Sedation, analgesia and paralysis
Fentanyl (Sublimaze) drip
Sublimaze
Dosing
| Start | 25–50 mcg/h (range 0.7–10 mcg/kg/h) |
|---|---|
| Titrate | 25 mcg/h every 15–30 minutes, with boluses |
| Maximum | No ceiling; most patients need under 200–300 mcg/h |
| Common bags | 2,500 mcg in 250 mL (10 mcg/mL); 1,000 mcg in 100 mL (10 mcg/mL) |
| Dose units | mcg/h, mcg/kg/h |
Line and administration
- Peripheral or central
Watch for
- Respiratory depression
- Chest wall rigidity with fast large boluses
- Accumulates with long infusions
Fentanyl: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Airway and RSIInduction and paralysis: pharmacology in depth: Fentanyl 1–3 mcg/kg, pretreatment: Blunts the laryngoscopy surge: ICH, dissection, ischemia; skip in shock
- Toxidromes and AntidotesThe first hour: approach to the poisoned patient: Urine immunoassays show exposure, not cause; standard opiate screens miss fentanyl, methadone, buprenorphine and often oxycodone.
- Toxins, Stings and Anaphylaxis in the FieldOpioids and sedatives: Fentanyl patch: Heat (heating pad, fever) raises absorption: Remove patch and heat; naloxone to breathing; levels fall only 50% in 20-27 h and naloxone may end within 1 h: transport
- Abdominal, GI Bleeding, GU and Dialysis EmergenciesEvery abdomen: first steps: Treat pain: analgesia does not hide the diagnosis (Merck). Fentanyl and ondansetron doses: ems-pharmacology. Ketorolac 15 mg IV or 30 mg IM, not with hypotension, kidney disease, peptic ulcer or pregnancy (NASEMSO).
- Asthma and COPD ExacerbationsSedation, paralysis and rescue therapies: Deep sedation early suppresses the air hunger that drives a fast rate and dyssynchrony. Propofol (bronchodilating, but hypotensive) with fentanyl is common; ketamine adds bronchodilation with less hypotension but more secretions; avoid morphine, which releases histamine. Lighten sedation as obstruction resolves.
- Common EMS MedicationsPain, sedation, nausea and bleeding: Fentanyl, opioid: Moderate to severe pain: 1 mcg/kg, first dose ≤100 mcg; IV/IO/IN/IM: Hypotension, hypoventilation, MAOI in 14 days
Practice Airway and RSI questions free196 exam-style questions with rationales on the topic where fentanyl comes up most. No account or download needed.
Other sedation, analgesia and paralysis
- Propofol
- Dexmedetomidine
- Midazolam
- Cisatracurium
- Ketamine
- Hydromorphone
- Rocuronium
- Vecuronium
- Pentobarbital
- Remifentanil
Practice free in your browser2,450+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.