Opioids
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Opioid | Dose | Onset | Duration | Elimination | Unique effects/indications |
---|---|---|---|---|---|
Fentanyl | 1-20 ug/kg | 4-6 min | 30-45 min | Hepatic | Not used as infusion |
Sufentanyl | 0.3-1 ug/kg | 1-2 min | 20-40 min | Hepatic | ... |
Remifentanyl | 0.3-1 ug/kg | 1-1.5 min | 5-10 min | Plasma esterases, context sensitive half-life | Profound hypotension/bradycardia, "MAC sparing" reduces need for other anesthetics by 75% |
Alfentanyl | 5-50 ug/kg | 1-2 min | 20 min | Hepatic | ... |
Morphine sulfate | 25-75 mg | 10-30 min | 2-5 hrs | Hepatic | Can cause histamine release |
Meperidine | Example | 10-30 min | 2-5 hrs | Hepatic | Used for post-op shivering, can't give to patients taking MAOIs |
- Don’t combine benzodiazepines and opioids. If you need to reverse, use flumazenil.
- Central loci of opioid action (descending inhibitory pain pathways)
- PAG
- Nucleus Raphe magnus
- Rostral ventromedial medulla
Short-Acting
- Oxycodone, Hydromorphone, Morphine
- Morphine can cause rash/pruritis
Long-Acting
- Oxycodone ER = OxyContin
- Methadone
- Fentanyl is really only used intra-op or in palliative care.