Fentanyl

Provider Level

AEMT/RN/Paramedic

Class

Synthetic opioid analgesic

Mechanism of Action

Binds to opiate receptors in the CNS, altering the perception of and response to pain, producing generalized CNS depression.

Indications

Severe pain, adjunct to sedation, maintenance of analgesia during procedural sedation.

Contraindications

Hypersensitivity to fentanyl, severe respiratory depression, severe hypotension, increased intracranial pressure (relative), uncorrected hypovolemia, concurrent use of MAOIs within 14 days.

Routes

IV, IO, IM, Buccal, Dermal

Onset / Duration

Onset: 1 to 3 minutes for IV/IO, up to 15 minutes for IM. Duration: 30 to 60 minutes for IV/IO, 1 to 2 hours for IM.

Adverse Effects

Respiratory depression, apnea, hypotension, bradycardia, nausea, vomiting, dizziness, altered mental status, and chest wall rigidity (particularly with rapid IV administration or high doses).

Precautions & Interactions

Use with caution in elderly patients, patients with severe renal or hepatic impairment, and patients with compromised baseline respiratory function. Concurrent use with other CNS depressants (e.g., benzodiazepines, alcohol) significantly increases the risk of profound respiratory depression.

Special Considerations

Continuous monitoring of vital signs, including pulse oximetry and capnography, is required. Naloxone and appropriate airway management equipment must be readily available to manage potential respiratory depression or apnea. Chest wall rigidity can be life-threatening and may require neuromuscular blockade and intubation if naloxone is ineffective.