Table 1 Symptom-triggered IV fentanyl induction orders
From: Case report: acute care management of severe opioid withdrawal with IV fentanyl
Phases | Medication | Monitoring |
|---|---|---|
Pre-induction | Discontinue all opioids | Â |
Induction | Fentanyl 100–200 mcg IV q5min until patient satisfaction and RASS 0/−1 | COWS before/after induction RASS, vitals* after each dose |
Maintenance (0–24 h post-induction) | Fentanyl X mcg IV q1h PRN to maintain patient comfort and RASS 0/−1, where X is 50% of cumulative induction dose | RASS, vitals* q1h Continuous ECG and oxygen saturation monitoring |
Consolidation (24 h + post-induction) | Reduced frequency of dosing on consecutive days to q2h, q3h, q4h PRN, where fentanyl dose is calculated using 24 h cumulative dose divided by dosing frequency | RASS, vitals* q1h Continuous ECG and oxygen saturation monitoring |
Oversedation (RASS ≤ -2) | Naloxone 0.1 mg IV push q2min PRN until patient awakens | RASS, vitals* q1h Continuous ECG and oxygen saturation monitoring |