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
- Sedation, Pain and Delirium ScalesPharmacology and ICU pitfalls: Fentanyl: 0.7–10 mcg/kg/h: Accumulates after long infusions
- Airway and RSIInduction and paralysis: pharmacology in depth: Fentanyl 1–3 mcg/kg, pretreatment: Blunts the laryngoscopy surge: ICH, dissection, ischemia; skip in shock
- Mental Health: Meds and CommunicationAntidepressants in the ICU and serotonin toxicity: In the ICU the second drug is often not an antidepressant: linezolid and methylene blue inhibit MAO, and fentanyl, methadone, tramadol, meperidine, dextromethorphan and ondansetron are implicated. The ZYVOX label (June 2026) now asks for monitoring rather than avoidance with serotonergic drugs; in an older-adult cohort (n = 1,134) serotonin syndro
- 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.
- End of Life, Brain Death and Organ DonationWithdrawing life support: Fentanyl: 0.5–2 mcg/kg: 0.5–10 mcg/kg/h
- Acute Abdomen and GI Surgical EmergenciesReading the acute abdomen: High-risk groups are the very old, the very young and anyone on corticosteroids or other immunosuppressants. These drugs blunt the inflammatory response, so a perforation can cause less pain, less tenderness and a smaller WBC rise than expected; a new tachycardia may be the main clue. Merck states that moderate IV analgesia (fentanyl 50-100 mcg or morphine 4-6 mg) does n
Practice Sedation, Pain and Delirium Scales questions free123 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
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.