Neuromuscular Scoliosis Spinal Fusion — Fentanyl Infusion Management — Clinical Pathway

Neuromuscular Scoliosis Spinal Fusion — Fentanyl Infusion Management — Clinical Pathway

Fentanyl Infusion Management

Loading Dose
Before Incision
  • Up to 5 mcg/kg
  • With incision, expect to see an increase in vital signs that wane
Infusion
  • Initial dose: 2 mcg/kg/hr
  • After incision and initial heavy dissection
    • Decrease to 1.5 mcg/kg/hr then
    • 1 mcg/kg/min by 1 hr later
  • On occasion, an additional bolus may be needed if stimulation changes abruptly
  • If no methadone bolus at beginning of procedure, infusion may run until end of the case if patient is breathing spontaneously
If Using Methadone
  • In addition to methadone, load can bolus fentanyl up to max total 10 mcg/kg, 5 mcg/kg typically adequate
  • Turn off fentanyl infusion when surgeon begins closure