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In children, intranasal fentanyl is useful for the treatment of moderate and severe pain and is well tolerated. In emergency medicine, safe administration of intranasal fentanyl with a low rate of side effects and a promising pain-reducing effect was demonstrated in a prospective observational study in about 900 out-of-hospital patients.
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For both emergency and palliative use, intranasal fentanyl is available in doses of 50, 100, and 200 µg.
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The bioavailability of intranasal fentanyl is about 70–90%, but with some imprecision due to clotted nostrils, pharyngeal swallow, and incorrect administration. Pain management Ī fentanyl nasal spray with a strength of 100 μg per use For this reason, shorter acting agents such as alfentanyl or remifentanil may be more suitable in the context of inducing general anaesthesia. At high doses, the drug may act on the fetus to cause postnatal respiratory distress. In obstetrics, the dose must be closely regulated in order to prevent large amounts of transfer from mother to fetus. It is widely used in obstetrical anesthesia because of its short time to action peak (about 5 min.), the rapid termination of its effect after a single dose, and the occurrence of relative cardiovascular stability. Because of fentanyl's high lipid solubility, its effects are more localized than morphine, and some clinicians prefer to use morphine to get a wider spread of analgesia. Obstetrics įentanyl is sometimes given intrathecally as part of spinal anesthesia or epidurally for epidural anaesthesia and analgesia. The almost immediate onset of fentanyl reduces visceral discomfort and even nausea during the procedure. Spinal administration of hyperbaric bupivacaine with fentanyl may be the optimal combination. Regional anesthesia įentanyl is the most commonly used intrathecal opioid because its lipophilic profile allows a quick onset of action (5–10 min.) and intermediate duration of action (60–120 min.). Balancing this medication and titrating the drug based on expected stimuli and the person's responses can result in stable blood pressure and heart rate throughout a procedure and a faster emergence from anesthesia with minimal pain. įor pain relief after surgery, use can decrease the amount of inhalational anesthetic needed for emergence from anesthesia. These are often given in 15–30 minute intervals throughout procedures such as endoscopy and surgeries and in emergency rooms. To maintain anesthesia, inhaled anesthetics and additional fentanyl may be used. To induce anesthesia, it is given with a sedative-hypnotic, like propofol or thiopental, and a muscle relaxant. Intravenous fentanyl is often used for anesthesia and to treat pain. Factories in China manufacture fentanyl or fentanyl precursors it is then smuggled into other countries for illicit sale in the United States, the Chinese-manufactured fentanyl is smuggled primarily via Mexico. It can be cut into, or even replace entirely, the supply of heroin and other opiates. Compared with heroin, it is more potent, has higher profit margins, and, because it is compact, has simpler logistics. In 2021, fentanyl and fentanyl analogues accounted for most drug overdose deaths in the United States with 71,238 deaths. It is on the World Health Organization's List of Essential Medicines. As of 2017, fentanyl was the most widely used synthetic opioid in medicine in 2019, it was the 278th most commonly prescribed medication in the United States, with more than one million prescriptions. In 2015, 1,600 kilograms (3,500 pounds) were used in healthcare globally. It is around 100 times stronger than morphine and about 50 times stronger than heroin.įentanyl was first made by Paul Janssen in 1960 and approved for medical use in the United States in 1968. Fentanyl works by activating μ-opioid receptors. Serious adverse effects may include respiratory depression, hallucinations, serotonin syndrome, low blood pressure, or development of an opioid use disorder. Ĭommon adverse effects of fentanyl include nausea, vomiting, constipation, itching, sedation, confusion, and injuries related to poor coordination.
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Medically, it is used by injection, nasal spray, or skin patch, or absorbed through the cheek as a lozenge or tablet. It has a rapid onset and its effects generally last under two hours. Fentanyl is commonly used to create counterfeit pills disguised as Ox圜ontin, Xanax, Adderall, among others. Its potentially deadly overdose effects can be neutralized by naloxone. It is also used illicitly as a recreational drug, sometimes mixed with heroin, cocaine, benzodiazepines or methamphetamine. Together with other drugs, fentanyl is used for anesthesia. Fentanyl, also spelled fentanil, is a potent opioid used as a pain medication.