Sufentanil Citrate

Pronunciation: sue-FEN-tuh-nill SIH-trate
Class: Opioid analgesic

Trade Names

Sufenta
- Injection 50 mcg (as citrate)/mL

Pharmacology

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.

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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 25 mcg prn for maintenance.

Major Surgical Procedures (with Nitrous Oxide/Oxygen)
Adults

IV 2 to 8 mcg/kg initially; 10 to 50 mcg 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 yr

IV 10 to 25 mcg/kg initially; 25 to 50 mcg prn for maintenance.

Labor and Delivery
Adults

Epidural 10 to 15 mcg sufentanil mixed with 10 mL bupivacaine 0.125% with or without epinephrine. Can give total of 3 doses 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 anesthetics

May cause increased CNS and respiratory depression.

Beta blockers

The incidence and degree of bradycardia and hypotension during induction of sufentanil may be greater in patients on chronic beta blocker therapy.

Calcium channel blockers

The incidence and degree of bradycardia and hypotension during induction of sufentanil may be greater in patients on chronic calcium channel blocker therapy.

Nitrous oxide

Nitrous 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.

Copyright © 2009 Wolters Kluwer Health.

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