Parenteral Manual


Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Narcotic analgesic
Original Date: 
August 2005
  • Induction and maintenance of anesthesia (with 100% oxygen)
  • Analgesic adjunct
Reconstitution and Stability: 
  • Available as a 50 mcg/mL injection
  • Store at room temperature. Protect from light

- Solutions Compatible: D5W, NS

- Y-site Compatible: propofol

- Incompatible: acidic solutions, thiopental


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Push

Usual dilution: undiluted (50 mcg/mL)
Infusion time: 3-5 minutes

IV Intermittent Infusion YES
Usual dilution: dilute in D5W or NS
Infusion rate: >1 mcg/kg/hr in children >12 years
IV Continuous Infusion YES: in NICU

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • Titrate dose to appropriate effects;  wide range of doses dependant upon desired degree of analgesia or anesthesia

Children 2-12 years: 
- Anesthesia:

  • Initial: 10-25 mcg/kg IV
  • Maintenance: up to 25-50 mcg IV PRN

- Anesthesia:

  • Initial: 8-30 mcg/kg IV
  • Maintenance: 10-50 mcg IV PRN

-  Analgesic Adjunct:

  • Low Dose
    - Initial: 0.5-1 mcg/kg IV
    - Maintenance: 10-25 mcg IV PRN
  • Moderate Dose:
    - Initial: 2-8 mcg/kg IV
    - Maintenance: 10-50 mcg IV PRN
Potential hazards of parenteral administration: 
  • Apnea, respiratory depression
  • Hypotension, hypertension, bradycardia
  • CNS depression, sedation, dizziness
  • Nausea, vomiting
  • Skeletal muscle and chest wall rigidity (especially with rapid IV administration)
  • Antidote: Naloxone
  • Contraindicated in increased intracranial pressure and severe respiratory depression
  • Monitor respiratory rate, blood pressure, heart rate, oxygen saturation,  neurological status (degree of analgesia/anesthesia)
  • Abrupt discontinuation after prolonged use may result in withdrawal symptoms
  • Onset of action: 1-3 minutes
  • Duration: dose dependant
    - Anesthesia adjunct doses: 5 minutes

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.