From the Guidelines
Fentanyl should be administered at a dose of 0.5-1 μg/kg as a bolus, with subsequent doses of 0.5 μg/kg as required, to blunt the response to intubation. This recommendation is based on the most recent and highest quality study available, which provides guidelines for awake tracheal intubation in adults 1. The study suggests that fentanyl has an onset of action of 2-5 minutes and a duration of action of 30-60 minutes, making it a suitable choice for blunting the hemodynamic response to intubation.
When administering fentanyl for this purpose, it is essential to consider the potential risks and benefits, including the risk of respiratory depression, which can be mitigated by careful monitoring and the availability of resuscitation equipment. The study also notes that fentanyl can be used in combination with other medications, such as propofol or midazolam, to achieve the desired level of sedation and analgesia.
Some key points to consider when using fentanyl for intubation include:
- Onset of action: 2-5 minutes
- Duration of action: 30-60 minutes
- Dosing: 0.5-1 μg/kg as a bolus, with subsequent doses of 0.5 μg/kg as required
- Potential risks: respiratory depression, chest wall rigidity
- Benefits: effective analgesia and blunting of the hemodynamic response to intubation.
It is crucial to weigh these factors and use clinical judgment when determining the optimal dose and administration strategy for fentanyl in the context of intubation, as supported by the guidelines outlined in the study 1.
From the Research
Fentanyl Dose for Blunting Response to Intubation
- The optimal dose of fentanyl to blunt the response to intubation is not explicitly stated in the provided studies, but the doses used in the studies range from 1-3 micrograms/kg 2, 3, 4, 5.
- A study from 1998 found that administering fentanyl 5 minutes before tracheal intubation was the most effective time to protect circulatory responses to laryngoscopy and tracheal intubation 2.
- Another study from 2000 compared the effects of small doses of fentanyl and remifentanil on cardiovascular changes after tracheal intubation, and found that remifentanil was more effective in controlling cardiovascular responses than fentanyl 3.
- A study from 2006 found that a combination of fentanyl, midazolam, and propofol provided better intubating conditions than a combination of fentanyl, lignocaine, and propofol 4.
- A study from 2010 compared the effects of fentanyl and dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation, and found that the dexmedetomidine combination provided better intubation conditions, but with a higher risk of bradycardia 5.
Comparison of Fentanyl Doses
- The study from 1998 used a dose of 2 micrograms/kg of fentanyl 2.
- The study from 2000 used a dose of 3 micrograms/kg of fentanyl 3.
- The study from 2006 used a dose of 2 micrograms/kg of fentanyl 4.
- The study from 2010 used a dose of 2 micrograms/kg of fentanyl 5.
- The study from 2023 used a dose of 1.0-1.5 micrograms/kg of fentanyl 6.