Intranasal fentanyl for respiratory distress in children and adolescents with life-limiting conditions

Pieper, Lucas; Wager, Julia; Zernikow, Boris

doi:10.1186/s12904-018-0361-x

Cited by 12 publications

(6 citation statements)

References 51 publications

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“…In children, fentanyl may be given intravenously, by transdermal application, and by buccal administration and the dose varies according to child age and body-weight [4]. Fentanyl has been found efficacy and safe in infants and children [5][6][7][8][9][10][11][12][13]. Continuous infusion of fentanyl is found efficacy and safe in reducing acute pain in preterm infants maintained on mechanical ventilation [5].…”

Section: Discussionmentioning

confidence: 99%

“…Oral fentanyl administered 30 min before starting surgery is efficacy and safe in reducing pain [6]. Intranasal fentanyl has been found efficacy and safe in reducing pain in infants without inducing adverse-effects [7], and in treatment of acute attacks of respiratory distress in children with life-limiting conditions [8]. Intranasal fentanyl, administered at a dose of 1.5 µg/kg, is an effective and safe analgesic agent in reducing acute severe pain in children [9] and in the management of pain in both in-hospital and out-hospital children [10].…”

Section: Discussionmentioning

confidence: 99%

“…Ziesenitz et al [21] reviewed the pharmacokinetics of fentanyl in 51 infants and children aged 0 to 1 month to 9.5+2. 8 Fentanyl plasma concentrations after an intravenous bolus (about 30 µg/kg) are found to be lower in infants than in children and these findings may result from a larger distribution volume or age-related differences in protein binding. An increase in the total body clearance probably reflects maturation of CYP enzymes suggesting that the Michaelis-Menten constant is age dependent.…”

Section: Pharmacokinetics Of Fentanyl In Infants and Childrenmentioning

confidence: 93%

“…Intranasal fentanyl is found effective and safe in infants and reduces pain and does not induce adverse-effects [7]. Intranasal fentanyl is a safe and effective medication for the treatment of acute attacks of respiratory distress in children with life-limiting conditions [8]. Intranasal fentanyl, at a dose of 1.5 µg/kg, is a safe and effective analgesic in the prehospital management of acute severe pain in children and may be an attractive alternative to both oral and intravenous opiates [9].…”

Section: Efficacy and Safety Of Fentanyl In Infants And Childrenmentioning

confidence: 99%

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Clinical Pharmacology of Fentanyl in Infants and Children

Pacifici¹

2022

JCCRS

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Fentanyl is a systemic opioid related to the phenylpiperidines, it is used in anaesthetic practice and in analgesia and the analgesic effect is about 100 times higher than that of morphine. Fentanyl is highly lipid soluble, rapidly crosses the blood-brain-barrier, and fentanyl concentrations rapidly decline in plasma and cerebrospinal fluid. Fentanyl causes respiratory depression and decreases the heart rate through vagal activation. Fentanyl may be administered intravenously, orally, by transdermal, intranasal or by buccal application and the oral bioavailability is poor. In infants, fentanyl is given for short term use, sustained use, and during therapeutic hypothermia. In children, fentanyl is given intravenously, by transdermal application, or by buccal administration and the fentanyl dose varies with the child age and body-weight. Fentanyl has been found efficacy and safe in infants and children but it may induce adverse-effects and fentanyl causes different effects in infants and children. Following intravenous administration of fentanyl to infants and children, the fentanyl elimination half-life ranges from 208 to 1,266 min and the distribution volume ranges from 1.92 to 15.2 L/kg. Such variability is due to the wide variation of subject’s demographic characteristics. Fentanyl interacts with drugs, the treatment and trials with fentanyl have been studied in infants and children. Fentanyl freely crosses the human placenta and poorly migrates into the breast-milk. The aim of this study is to review fentanyl dosing, efficacy, safety, effects, adverse-effects, metabolism, pharmacokinetics, drug interaction, treatment, and trials in infants and children, and fentanyl placental transfer and migration into the breast-milk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Pharmacokinetics Of Fentanyl In Infants and Childrenmentioning

confidence: 93%

Section: Efficacy and Safety Of Fentanyl In Infants And Childrenmentioning

confidence: 99%

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Clinical Pharmacology of Fentanyl in Infants and Children

Pacifici¹

2022

JCCRS

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“…[9] reported the use of intranasal fentanyl in 11 dying newborns and infants, and reported that in eight cases a decrease in laboured breathing and restlessness was observed. A more recent case series (n=16) described successful use in children with life-limiting conditions and acute respiratory distress (after the first dosage laboured breathing improved in 89%; tachypnoea improved in 73% and, if reported, dyspnoea improved in 59%) [10]. A pilot RCT in 23 patients with cancer did not show a difference in exercise-induced dyspnoea between the nasal fentanyl and control group, although the study was not powered to detect between-group differences [11].…”

Section: Case Reportmentioning

confidence: 99%

Fentanyl nasal spray in a patient with end-stage COPD and severe chronic breathlessness

Janssen

Everdingen

Verberkt

et al. 2019

Breathe

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Chronic breathlessness syndrome, defined as breathlessness that persists despite optimal treatment of the underlying pathophysiology, resulting in disability, is a major problem for patients with advanced chronic lung disease, and can be difficult to manage [1, 2]. Opioids should be considered for treatment of these patients [3]. Episodic breathlessness is severe worsening of breathlessness intensity, which can be predictable or unpredictable [4]. Episodic breathlessness can have a major impact on activities of daily life, but ∼90% of episodes last for 20 min or less [5]. Therefore, the selection of appropriate palliative pharmacological therapy is a complex issue. Indeed, the onset of action of short-acting oral opioids is between 15 and 30 min [6]. The rapid onset of action (between 1 and 4 min [7]) is the major advantage of fentanyl nasal spray. This case report relates the experience and insight gained when fentanyl nasal spray was prescribed to a patient with end-stage chronic obstructive pulmonary disease (COPD) and the lessons we have learned. Written informed consent for publication of the clinical details was obtained from the deceased patient's spouse.

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