Bedside Snapshot
- Use It For
- Moderate to severe acute pain; pediatric pain without IV access (IN first); intubation pretreatment and post-intubation analgesia; ICU analgesia-first sedation
- Adult Dose
- Pain: 1 mcg/kg IV/IO slowly (usual 25–100 mcg; max initial 100 mcg), repeat after ≥5 min
- IN: 1 mcg/kg (max initial 100 mcg)
- ICU infusion: 0.7–10 mcg/kg/hr
- Pediatric Dose
- 1 mcg/kg IN, IV or IO (max initial 100 mcg), repeat after ≥5 min. IN not used under 12 months. Neonates: specialist use only
- Onset / Duration
- IV: <1 min (almost immediate) / 30–60 min; IN: within 5 min / 30–60 min; IM: 7–8 min / 1–2 hr
- Do Not Give / Hold If
- Not rousable to voice; RR <10, SpO₂ <90% or EtCO₂ >50 mmHg without airway support; SBP <90 mmHg; MAOI within 14 days; hypersensitivity
- Watch For
- Apnea (rising EtCO₂, falling RR; peaks 5–15 min after IV); chest wall rigidity (cannot ventilate after a fast bolus); hypotension and bradycardia; accumulation on infusions
- Reversal / Rescue
- Ventilate first; naloxone 0.2–2 mg IV/IO/IM or 2–4 mg IN every 2–3 min to breathing (AHA 2025; label starts at 0.4 mg). Child: 0.1 mg/kg IV/IO (max 2 mg). Rigidity: BVM, naloxone; neuromuscular blocker if credentialed.
- Must Remember
- Micrograms, not milligrams: 1 mL = 50 mcg, and vials hold 100–2,500 mcg. Push slowly; respiratory depression peaks after the analgesia. Patches and lozenges are for opioid-tolerant patients only
Indications
Emergency & Prehospital
- Moderate to severe acute pain: trauma, fractures, burns, renal colic. Analgesia does not mask abdominal findings. NAEMSP 2023 also backs non-opioid options (IV ketamine, IV NSAIDs, acetaminophen).
- Children in pain without IV access: IN fentanyl is the preferred choice over IV opioids. NAEMSP 2023 makes that a strong recommendation, and the route is off-label.
- Adults without IV access: go IN or IM when an IV is not otherwise needed. IN is off-label.
- Ischemic chest pain not relieved by nitrates: use small, titrated doses (see Interactions)
- Post-intubation analgesia: start after tube confirmation (see intubation)
ED / ICU / Transport
- Intubation pretreatment: in selected patients it blunts the laryngoscopy response (see RSI)
- Analgesia-first sedation, ventilated adults: intermittent doses or an infusion, titrated to a pain score (off-label infusion, see analgosedation)
Other Uses
- Anesthesia premedication and supplement (FDA-labeled). Also cancer or chronic pain in opioid-tolerant patients, transdermal or transmucosal only.
Dosing & Administration
Treat these as house reference doses. Your local protocols may differ from them.
Available Forms
- Injection: 50 mcg/mL (as citrate) in 2 to 50 mL vials (100–2,500 mcg). It has no preservative, and this is the only EMS strength.
- Transdermal (12–100 mcg/hr) and transmucosal lozenge or buccal tablet (REMS). Both are for opioid-tolerant patients only.
High-Alert Medication: Know your numbers: 50 mcg = 0.05 mg = 1 mL. Here's the trap: a 2,500 mcg vial drawn up for a 100 mcg dose is a 25-fold overdose. Check mcg, mcg/kg, volume and pump units twice.
Adult Dosing
| Indication | Dose & Route | Repeat / Max | Notes |
|---|---|---|---|
| Acute pain, IV/IO | 1 mcg/kg IV/IO slow push over 1–2 min (usual 25–100 mcg) | Max initial 100 mcg (NASEMSO). Repeat after ≥5 min if breathing allows; each dose ≤100 mcg. Field ceiling 200 mcg total; exceed only with medical control (reference ceiling from one EMS protocol, not a national standard) | High-alert Start low in older, frail or opioid-naive patients |
| Acute pain, IM | 50–100 mcg IM | Label range; repeat every 1–2 hr as needed. The 200 mcg field ceiling applies to all routes combined (IV, IN, IM) | High-alert Onset 7–8 min |
| Acute pain, IN (off-label route) | 1 mcg/kg IN by atomizer, split between nares (50 mcg/mL) | Max initial 100 mcg (2 mL; 1 mL per naris); repeat after ≥5 min; counts toward the 200 mcg ceiling | High-alert NASEMSO generally defines pediatric as up to 40 kg or 14 years, whichever comes first; the definition varies by state |
| Intubation pretreatment | 1–3 mcg/kg IV, slow push before the induction agent | Single dose; reduce or omit in shock or hypotension | High-alert Differs from FDA label: the label gives only the anesthesia low dose (2 mcg/kg) |
| Post-intubation / ICU intermittent | 0.35–0.5 mcg/kg IV every 30–60 min | No fixed max: titrate to CPOT/BPS or NRS | High-alert Start before or with the sedative |
| Anesthesia adjunct (OR, label) | Low 2 mcg/kg; moderate 2–20 mcg/kg; high 20–50 mcg/kg IV | Maintenance 25–100 mcg IV/IM as needed | High-alert Moderate and high doses need controlled ventilation |
Pediatric Dosing
Pediatric source: NASEMSO National Model EMS Clinical Guidelines v3.0 (2022) first, then the US label. Where neither gives a dose, no dose is shown. A pediatric maximum never exceeds the adult maximum (NASEMSO Universal Care, p. 13). Unless a dose is marked labeled, it is off-label.
| Indication | Dose (per kg) & Route | Max Single / Max Total | Notes |
|---|---|---|---|
| Acute pain, IN (age ≥12 months) | 1 mcg/kg IN by atomizer (50 mcg/mL), split between nares | Max initial 100 mcg (not above adult); repeat after ≥5 min | High-alert Differs from RCH Melbourne (2025): 1.5 mcg/kg, first dose max 75 mcg (volume limit). Use length-based weight (Broselow) |
| Acute pain, IV/IO/IM | 1 mcg/kg IV/IO slow push, or IM | Max initial 100 mcg; repeat after ≥5 min; total 200 mcg as for adults (no pediatric total stated) | High-alert Differs from FDA label: safety under 2 years not established. Differs from Nova Scotia EHS: pediatric IV max 50 mcg per dose. Infants: same dose; IN not used under 12 months |
| Anesthesia induction, age 2–12 yr (label) | 2–3 mcg/kg IV | Anesthesia or specialist use only | High-alert Label: safety under 2 years not established |
| Neonates and preterm infants | Specialist (NICU/PICU) use only | — | Not covered by the label or NASEMSO: neonatal transport protocol and medical control |
Continuous Infusion
| Setting | Example Concentration | Start | Titrate | Usual Range / Max |
|---|---|---|---|---|
| ICU analgesia-first sedation, ventilated adult | 50 mcg/mL by syringe pump, or an institution premix (example, institution-specific) | 0.7 mcg/kg/hr after a 0.35–0.5 mcg/kg bolus if in pain | To a CPOT/BPS or NRS goal, then the RASS goal | 0.7–10 mcg/kg/hr; context-sensitive half-time about 200 min at 6 hr, 300 min at 12 hr |
Preparation & Administration
- Push and dilution: give it over 1–2 min, undiluted (50 mcg/mL), unless your institution specifies a dilution. Rigidity tracks the dose and the speed. Flush after each push.
- IN: atomizer on a Luer-lock syringe. Max 1 mL per naris. Skip it with active epistaxis or both nares blocked.
- IO, IM and pump: the IO dose equals the IV dose. Run it on a smart pump with a drug library. Protect it from light.
Dosing Notes: Have naloxone or nalmefene, a bag-valve mask, oxygen, suction and airway equipment in reach before the first dose (label). Respiratory depression peaks 5–15 min after an IV dose.
Contraindications & Precautions
Contraindications
- Hypersensitivity to fentanyl: the label lists this as the only contraindication
- MAOI within 14 days (including linezolid and IV methylene blue). The label says not recommended. NASEMSO lists it as a contraindication.
- IN route (RCH): under 12 months, active epistaxis, both nares obstructed, altered consciousness
- Transdermal and transmucosal products: opioid-naive patients and acute pain
Precautions
- Reduced respiratory reserve (COPD, sleep apnea, hypoxia or hypercapnia). Apnea can occur even at recommended doses.
- Hypovolemia and shock: watch for severe hypotension. Resuscitate and reduce the dose
- Head injury, raised ICP: the concern is CO₂ retention. Opioids also obscure the neurologic exam
- Older, cachectic or debilitated patients: start low and titrate slowly
- Opioid-induced hyperalgesia (label section 5.7). The pain rises as the dose rises. Consider lowering the dose or rotating opioids
- Patch on the skin: heat and fever raise absorption (label). Seizure disorders: they may lower the threshold
Hold / Reassess If
- Not rousable to voice before a repeat dose
- RR <10, SpO₂ <90% despite oxygen, or EtCO₂ >50 mmHg or rising: stop, support ventilation
- SBP <90 mmHg or new bradycardia: hold, treat the cause
- GCS <15 or a new head injury: use with caution and medical direction
FDA Boxed Warning: Four warnings. (1) Addiction, abuse and misuse. (2) Respiratory depression can threaten life, most of all at initiation or after a dose increase. (3) Benzodiazepines and other CNS depressants, alcohol included, can bring profound sedation, respiratory depression, coma and death. (4) Adding a CYP3A4 inhibitor, or stopping a CYP3A4 inducer, can cause fatal overdose.
Adverse Effects & Toxicity
Common
- Nausea and vomiting (4–8% after IN doses in pediatric ED studies); dizziness (1–17%)
- Pruritus, flushing, sweating; IN route: nasal burning (13%)
- Constipation and urinary retention with repeated dosing or infusions
Serious / Life-Threatening
| Effect | Recognition | Management |
|---|---|---|
| Respiratory depression / apnea | Falling RR and tidal volume, rising EtCO₂, then falling SpO₂; peak 5–15 min after IV dose | Stimulate, airway maneuvers, BVM with O₂; titrated naloxone |
| Chest wall rigidity ("wooden chest") | Cannot ventilate after a large or fast IV dose; rigid chest, glottic (vocal cord) closure, high airway pressures, no EtCO₂ waveform | Stop fentanyl; BVM with 100% O₂; IV/IO naloxone, overdose doses if you cannot ventilate. Still inadequate and credentialed: rocuronium or succinylcholine with controlled ventilation |
| Bradycardia / hypotension | HR and BP fall; worse with hypovolemia or sedatives | Hold doses; fluids; vasopressor if needed |
| Laryngospasm | Stridor or silent chest, flat capnogram | Jaw thrust, positive pressure with O₂; paralyze and intubate if it persists |
| Serotonin syndrome | Agitation, hyperthermia, clonus with serotonergic drugs | Stop fentanyl; supportive care; toxicology consult |
| Withdrawal or adrenal insufficiency | Withdrawal: agitation, sweating, diarrhea on abrupt stop. Adrenal: after more than 1 month, nausea, weakness, hypotension | Taper rather than stop abruptly; confirm adrenal insufficiency by testing and replace corticosteroid |
Overdose & Toxicity Management
- Signs: respiratory depression, somnolence to coma, pinpoint pupils, bradycardia, hypotension, pulmonary edema.
- Immediate: open and protect the airway, ventilate and give oxygen before any antagonist; ACLS for arrest.
- Naloxone, iatrogenic or monitored (adult): 0.1–0.2 mg IV every 2–3 min to adequate breathing; not full reversal.
- Naloxone, overdose (adult): ventilate first, then naloxone 0.2–2 mg IV/IO/IM or 2–4 mg IN, repeat every 2–3 min, titrate to breathing (2025 AHA Table 4). Label starts at 0.4 mg. Question the diagnosis if no response after 10 mg (label).
- Naloxone, pediatric overdose: 0.1 mg/kg IV/IO (max 2 mg; IN max 4 mg per NASEMSO), repeat every 2–3 min. Label starts at 0.01 mg/kg. Pediatric iatrogenic: 0.005–0.01 mg IV increments (label).
- Naloxone wears off first: after large doses, infusions or patch removal, keep watching until breathing is reliably spontaneous. Every patch comes off, and you monitor at least 72–96 hr after a patch overdose (transdermal label).
- Opioid-dependent patients: go in smaller increments to avoid precipitating withdrawal.
Monitoring
| Parameter | When / How Often | Target / Act If |
|---|---|---|
| Clinical: SpO₂ and waveform EtCO₂ | Continuous from the first dose; EtCO₂ warns earlier than SpO₂ | SpO₂ <90% or EtCO₂ >50 mmHg (or a rise >10 mmHg, or a flat waveform): stop dosing, airway, O₂, ventilate, consider naloxone |
| Clinical: RR and sedation | Before each dose; every 5 min for 2 checks after the last | RR <10 or not rousable to voice: no further doses, support ventilation |
| Clinical: BP and HR | Baseline and after each dose | SBP <90 mmHg or new bradycardia: hold, treat |
| Clinical: pain score | Before and after each dose, and on arrival | NRS; FACES (4–12 yr); FLACC under 4 yr or nonverbal |
| ICU: CPOT or BPS, and RASS | Each assessment and around each bolus or titration | CPOT >2 or BPS >5: treat pain before adding sedative. RASS deeper than goal: reduce the infusion |
| Infusion safety | Each titration and handoff | Confirm concentration, units (mcg/hr vs mcg/kg/hr), rate and cumulative dose |
Interactions & Compatibility
Clinically Significant Interactions
| Drug / Class | Effect | What To Do |
|---|---|---|
| Benzodiazepines, propofol, gabapentinoids, alcohol, nitrous oxide, CNS depressants | Profound sedation, respiratory depression, hypotension, coma, death (boxed warning) | Lower each dose; continuous SpO₂ and EtCO₂; ventilation ready |
| CYP3A4 inhibitors (erythromycin, clarithromycin, azoles, ritonavir, grapefruit juice) | Higher, longer levels; fatal respiratory depression (boxed warning), mostly with infusions | Reduce the dose; monitor closely when an inhibitor is added to a stable infusion |
| CYP3A4 inducers (rifampin, carbamazepine, phenytoin) | Lower levels; stopping the inducer raises levels | Titrate up on the inducer; reduce the dose after it stops |
| Serotonergic drugs (SSRIs, SNRIs, TCAs, triptans, ondansetron, tramadol) and MAOIs | Serotonin syndrome or opioid toxicity | Observe after starting or increasing; not recommended within 14 days of an MAOI |
| Buprenorphine, nalbuphine, butorphanol, pentazocine | Reduced analgesia; precipitated withdrawal | Avoid together (label); seek specialist advice for maintenance buprenorphine |
| Neuroleptics (e.g., droperidol); muscle relaxants (cyclobenzaprine, metaxalone) | QT prolongation and hypertension; enhanced neuromuscular blockade and respiratory depression | ECG monitoring with neuroleptics; monitor breathing with relaxants |
| Oral P2Y12 inhibitors (ticagrelor, clopidogrel, prasugrel) | Opioids slow gastric emptying; IV fentanyl delayed ticagrelor absorption and platelet inhibition in a randomized PCI trial | In ACS, use fentanyl only for pain not relieved by nitrates, at the smallest effective dose; tell the receiving team the time and dose |
IV Compatibility
- Usually given undiluted. Do not mix it in the same syringe unless compatibility is confirmed. Flush between drugs on a shared line. Check an institutional compatibility resource.
Special Populations
- Pediatrics: without IV access, IN is the preferred first route, per NAEMSP 2023. The label does not establish safety under 2 years. Avoid IN under 12 months. See Pediatric Dosing.
- Neonates: specialist (NICU) use only. Follow the neonatal transport protocol and medical control.
- Pregnancy: data on birth defects are insufficient. Prolonged use can cause neonatal opioid withdrawal. Fentanyl crosses the placenta, and near delivery it can depress neonatal breathing. In labor, follow OB or medical direction. Do not withhold indicated emergency analgesia.
- Lactation: it passes into breast milk. Watch the infant for sedation and breathing problems (label).
- Older Adults: they are more sensitive to respiratory and CNS depression, so start low. The 2023 AGS Beers Criteria say to avoid opioids paired with benzodiazepines or gabapentinoids.
- Renal and Hepatic Impairment: with no active metabolites, fentanyl is generally preferred over morphine in kidney disease. Liver disease is different: CYP3A4 metabolism means it can accumulate. Reduce doses and monitor.
- Obesity / Dosing Weight: it is lipophilic, so it accumulates with a prolonged infusion. The 100 mcg bolus cap applies (NASEMSO). Titrate infusions to scores, not to weight alone.
- Opioid-Tolerant Patients: they need larger, more frequent doses. Document any home patch, its dose and its site, at handoff.
Field & Transport Considerations
- Scope: paramedic, RN and critical-care transport. It varies by state and agency protocol.
- Storage and Carried Concentration: Store at 20–25 °C, in the carton, protected from light. Schedule II controls apply. Carry 50 mcg/mL only. At cross-check, state mcg and mL (100 mcg = 2 mL). Never write "mg" or "µg".
- Military / TCCC: oral transmucosal fentanyl (OTFC) is no longer part of TCCC. TCCC Guideline Change 25-03 (2026) removed it once access was lost in 2025. Step 2 is now fixed-dose ketamine or esketamine with the non-opioid pill pack. Follow current TCCC guidance.
- Handoff: time, mcg and mcg/kg of each bolus, total dose, pain and sedation scores, airway or rigidity events, naloxone given, current infusion rate and last titration.
Clinical Pearls
Wooden chest (FP-C, CCP-C): Suddenly you cannot bag after a fast fentanyl bolus. The chest is rigid and the EtCO₂ waveform is gone. That is chest wall rigidity with the vocal cords closed, not bronchospasm. Bronchodilators will not help you here. Keep bagging, give IV/IO naloxone and, if credentialed, a neuromuscular blocker.
Breathing fails after the pain is gone: The worst depression lands 5–15 min after an IV dose. After large doses, the CO₂ response can stay blunted for hours. Keep SpO₂ and EtCO₂ on until well after the last dose.
IN technique: A 20 kg child at 1 mcg/kg needs 20 mcg. That is 0.4 mL total at 50 mcg/mL, or 0.2 mL each side.
Fentanyl vs morphine vs hydromorphone (NREMT, CEN):
- Fentanyl: the fastest onset (IV under 1 min, Nova Scotia EHS Table 2). No active metabolites.
- Morphine: IV onset 1–2 min (Nova Scotia EHS Table 2). It releases histamine, and active metabolites build up in kidney failure
- Hydromorphone: IV onset 5–15 min (Nova Scotia EHS Table 2). It accumulates in renal or hepatic impairment
Analgesia first (CCRN): PADIS favors treating the pain before you sedate. In a ventilated adult who cannot self-report, score the pain with CPOT or BPS first. See analgosedation.
Patches and lozenges are not acute-pain drugs: A 100 mcg/hr patch is not 100 mcg IV. In toxicity, take the patch off. The skin keeps releasing fentanyl for a day or more.
Pharmacology
Mechanism of Action
- μ-opioid receptor agonist → analgesia and sedation.
- Brainstem respiratory centers → blunted CO₂ response → dose-related hypoventilation and apnea.
- Bradycardia and vasodilation → hypotension, mainly with hypovolemia or other sedatives.
- Large or rapid doses → skeletal and respiratory muscle rigidity.
Pharmacokinetics
| Route | Onset | Peak | Duration |
|---|---|---|---|
| IV | <1 min (almost immediate) | Analgesia within minutes; respiratory depression 5–15 min | 30–60 min (single dose up to 100 mcg) |
| IN | Within 5 min | Peak arterial concentration about 7 min | 30–60 min |
| IM | 7–8 min | — | 1–2 hr |
- Half-life: terminal about 219 min (3.7 hr, per label). Context-sensitive half-time is about 200 min after 6 hr and 300 min after 12 hr of infusion.
- Distribution and metabolism: it is highly lipophilic (volume about 4 L/kg, per label). The liver clears it by CYP3A4 N-dealkylation into inactive metabolites, and first-pass clearance is high.
- Elimination: about 75% leaves in urine, mostly as metabolites. About 9% leaves in feces. IN bioavailability: about 71–89% (Serra 2023 review).
Names & Classification
- Generic Name
- Fentanyl citrate (doses expressed as fentanyl base)
- Brand Names
- Injection: generic (originally Sublimaze). Transdermal: Duragesic and generics. Transmucosal: Actiq (lozenge), Fentora (buccal tablet).
- Pharmacologic Class
- Synthetic opioid; potent μ-opioid receptor agonist (piperidine derivative)
- Therapeutic Class
- Opioid analgesic; anesthetic adjunct
- Controlled Substance
- C-II (DEA Schedule II)
- ISMP High-Alert
- Yes: ISMP high-alert medication (opioids: IV, transdermal and oral)
- Look-Alike / Sound-Alike
- fentaNYL / SUFentanil; fentaNYL / ALfentanil (ISMP list)
- Error-Prone Abbreviations to Avoid
- µg or μg (write mcg); writing fentanyl doses in mg
References
- Hospira, Inc. (2026). Fentanyl citrate injection, for intravenous or intramuscular use, CII: Prescribing information (revised 6/2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bfa8018a-4cbc-434b-e09e-782872b0340a. Related labels: SpecGx LLC. (2026). Fentanyl transdermal system, CII: Prescribing information (revised 4/2026). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e15a7e9b-8025-49dd-9a6d-bafcccf1959f; Fresenius Kabi USA, LLC. (2023). Naloxone hydrochloride injection: Prescribing information (revised 5/2023). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=201fdedf-1736-4e52-9d7d-de14292547fd
- Lindbeck, G., Shah, M. I., Braithwaite, S., Powell, J. R., Panchal, A. R., Browne, L. R., et al. (2023). Evidence-based guidelines for prehospital pain management: Recommendations. Prehospital Emergency Care, 27(2), 144–153. https://pubmed.ncbi.nlm.nih.gov/34928760/
- National Association of State EMS Officials (NASEMSO) Medical Directors Council. (2022). National Model EMS Clinical Guidelines, Version 3.0: Pain management (copy hosted by Iowa HHS). https://hhs.iowa.gov/media/198/download
- Nova Scotia Emergency Health Services. (2023). Fentanyl medication protocol 6956.05 (last updated July 20, 2023). Nova Scotia Department of Health. https://novascotia.ca/dhw/ehs/documents/medications/EHS-Fentanyl.pdf
- Cao, Y., et al. (2025). 2025 American Heart Association Guidelines for CPR and ECC, Part 10: Adult and pediatric special circumstances of resuscitation, Table 4: Commonly used doses of antidotes for resuscitation in critical poisoning. Circulation, 152(16 Suppl 2), S578–S672. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/adult-and-pediatric-special-circumstances-of-resuscitation/content/guidelines-accordion/toxicology-nested-section/table-4
- Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., et al. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU (PADIS). Critical Care Medicine, 46(9), e825–e873. https://doi.org/10.1097/CCM.0000000000003299. Focused update: Lewis, K., Balas, M. C., Stollings, J. L., McNett, M., Girard, T. D., Chanques, G., et al. (2025). A focused update to the clinical practice guidelines for the prevention and management of pain, anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 53(3), e711–e727. https://doi.org/10.1097/CCM.0000000000006574
- Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., et al. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit (landmark guideline; source of the ICU opioid dosing table). Critical Care Medicine, 41(1), 263–306. https://doi.org/10.1097/CCM.0b013e3182783b72
- The Royal Children's Hospital Melbourne. (2025). Clinical Practice Guidelines: Intranasal fentanyl (updated October 2025). https://www.rch.org.au/clinicalguide/guideline_index/intranasal_fentanyl/
- Serra, S., Spampinato, M. D., Riccardi, A., Guarino, M., Pavasini, R., Fabbri, A., & De Iaco, F. (2023). Intranasal fentanyl for acute pain management in children, adults and elderly patients in the prehospital emergency service and in the emergency department: A systematic review. Journal of Clinical Medicine, 12(7), 2609. https://pmc.ncbi.nlm.nih.gov/articles/PMC10095441/
- Barbee, G. A., Byrne, B. T., Clayton, C. E., Cole, J. H., Conklin, C. C., Donovan, K. A., et al. (2026). Analgesia in Tactical Combat Casualty Care (TCCC): TCCC Guideline Change 25-03. Journal of Special Operations Medicine, 26(2), 97–111. https://doi.org/10.55460/J.Spec.Oper.Med.2026.75L9-4KVD
- Bennett, J. A., Abrams, J. T., Van Riper, D. F., & Horrow, J. C. (1997). Difficult or impossible ventilation after sufentanil-induced anesthesia is caused primarily by vocal cord closure (older mechanism study; source for glottic rigidity). Anesthesiology, 87(5), 1070–1074. https://pubmed.ncbi.nlm.nih.gov/9366458/
- McEvoy, et al. (2018). Effect of intravenous fentanyl on ticagrelor absorption and platelet inhibition among patients undergoing percutaneous coronary intervention (randomized trial). Circulation, 137, 307–309. https://doi.org/10.1161/CIRCULATIONAHA.117.031678
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