Fentanyl is a highly lipophilic, short-acting, potent opioid and an analgesic drug. It is generally given intravenously at the beginning of painful surgical procedures; hence the reflex effects of painful stimuli are eliminated.
It is frequently used to supplement anesthetics in balanced anesthesia. This allows for the use of lower anesthetic concentrations with better hemodynamic stability.
Mechanism of action.
- It inhibits ascending pain pathways, hence altering the response to pain and increasing the pain threshold
- It also produces analgesia, respiratory depression, and sedation.
Clinical uses.
- It is used as a pre-medication during surgery.
- Used as general anesthesia during surgery
- It may be used as an analgesic medication.
- Combined with benzodiazepines, it can prevent the need for inhaled anesthetics for diagnostic, endoscopic, angiographic, and burn-to dress.
It is also used as an adjunct to spinal and nerve block anesthesia.
- Relieve postoperative pain.
Adverse effects.
- Heart rate decreases because fentanyl stimulates the vagus nerve.
- Nausea, vomiting, and itching often occurs during recovery.
- Urinary retention, fever, and flatulence.
- Respiratory and circulatory depression.
- Visual disturbance.
- Dysphoria and mental clouding
Drug interactions.
- Rasagiline increases the toxicity of fentanyl in the body.
- Safinamide increases the toxicity of fentanyl.
- Concomitant use could lead to life-threatening serotonin syndrome.
Contraindications
· Hypersensitivity reaction to the drug or components of the formulation.
· Significant respiratory depression.
· Acute or severe bronchial asthma.
· Suspected gastrointestinal obstruction, i.e., paralytic ileus
· Within two weeks of monoamine oxidase inhibitor (MAOI) use.
Dosages.
- TROFENTYL, FENDOP, FENT 50 µg/ml in 2 ml amp, 10 ml vial.
- Alfentanil, Sufentanil and remifentanil are still shorter acting analogues which can be used in place of fentanyl.
