Fentanyl

• Used for:

  • Reducing airway reflexes: Suppresses cough reflex and bronchospasm during intubation

  • Reducing autonomic response to painful stimuli during intubation

  • Supplementing sedation: Allows you to reduce the dose and avoid side effects of the primary induction agent

  • GA goals met: Sedation, Analgesia

• Mechanism: 

  • Part of the opioid drug class. Activates central and peripheral mu receptors. 

• Physiological Effects: 

  • Analgesia and sedation: But has no amnesic effects. 

  • Stable/decreases HR and BP: Blunts sympathetic tone.

  • Decreases RR: Opioids cause respiratory depression from acting on respiratory centers in the medulla. 

• Adverse Effects:

  • Respiratory depression, drowsiness, confusion

  • High rates of PONV due to stimulation of the chemoreceptor trigger zone in the brain stem.

• Contraindications:

  • Patients with obstructive airway disease (e.g., asthma, COPD, obstructive sleep apnea)

  • Liver failure: Fentanyl undergoes hepatic clearance 

Fentanyl Overdose Presentation:

• Pinpoint pupils

• Slow, deep breathing (increased TV, reduced RR)

• Drowsiness and confusion

• Cold, clammy skin

• Antidote: Naloxone