Fentanyl Drip

Your propofol dropped the heart rate.. that is a common effect seen with propofol.

Symptomatic or asymptomatic bradycardia ?

Both propofol and precedex cause bradycardia.

Fentanyl rarely causes a drop in heart rate or blood pressure, especially not at such a low dose of 15 mcg per hour.

Thank you so much for your reply. I am sure you are correct.

The next day the discontinued the propofol and precedex drip. Left the fentanyl drip on with ranges of 50 to 75mcg/kg/hr. Pt had continued transient asymptomatic bradycardia. I suspect, in this situation, her heart rate had nothing to do with the drips.

Everyone was telling me that it was the fentanyl but didn't understand it. I learn and remember things better

Fentanyl is preferred because of its ability to attentuate hemodynamic stability but it can stimulate a vasovagal response. Could fentanyl effect the heart rate with no changes to the blood pressure?

15mcg/hr of Fentanyl didn't touch your HR, it was the propofol. I have gone over 200mcg an hour per order with no big changes

Precedex is usually the big culprit, I have seen it work well and not effect hemodynamic stability (alpha agonist) but it has diminishing returns if the patient has been on it a few days. Also it's very expensive which turns our pharmacists into Nazis.

15mcg/he of Fentanyl should not drop the pressure or hr. That is a very ow dose.

I guess it's quite different in peds - we run propofol gtt for no more than 24 hours, but when we start we run at 75-125 mcg/kg/min and titrate from there (not unusual to see 175 mcg/kg/min in the smaller patients). Seems like the smaller they are, the quicker they metabolize it. I know it's not directly related to your question, but just an observation :)

The patient came in with a narcotic overdose ... surprised there was any basal rate on the fentanyl PCA at all considering this.

Cheers

Thank you so much for your reply. I am sure you are correct.

The next day the discontinued the propofol and precedex drip. Left the fentanyl drip on with ranges of 50 to 75mcg/kg/hr. Pt had continued transient asymptomatic bradycardia. I suspect, in this situation, her heart rate had nothing to do with the drips.

Everyone was telling me that it was the fentanyl but didn't understand it. I learn and remember things better

Fentanyl is preferred because of its ability to attentuate hemodynamic stability but it can stimulate a vasovagal response. Could fentanyl effect the heart rate with no changes to the blood pressure?

I don't believe it was either of the drips. These explanations for the bradycardia are essentially zebras when there was much more likely a horse which caused it.

Fentanyl does not cause a vasovagal response. The only time you'll see a change in hemodynamics when administering fentanyl is if the hemodynamics are being held where they are due to a stress response from patient being in pain.

This patient, having OD'd on narcotics, was so used to them from home that 15 mcg/hr is probably juuuust keeping them from DTs. It's not even touching them. You can give 15 mcg of fentanyl to a 80 y/o little old lady and she won't blink from it. It must have been running at 0.3 ml/hr! They probably didn't even get any in there IV lol! It just gets funnier the more I think about it.

The propofol isn't "maxed out" either, maybe it is by your unit's policy. However 50 mcg/kg/hr is again, nothing for this patient.

The bradycardia was certainly from another cause.

I've never given less that 50mcg of fentanyl as a continuous gtt. Also, depending on body habitus, 50mcg of propofol is like sugar water.... Useless...