From episode 151 on the ECC stream. With Dr Claire Sharp.
We like fentanyl CRI’s because fentanyl is short-acting, which means you can quickly titrate the dose up and down to meet your patient’s needs. And when you switch it off, it’s gone out of the body by the time the patient goes home. Yes, BUT… did you know that:
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Fentanyl accumulates over time, meaning that after the first day or so it will lose its rapidly titratable properties.
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It can take up to 12 - 24 hours from stopping the CRI until the fentanyl is no longer having any effect once the patient has been on it for more than a day.
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Remifentanil, in contrast, is a genuinely and persistently shorter acting pure mu-agonist. But it's more expensive, and most practices don't have it.
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