Sufentanil Citrate (Sufenta)

Anesthesia Implications

Classification: Opioid, Narcotic
Therapeutic Effects: Analgesia
Time to Onset: IV: 1-3 min
IN: < 5 min
Neuraxial: 4-10 min
Time to Peak: IV: 3-5 min
IN: 10 min
Neuraxial: < 30 min
Duration: IV: 20-45 min
IM: 2-4 hrs
Neuraxial: 4-6 hrs

Primary Considerations

Potency – 5-10 times more potent than Fentanyl

Context-sensitive half-time (CSHT) – for continuous infusions, Sufenta INITIALLY has a longer CSHT than Fentanyl and a shorter half-time than Alfentanil. After a short period of infusion, this reverses – Fentanyl and Alfentanil become significantly more prolonged.

Side effects – may cause bradycardia, hypotension, respiratory depression, and chest muscle rigidity (with rapid administration). There’s very little affect on cerebral blood flow, CMRO2, and may lower intracranial pressure (ICP) and cerebral perfusion pressures (CPP)

OB – Readily crosses the placenta, so use extreme caution in parturients

Dosing – use ideal body weight in the obese. Consider reducing doses in the elderly hypovolemic, and opioid naive.

Common mixtures – 5 mcg/ml and 10 mcg/ml

Infusion recommendations – discontinue drip 35-45 minutes prior to emergence. Respiratory depression and LOC issues are common if not discontinued with enough time before emergence.

IV push dose

DL blunting: 0.1-0.3 mcg/kg
Sole-agent Induction: 2-10 mcg/kg

IV infusion dose

Common dose: 0.2 mcg/kg/hr
Textbook: 0.15 – 0.5 mcg/kg/hr
Textbook: 0.005 – 0.015 mcg/kg/min
MAX: 1 mcg/kg/hr (total infusion + bolus doses)

Epidural bolus dose

10 – 50 mcg – this can be up to 3 administrations (1 hour apart). Each dose should provide 1-2 hours of analgesia

Epidural maintenance rate

10-50 mcg/hr

Spinal bolus dose

5-10 mcg. This gives ~ 4-6 hours of analgesia

Reversal

Adult: 0.5–1 mcg/kg every 3–5 min, titrated to respiratory rate
(in a 10 ml syringe, draw up the 1 ml 0.4 mg/ml with 9 ml of saline. That makes 40 mcg/ml)

This drug will wear off well before standard opioids, so follow with IM naloxone (1-2 mcg/kg) or an infusion (4-5 mcg/kg/hr)

Method of Action

Opioid agonist

Metabolism

Hepatic