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 Pharmacology:Synthetic opioid with no active metabolites.Broken down through the CYP3A4 pathway, with a potential for prolonged effect with certain chemotherapy agents.Highly lipid soluble.Onset of action 1–2 minutes, duration of effect ~40 minutes.Elimination half‐life 2–4 hours.CSHT is 200 minutes after a 6 hour infusion, and 300 minutes or greater after a 12 hour infusion (this can increase unpredictably in multiorgan failure).

 Drug‐specific side effects:Chest wall rigidity: a very uncommon side effect of synthetic opioids that can be complicated by glottic closure and trismus. Appears somewhat related to dosage, rapidity of administration, extremes of age, presence of critical illness, and use of antidepressant medications. Can render a patient unable to ventilate. Requires immediate reversal with naloxone and preparations for emergent intubation with a neuromuscular blocker. If no further complications are noted (e.g. negative pulmonary pressure edema due to closed glottis), extubation can be attempted within minutes of cessation of rigidity and neuromuscular blockade. This is not an allergic reaction and does not preclude the patient from receiving this analgesic agent in the future.

 Recommended doses:Bolus: 0.35–0.5 μg/kg IV every 0.5–1 hour.Infusion: 0.7–10 μg/kg/h.PCA: bolus 15–75 μg, lockout interval 3–10 minutes.