Sufentanil

Indications

Sufentanil is used for: Adjunct to anaesthesia with nitrous oxide and oxygen, As primary anaesthetic, Pain relief during labour and delivery, Postoperative pain

Adult Dose

Intravenous Adjunct to anaesthesia with nitrous oxide and oxygen Adult: For surgical procedures ?8 hr: Up to 75% of the dose to be given before intubation followed by additional doses of 10-50 mcg as needed during surgery; dose may also be given by continuous or intermittent infusion. Total dose should not exceed 1 mcg/kg/hr. As primary anaesthetic Adult: Given with 100% oxygen, initially, 8-30 mcg/kg. For maintenance, additional doses of 0.5-10 mcg/kg may be given as necessary. Max (total dose): 30 mcg/kg. Epidural Pain relief during labour and delivery Adult: 10-15 mcg plus 10 ml bupivacaine 0.125% with or without epinephrine. May repeat dose twice at intervals of at least 1 hr until delivery. Max (total dose): 30 mcg. Intravenous Postoperative pain Adult: Initially, 30-60 mcg. Additional doses of up to 25 mcg may be given at intervals of at least 1 hr if necessary.

Child Dose

Intravenous Adjunct to anaesthesia with nitrous oxide and oxygen Child: Given with 100% oxygen, 10-25 mcg/kg as initial dose; maintenance doses: 25-50 mcg as necessary. Elderly: Dosage reduction may be required. As primary anaesthetic Child: Initially, 10-25 mcg/kg, to be used with 100% oxygen. Maintenance doses of up to 25-50 mcg.

Renal Dose

Administration

Contra Indications

Acute respiratory depression, acute alcoholism, hypersensitivity, comatose patients.

Precautions

Therapy exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death; assess each patient’s risk prior to prescribing therapy, and monitor all patients regularly for the development of these behaviors and conditions Hypotension; hypothyroidism; asthma, pulmonary disease, decreased respiratory reserve; prostatic hypertrophy; renal or hepatic impairment; pregnancy and lactation; elderly, obese and debilitated patients; convulsive disorders. Monitor vital signs during admin of sufentanil. Head injuries, phaeochromocytoma, gradual withdrawal is advised. Increased risk of bradycardia and hypotension in patients on chronic calcium channel and β-blocker treatment.

Pregnancy-Lactation

Pregnancy Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome; available data in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage Labor or delivery Opioids cross placenta and may produce respiratory depression and psycho-physiologic effects in neonates; an opioid antagonist, such as naloxone, must be available for reversal of opioid induced respiratory depression in neonate; drug is not recommended for use in women during and immediately prior to labor, when use of shorter-acting analgesics or other analgesic techniques are more appropriate; opioid analgesics can prolong labor through actions that temporarily reduce strength, duration, and frequency of uterine contractions; however, this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor; monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression Lactation The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy; capsules and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition Monitor infants exposed to drug through breast milk for excess sedation and respiratory depression; withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breast- feeding is stopped Withdrawal signs can occur in breast-fed infants when maternal administration of an opioid analgesic is stopped or when breastfeeding is stopped; naloxone may precipitate opioid withdrawal in a breast-fed infant whose mother received opioid analgesics

Interactions

Benzodiazepines, antipsychotics, TCAs, anxiolytics and hypnotics may enhance sedative effects. Cimetidine may increase plasma concentrations of sufentanil. May reduce serum concentrations of ciprofloxacin. Potentially Fatal: Possible CNS excitation or depression may occur when given with MAOIs or within 14 days of stopping MAOI treatment.

Adverse Effects

Side effects of Sufentanil : Frequency Not Defined Nausea Vomiting Constipation Sweating, flushing, warmness of the face/neck/upper thorax Pruritus, urticaria Bradycardia Dizziness Visual disturbances Mentalclouding/depression Sedation Coma Euphoria/Dysphoria Weakness Faintness Agitation Restlessness Nervousness Seizures Anticholinergic effects (dry mouth, palpitation, tachycardia) Respiratory/circulatory depression Respiratory arrest, shock, cardiac arrest QT-interval prolongation, severe cardiac arrhythmias, cardiac arrest, ST segment elevation, ventricular tachycardia Myocardial infarction, angina pectoris, syncope Urinary retention, oliguria

Mechanism of Action

Sufentanil is a phenylpiperidine-derivative opiate agonist related to fentanyl. It is used as an analgesic adjunct in anaesthesia and as a primary anaesthetic drug in procedures requiring assisted ventilation.