Latest revision as of 20:58, 31 January 2023

Commonly Used Opioids
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

@@ Line 4: / Line 4: @@
 ! Opioid !! Dose !! Onset !! Duration !! Elimination !! Unique effects/indications
 |-
-| Fentanyl || 1-20 ug/kg || 4-6 min || 15-30 min || Hepatic/Renal || Example
+| Fentanyl || 1-20 ug/kg || 4-6 min || 30-45 min || Hepatic || Not used as infusion
 |-
-| Sufentanyl || 0.3-1 ug/kg || 2-4 min || 5-15 min || Hepatic/Renal || Example
+| Sufentanyl || 0.3-1 ug/kg || 1-2 min || 20-40 min || Hepatic || ...
 |-
-| Remifentanyl || 0.1-0.3 ug/kg || 1-2 min || 2-5 min || Plasma esterases || Example
+| 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 || 15-50 ug/kg || Example || Example || Hepatic/Renal || Example
+| Alfentanyl || 5-50 ug/kg || 1-2 min || 20 min || Hepatic || ...
 |-
-| Morphine sulfate || 25-75 mg || 10-30 min || 2-5 hrs || Example || Can cause histamine release
+| Morphine sulfate || 25-75 mg || 10-30 min || 2-5 hrs || Hepatic || Can cause histamine release
 |-
-| Meperidine || Example || 10-30 min || 2-5 hrs || Example || Used for post-op shivering
+| Meperidine || Example || 10-30 min || 2-5 hrs || Hepatic || Used for post-op shivering, can't give to patients taking MAOIs
 |}