maintenance - 25 to 50 micrograms (0.5 to 1 ml) may be administered intravenously or intramuscularly when movement and/or changes in vital signs indicate surgical stress or lightening of analgesia.
Adjunct to regional anaesthesia: 50 to 100 micrograms (1 to 2 ml) may be administered intramuscularly or slowly intravenously when additional analgesia is required. Post-operatively - (Recovery room): 50 to 100 micrograms (1 to 2 ml) may be administered intramuscularly for the control of pain, tachypnoea, and emergence delirium.The dose may be repeated in one or two hours as needed.
Usual Dosage in Children: For induction and maintenance in children 2-12 years of age, a reduced dose as low as 20 to 30 micrograms (0.4 to 0.6 ml) per 10 kg is recommended.
Fentanyl injection can produce drug dependence of the morphine type and therefore has the potential for being abused. Fentanyl injection may be habit forming. Patients on chronic opioid therapy or with a history of opioid abuse may require higher doses.
Profound analgesia is accompanied by marked respiratory depression, which can persist or recur in the post-operative period. Hyperventilation during anaesthesia may alter the patient's responses to CO2, thus affecting respiration post-operatively. Therefore, patients should remain under appropriate surveillance.
Fentanyl injection may cause muscle rigidity, particularly involving the muscles of respiration. This effect is related to the speed of injection and its incidence can be reduced by a slow intravenous injection (ordinarily sufficient for lower doses) premedication with benzodiazapines and the use of muscle relaxants.
Head Injuries and Increased Intracranial Pressure:
Fentanyl Injection should be used with caution in patients who may be particularly susceptible to respiratory depression, such as comatose patients who may have a head injury or brain tumour. In addition, Fentanyl injection may obscure the clinical course of patients with a head injury.
Fentanyl injection may produce bradycardia and possibly asystole if the patient has received an insufficient amount of anticholinergic, or when Fentanyl injection is combined with non-vagolytic muscle relaxants. Bradycardia may be treated with atropine. However, Fentanyl injection should be used with caution in patients with cardiac bradyarrhythmias.
Pregnancy and Lactation
Pregnancy Category C. Consequently, risks and potential benefits should be considered before this medicine is administered to pregnant patients.
Use in Children: The safety of Fentanyl Citrate in children younger than two years of age has not been established.
Use in the Elderly or Debilitated Patients: It is recommended to reduce the dosage of Fentanyl injection in the elderly and in debilitated patients.
Effects on ability to drive and use machines: Patients should only drive or
operate a machine if sufficient time has elapsed after the administration of