What is the role of fentanyl in emergency department (ED) sedation?

Updated: Nov 06, 2018
  • Author: Arul M Lingappan, MD; Chief Editor: Erik D Schraga, MD  more...
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Fentanyl is a very potent synthetic opioid and one of the commonly used analgesic adjuncts in the ED. It rapidly crosses the blood-brain barrier and thus has a rapid onset of analgesia (< 90 s). However, the serum levels rapidly decline because of tissue redistribution, making the duration of action about 30-40 minutes. It has minimal cardiovascular effects such as hypotension. Respiratory depression is uncommon, but it is potentiated when used in combination with benzodiazepines.

The intravenous dose is 2-3 mcg/kg (50-200 mcg in adults), titrated in 50 to 100-mcg increments. It is the preferred drug for analgesia in short procedures and in cases of trauma with potential hemodynamic compromise. [1] As an analgesic adjunct to continuous sedation, it can be administered as a continuous infusion in doses of 1-3 mcg/kg/h.

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