sufentanil citrate
Sufenta

Available forms
Available by prescription only
Injection: 50 mcg/ml

Indications and dosages
 Adjunct to general anesthetic. Adults: 1 to 8 mcg/kg I.V. with nitrous oxide and oxygen. Maintenance dose is 10 to 50 mcg.
 Primary anesthetic. Adults: 8 to 30 mcg/kg I.V. with 100% oxygen and a muscle relaxant. Maintenance dose is 25 to 50 mcg.
Children: 10 to 25 mcg/kg I.V. with 100% oxygen and a muscle relaxant. Maintenance dose is up to 25 to 50 mcg.

Pharmacodynamics
Analgesic action: Sufentanil has a high affinity for opiate receptors, exerting an agonistic effect to provide analgesia. It’s also used as an adjunct to anesthesia or as a primary anesthetic because of its potent CNS depressant effects.

Pharmacokinetics
Absorption: Administered I.V.
Distribution: Highly lipophilic and is rapidly and extensively distributed in animals. It’s highly protein-bound (greater than 90%) and redistributed rapidly.
Metabolism: Appears to be metabolized mainly in the liver and small intestine. Relatively little accumulation occurs.
Excretion: Drug and its metabolites are excreted primarily in urine.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug. Use cautiously in elderly or debilitated patients and in those with decreased respiratory reserve, head injuries, or renal, pulmonary, or hepatic disease.

Interactions
Drug-drug. Anticholinergics: May cause paralytic ileus. Monitor patient closely.
Beta blockers: Decreases dosing requirements for sufentanil. If beta blockers have been used preoperatively, decrease dose of sufentanil.
Cimetidine: Increases respiratory and CNS depression. Reduce sufentanil dosage if necessary.
General anesthetics: Causes severe CV depression. Monitor patient closely.
Narcotic agonist-antagonist or a single dose of an antagonist: Causes acute withdrawal syndrome if physically dependent patient receives high doses of these drugs. Avoid use together.
Nitrous oxide: May produce CV depression when given with high doses of sufentanil. Monitor patient closely.
Other CNS depressants, such as antihistamines, barbiturates, benzodiazepines, general anesthetics, muscle relaxants, narcotic analgesics, phenothiazines, sedative-hypnotics, and tricyclic antidepressants: Causes additive CNS depression. Use together cautiously.
Pancuronium: May produce a dose-dependent elevation in heart rate during sufentanil and oxygen anesthesia. Use moderate doses of pancuronium or a less vagolytic neuromuscular blocker. Vagolytic effect of pancuronium may be reduced in patients given nitrous oxide with sufentanil.
Drug-lifestyle. Alcohol use: May cause additive effects. Discourage use together.

Adverse reactions
CNS: chills, somnolence.
CV: hypotension, bradycardia, hypertension, arrhythmias, tachycardia.
GI: nausea, vomiting.
Musculoskeletal: intraoperative muscle movement.
Respiratory: chest wall rigidity, apnea, bronchospasm.
Skin: pruritus, erythema.

Effects on lab test results
• May increase plasma amylase, lipase, and serum prolactin levels.

Overdose and treatment
There’s no clinical experience with acute overdose of sufentanil, but signs and symptoms probably are similar to those caused by other opioids, with less CV toxicity. The most common signs and symptoms of acute opiate overdose are CNS depression, respiratory depression, and miosis (pinpoint pupils). Other acute toxic effects include hypotension, bradycardia, hypothermia, shock, apnea, cardiopulmonary arrest, circulatory collapse, pulmonary edema, and seizures.
 To treat acute overdose, establish adequate respiratory exchange via a patent airway and ventilation, as needed; administer a narcotic antagonist (naloxone) to reverse respiratory depression. (Because the duration of action of sufentanil is longer than that of naloxone, repeated naloxone dosing is needed.) Don’t give naloxone unless the patient has clinically significant respiratory or CV depression. Monitor vital signs closely.
 Provide symptomatic and supportive treatment (continued respiratory support, correction of fluid or electrolyte imbalance). Monitor laboratory parameters, vital signs, and neurologic status closely.

Special considerations
• Sufentanil should be given only by persons specifically trained in the use of I.V. anesthetics.
• Sufentanil has a more rapid onset and shorter duration of action than fentanyl and a more rapid onset of action than morphine.
• When used at doses exceeding 8 mcg/kg, postoperative mechanical ventilation and observation are essential because of extended postoperative respiratory depression.
• Sufentanil may produce muscle rigidity involving all the skeletal muscles (risk and severity are dose-related). Choose a neuromuscular blocker appropriate for the patient’s CV status.
• In patients weighing more than 20% above ideal body weight, determine dose based on ideal body weight.
Pediatric patients
• Safety and efficacy in children younger than age 2 have been documented in only a limited number of patients (who were undergoing CV surgery).
Geriatric patients
• Lower doses are usually indicated for elderly patients, who may be more sensitive to therapeutic and adverse effects of drug.

Patient education
• Assure patient and family of continuous monitoring.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use