Sufentanil Citrate
Pronouncation: (sue-FEN-tuh-nill SIH-trate)Class: Opioid analgesic
Trade Names:
Sufenta
- Injection 50 mcg (as citrate)/mL
Pharmacology
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Relieves pain by stimulating opiate receptors in CNS; causes respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting and increased bladder tone.
Pharmacokinetics
Absorption
Sufentanil T max is 1.4 min. After epidural administration totalling 5 to 40 mcg during labor and delivery, maternal and neonatal plasma concentrations were at or near the 0.05 to 0.1 ng/mL limit of detection and were slightly higher in mothers than infants.
Distribution
Sufentanil is 93% protein bound in males, 91% bound in mothers, and 79% bound in neonates.
Metabolism
Sufentanil is metabolized in liver and small intestines.
Elimination
Sufentanil t ½ is 164 min. Approximately 80% is excreted within 24 h and only 2% of the dose is eliminated as unchanged drug.
Onset
Onset of action is immediate.
Indications and Usage
Adjunct for surgical analgesia; induction of primary anesthesia for major surgical procedures requiring favorable myocardial or cerebral oxygen balance or when extended postoperative ventilation is anticipated; epidural analgesia with bupivacaine during labor and vaginal delivery.
Contraindications
Upper airway obstruction; acute asthma; diarrhea caused by poisoning or toxins.
Dosage and Administration
General Surgery (with Nitrous Oxide/Oxygen)Adults
IV 1 to 2 mcg/kg initially; 10 to 25ߙmcg prn for maintenance.
Major Surgical Procedures (with Nitrous Oxide/Oxygen)Adults
IV 2 to 8 mcg/kg initially; 10 to 50ߙmcg prn for maintenance.
Major Cardiovascular Surgery/Neurosurgery (with 100% Oxygen)Adults
IV 8 to 30 mcg/kg initially; 25 to 50 mcg prn for maintenance.
Children less than 12 yrIV 10 to 25 mcg/kg initially; 25 to 50 mcg prn for maintenance.
Labor and DeliveryAdults
Epidural 10 to 15 mcg sufentanil mixed with 10 mL bupivacaine 0.125% with or without epinephrine. Can give total of 3ߙdoses at least 1 h intervals until delivery.
General Advice
- Limit epidural or intrathecal administration of preservative free sufentanil to the lumbar area.
Storage/Stability
Store at room temperature. Protect from light.
Drug Interactions
Barbiturate anestheticsMay cause increased CNS and respiratory depression.
Beta blockersThe incidence and degree of bradycardia and hypotension during induction of sufentanil may be greater in patients on chronic beta blocker therapy.
Calcium channel blockersThe incidence and degree of bradycardia and hypotension during induction of sufentanil may be greater in patients on chronic calcium channel blocker therapy.
Nitrous oxideNitrous oxide may cause cardiovascular depression with high-dose sufentanil.
Laboratory Test Interactions
Increased amylase and lipase for up to 24 h after dose may occur.
Adverse Reactions
Cardiovascular
Hypotension; orthostatic hypotension; hypertension; bradycardia; tachycardia; arrhythmias.
CNS
Sedation.
Dermatologic
Pruritus.
GI
Nausea; vomiting.
Respiratory
Bronchospasm; depression of cough reflex; respiratory depression; postoperative respiratory depression; chest wall rigidity.
Miscellaneous
Chills; intraoperative muscle movement; tolerance.
Precautions
Pregnancy
Category C .
Lactation
Undetermined.
Children
Safety and efficacy have been demonstrated in limited number of children less than 2 yr undergoing cardiovascular surgery.
Elderly
May require dosage reduction.
Renal Function
Duration of action may be prolonged; dosage reduction may be required.
Hepatic Function
Duration of action may be prolonged; dosage reduction may be required.
Special Risk Patients
Use drug with caution in patients with decreased respiratory reserve, head injury, increased intracranial pressure, or hypoxia.
Drug dependence
Has abuse potential.
Hypoventilation
Naloxone and intubation equipment must be available in case hypoventilation occurs.
Obese patients
If patient is greater than 20% above ideal weight, dose must be adjusted based on ideal body weight.
Skeletal muscle rigidity
May cause skeletal muscle rigidity, particularly of the truncal muscles. The incidence and severity of muscle rigidity is usually dose-related.
Overdosage
Symptoms
Miosis, respiratory and CNS depression, circulatory collapse, seizures, cardiopulmonary arrest, death.
Patient Information
- Inform patient that nausea, vomiting or constipation may occur and advise patient to notify health care provider should these symptoms become prominent.
- Advise patient to ask for assistance with ambulation.
- Instruct patient to report these symptoms to health care provider: shortness of breath or difficulty breathing.
- Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
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More Sufentanil Citrate resources:
Sufenta - Includes detailed dosage instructions.
Sufentanil Citrate Drug Interactions
