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Discussion

? about Fentanyl

This is actually a question of my huband who is a paramedic. The local paremdics/emts want to know about a new protocol they have, and I don't blame them! They are trying to replace morphine on the ambulances with Fentanyl. Many fear that it doesn't have the MONA potential for MI...but someone says it does (Hubby was on the phone and couldn't elaborate..but asked me to post this for comment).

Now...my hospital does not use Fentanyl unless in patch form..and I will find out why (we use morphine IV or Dilaudid IV..then I try to get my ortho pts on po quickly when tolerated for longer effects and antispasmotics). So I don't deal with cardiac effects as much...but as I recall..fentanyl never was mentioned as cardiac???

Anyone have insight?

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cee

I think we are all talking about use of IV fentanyl in the cardiac patient, not the patch.

Swtooth

Well, someone else brought up the patch. Certainly just my $0.02 worth.

Fentanyl is the pain drug of choice for Pt's with Gall Bladder pain because Morphene makes GB issues worse not better. We also use it for end of life cancer pain for GI cancers along with roxenal and Morphene (anything that helps is given for those in this condition - have put 8 Fentanyl patches + IV push Morphene every hour + sublingual Roxenal with some of these pts that nothing else helps with.

Fentanyl is the pain drug of choice for Pt's with Gall Bladder pain because Morphene makes GB issues worse not better. We also use it for end of life cancer pain for GI cancers along with roxenal and Morphene (anything that helps is given for those in this condition - have put 8 Fentanyl patches + IV push Morphene every hour + sublingual Roxenal with some of these pts that nothing else helps with.

I administer fentanyl many times a day and never have thought about its use in an acute MI but this question is forcing to to think! Its the narcotic of choice for cardiac anesthesia because in large doses it prevents increases in heart rate. Pain during an MI should be treated aggressively to decrease sympathetic stimulation and fentanyl would be more ideal for this than morphine. No problem with it being short acting - just give it more often or follow it with a morphine chaser. Pain is always the enemy during MI.

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