I was having a discussing with someone who knows a lot about children and she told me that Fentanyl is a common sedative for fussy kids when trying to do a study in a hospital setting (i.e. an echocardiogram). Obviously it would have to be administered by an anesthetist , but even then, I have a hard time imaging a drug as addictive and deadly being used on kids when I assume there are any number of alternative sedatives.
So first, is my analogy to heroin relitively accurate (Fentany=medical grade heroin) and second, is it true that it is frequently used to sedate kids?
Fentanyl is a superior adjunct to anesthesia, so yes, it is used to sedate kids. And I believe some oral forms have been developed, such as the fentanyl lollipop. (not sure if that is still used, had too many bad possible outcomes if the “candy” got diverted).
I don’t really know what your objection is. It is a helpful drug, far more potent than morphine or heroin, with a very brief half-life so that it gets out of the system fast when it’s no longer needed. It’s used in very tightly controlled circumstances, via IV infusion pumps under continuous monitoring by the anesthesia team.
It also has less euphoria associated with it than morphine or heroin does, at least according the the anesthesiologist/junkies I have known (and I have known quite a few).
So no, it’s not “medical grade heroin”. Heroin was medical grade heroin. Heroin was a superior pain-killer and anti-tussive, but the extreme degree of euphoria resulting from it far exceeded that with morphine, so its abuse potential outweighed its benefits, and it got pulled.
There are also fentanyl patches, worn on the skin, which deliver superior pain relief with less sedation and nausea that many other narcotics. It’s quite useful in treating malignant pain from cancer, among other malignant pain syndromes.
I’ll add one more thing to QtM’s excellent answer.
Addiction is rarely an issue when a narcotic is used in the way it is intended.
Street addiction is more psychological than physical.
A trauma patient can be on a morphine or fentanyl drip for weeks. Controlled withdrawal takes about three days. After they heal, and are discharged, we don’t see them in the ER drug seeking.
[slight hijack]Is there any reason why Fentanyl wouldn’t work on a person? I’ve successfully had morphine and Dilaudid for post-op pain relief, and I’ve had IV Fentanyl prescribed for post op pain relief. It’s never done a thing for me. I understand it doesn’t cause the same level of euphoria, and that’s fine. But it doesn’t seem to provide any pain relief, either.[/hijack]
Not only is it used for children, it’s used for teeny-tiny neonates (premature babies.) WhyBaby was on Fentanyl for a couple of weeks when she was born early (17 weeks early), to keep her sleepy and out of it so she didn’t fight her breathing tube or waste any energy crying or moving.
nitpick/fentanyl is an opiate receptor analgesic, not a sedative, and yes it’s an important distinction/nitpick
I’ve given buckets of it to kids without anesthesia present, works great, doesn’t last long, has less histamine release, so they don’t drop their pressure, and if the surgeon has a cow you tell them to go pee, get a cup of coffee and the pt will be clear when they get back
Larry
[nitpick pick]Generally, a sedative is any class of medication that decreases anxiety, and as such, opiates fall into that class.
In the common use, sedatives usually refer to that class of sedative/hypnotics which include barbiturates, benzodiazepines, and other tranquilizers. As such, this would exclude opiates
A sedagive is a different class of medication (semiobscure reference that most dopers will get.) [/nitpick pick]
Larry, are they using oral fentanyl on anyone these days?
we don’t have the lollipops, and I don’t think I’ve given fentanyl orally. Some docs will order oral versed, but I think that the response is so variable that it’s of questionalbe efficacy. I’ve done rectal brevital, oral versed, and oral morphine sulfate, but half the time you don’t get enough effect and have to put in a line and start again, and polypharmacy ensues, and 6 hours later cha cha cha. Of couse when it works you look great, but on average I don’t think we save any time or distress.
In the ER we’re very specific about anagesia vs sedation for some of our pts, namely fractures getting reduced or traction, trauma, and esp. chemically paralyzed and intubated pts. I admit it’s a nitpick.
BTW, it’s FrankenSTEEN, Igor
I got hit with IV versed followed by fentanyl for a coronary cath, and retained full accurate memory of what was going on in the cath lab, down to what my coronary architecture looked like.
But the memory of about 60 minutes of my stay in the recovery room are gone gone gone. Folks I talked to on the phone during that time said I was quite amusing.
fascinating…I can now understand why such a powerful drug could be appropriate for a wide range of situations. I guess the only question left in my mind is are there really not a lot of safer simpler alternatives? What about that clorophorm stuff they always talk about in the movies? Or even IV sleeping pills (i.e. Benydryl)? Super strong opiod seems overkill for making a kid sleepy.
Chloroform?? Nasty stuff, the dose necessary to render someone unconscious is quite variable, and what you think should make them unconscious either leaves them wide awake or makes them stop breathing.
IV benadryl? It is to laugh. It has a paradoxical stimulating effect on 1 out of 5 kids, and hangs around in the body for a long time.
No, opiates are great. With fentanyl, if you’ve given too much, just wait a few minutes, and it leaves the system on its own. If a few minutes is too long, give IV naloxone, and instantly reverse the effects of the drug. You can’t do that with barbiturates, benzodiazepines, alcohol, or any other form of sedative/analgesic.
Use the right tool for the right job. And don’t believe anything you see about making someone unconscious in the movies.
Yeah, heroin is a great pain-killer, and perhaps some of the reason behind pulling it was political. But we have other opiates that are equally or more effective as pain-killers so it’s really a moot point.
As far as I know, Benadryl’s not all that powerful a sedative - not enough to do major medical procedures at least, and from the descriptions above it sounds like it lasts a good deal longer than fentanyl - in some situations at least there’s advantages to being able to have the brat alert again. As for chloroform, it causes cardiac arrhythmia (IIRC) and cancer, so it’s not really the ideal choice . . .
What’s the objection? Most sedatives can have very unpleasant or dangerous side effects. Opiates are addictive, but so are barbiturates and benzodiazepines. If you’re sedating a child to perform a medical procedure, though, you need to take the risk of using drugs like that. I’m not sure why you’re convinced that opiates are necessarily worse than the other classes of sedatives. When used properly, administered by a doctor for a medical procedure, it’s not as though the child is facing a significant chance of addiction.
My nephew at age 9 had surgery on his legs at a Shriner’s Hospital for Children.
After the surgery, they wanted him to stay largely immobile for several hours, especially not moving his legs until they started to heal.
They had orders from his doctor to give him doses of morphine, up to several grains, as needed.
When I asked, they said that morphine is the best drug for this purpose:
it is very effective.
it works on all patients, with little variation in dosage needed.
it has fewer side effects than most other drugs.
it’s been used for centuries, so it’s actions are well known, as are antidotes for an overdose.
And they stated that for these patients, they were not worried about the addictiion possibility. The chances of a pre-teen patient being able to purchase and use morphine were very small.
Another point is that iv opiates are completely dose dependent, to say it’s too strong is to miss this point. I can give you so little that you can’t even feel it, or so much that you have to go on life suppport; what I’m GOING to do is cozy up to the sweet spot, get the job done and watch you closely till it passes, it’s really pretty easy, yes you have to know what you’re doing, and yes you have to be prepared, but that’s true all over.
THE ABSOLUTE WORST, screaming heebie jeebies, levitate off the gurney and spin your head around like Linda Blair spewing charcoal vomit instead of pea soup pt I’ve ever had was a benadryl overdose, gawd
I gave a 9 year old IV Fentanyl today (with some Propofol and Versed) to reduce a tricky Colles fracture. Fentanyl is a great drug – eighty times as potent as morphine and just stays around long enough to do the job.
I have never used chloroform but I like the old Tintin books where it is administered by handkerchief after sneaking up behind someone. I hardly ever get to order medicines “per handkerchief (PH)”.
