- Pain relief component of monitored anesthesia
- Adjunct to general or regional anesthesia
- RESTRICTED FOR USE in PICU by STAFF ANAESTHESIOLOGISTS in mechanically ventilated patients
- Store at room temperature. Protect from light.
- Diluted solutions 20 - 250 mcg/mL stable 24 hours at room temperature
-Solutions Compatible: D5W, 0.9% NaCl, 0.45% NaCl, D5W NS, sterile water for injection
-Y-site Compatible: acyclovir, aminophylline, ampicillin, calcium gluconate, cefazolin, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, cisatracurium, clindamycin, dexamethasone, digoxin, diphenhydramine, dobutamine, dopamine, enalaprilat, epinephrine, esmolol, fentanyl, fluconazole, furosemide, gentamicin, heparin, hydrocortisone sodium succinate, hydromorphone, imipenem/cilastatin, ketorolac, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, meperidine, methylprednisolone sodium succinate, metoclopramide, metronidazole, midazolam, morphine, nalbuphine, nitroglycerin, norepinephrine, ondansetron, piperacillin, piperacillin/tazobactam, potassium chloride, prochlorperazine, propofol, ranitidine,sodium bicarbonate, thiopental, tobramycin, trimethoprim/sulfamethoxazole, vancomycin
-Incompatible: amphotericin B, chlorpromazine, diazepam
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
|IV Intermittent Infusion||NO|
|IV Continuous Infusion||
YES -must be on an infusion pump
- Onset IV: 1 minute
- Maximum effect: 3 - 5 minutes
- Duration IV: 3 - 10 minutes
- Half-life: Terminal: 10-20 minutes; effective: 3-10 minutes
- Metabolized rapidly via blood and tissue esterases; not metabolized by plasma cholinesterase (pseudocholinesterase) and is not appreciably metabolized by the liver
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- Children: 0.025-0.3 mcg/kg/min for analgesia and sedation ; titrate up in 0.025 mcg/kg/min increments
- Respiratory depression, hypotension, bradycardia
- CNS depression, drowsiness, sedation, dizziness
- ADH release, hypersensitivity reactions
- Nausea, vomiting, constipation, biliary tract spasm, urinary tract spasm
- Muscle rigidity
- Administer 02 immediately
- Naloxone (see Naloxone monograph)
- Monitor RR, BP, HR, 02 saturation, bowel sounds, and abdominal distention
NURSING MONITORING GUIDELINES:
- Check physician's order against guidelines; question dosage if higher.
- Safely prepare and administer medication as per Medication Administration Policy.
- Continuous infusion must be on a pump.
- 02 and suction must be available at bedside
- Patient may need to be on a respiratory monitor (or Oximeter )if there are concerns
- IV solution without the added narcotic must be available at bedside with tubing primed, ready to be hooked to patient in case of an emergency.
- Naloxone must be available in the patient care area as ward stock
- Monitor: Level of consciousness, respiratory rate, BP and pulse:
- Just prior to beginning therapy
- Then every 5 minutes for 15 minutes after the initial dose or an increase in infusion rate
- Then monitor respiratory rate and pulse q1h × 4 hours thereafter as directed.
SIGNS & SYMPTOMS OF COMPLICATIONS:
- Respiratory depression (RR <10 breaths/minute)
- Somnolence, difficulty in arousing
- Orthostatic hypotension with bradycardia
- Nausea and vomiting
- Allergic reaction.
ACTIONS: Notify physician if:
- Respiratory rate below 10 breaths per minute
- Blood pressure decreased by 25% from baseline
- Patient difficult to rouse
- Allergic reaction
- Stop infusion of narcotic and start plain IV solution. Notify physician.
- Maintain patient airway and administer O2 as indicated.
- Contact Pharmacy, Anaesthesia, or Poison Information Centre if after hours, for appropriate dose of naloxone (Narcan)