Opioid analgesic supplement in general or regional anesth. Anesth premed w/ a neuroleptic agent for induction of anesth & adjunct in the maintenance of general & regional anesth. Anesth agent w/ O2 in selected high-risk patients undergoing major surgery.
Individualized dosage. As analgesic supplement to general anesth Low dose: 2 mcg/kg. Moderate dose: 2-20 mcg/kg. High dose: 20-50 mcg/kg. Supplemental doses of 25-250 mcg should be tailored to the needs of the patient. As anesth agent 50-100 mcg/kg. Ped 2-12 yr 2-3 mcg/kg.
Patients should remain under appropriate surveillance for resp depression. Resuscitation equipment & opioid antagonist should be readily available. Induction of muscle rigidity & non-epileptic myoclonic movements can occur. Bradycardia & cardiac arrest can occur if the patient has received insufficient amount of anticholinergic or when combined w/ non-vagolytic muscle relaxants. Appropriate measures to maintain arterial BP should be taken. Avoid use of rapid bolus inj in patients w/ compromised intracerebral compliance. Patients w/ uncontrolled hypothyroidism; pulmonary disease; decreased resp reserve; alcoholism. Co-administration w/ neuroleptics & drugs that affect the serotonergic neurotransmitter systems eg, SSRIs, SNRIs, MAOIs. May impair ability to drive & use machines. Impaired hepatic or renal function. Pregnancy & lactation. Childn <2 yr. Eldery & debilitated patients.
Barbiturates, benzodiazepines, neuroleptics, general anesth & other non-selective CNS depressants eg, alcohol may potentiate resp depression of opioids. Decreased clearance w/ CYP3A4 inhibitors. Co-administration w/ SSRIs, SNRIs or MAOIs may increase risk of serotonin syndrome.
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