SUFENTANIL CITRATE

SUFENTANIL CITRATE
(soo-fen'ta-nil)
Sufenta
Classifications: narcotic (opiate) agonist analgesic; general anesthetic;
Therapeutic: narcotic analgesic

Prototype: Morphine
Pregnancy Category: C
Controlled Substance: Schedule II

Availability

50 mcg/mL injection

Action

Synthetic opioid related to fentanyl with similar pharmacologic actions, but about 7 times more potent. Onset of action and recovery from anesthesia occur more rapidly with sufentanil than with fentanyl. In common with other opiate agonists, sufentanil can cause respiratory depression and suppression of cough reflex.

Therapeutic Effect

Effective agent for analgesia as a supplement or a primary anesthesia.

Uses

Analgesic supplement in maintenance of balanced general anesthesia and also as a primary anesthetic.

Contraindications

Hypersensitivity to opiate agonists; pregnancy (category C).

Cautious Use

Pulmonary disease, reduced respiratory reserve; COPD; cardiac disease; increased intracranial pressure; seizure disorders; impaired liver or kidney function; GI disease; lactation.

Route & Dosage

Adjunct to General Anesthesia
Adult: IV 1–8 mcg/kg, depending on duration of surgery, may give additional doses of 10–50 mcg if needed

As Primary Anesthetic
Adult: IV 1–30 mcg/kg administered with 100% oxygen and a muscle relaxant, may give additional doses of 10–50 mcg if needed
Child (<12 y): IV 10–25 mcg/kg administered with 100% oxygen and a muscle relaxant, may give additional doses of 25–50 mcg up to 1–2 mcg/kg/dose if needed

Obesity
Use lean body weight.

Administration

Intravenous
  • Administer only by qualified personnel, specifically trained in the use of IV anesthesia and in the management of respiratory depression.
  • Have available a narcotic antagonist (e.g., naloxone) to reverse respiratory depression.

PREPARE: Direct: Examine solution for particulate matter and discoloration (solution should be clear) before administration. Give undiluted.  

ADMINISTER: Direct: Give a bolus dose over 3–5 sec.  Epidural: Give by slow injection and closely monitor respirations after each injection.  

INCOMPATIBILITIES Solution/additive: Diazepam, lorazepam, phenobarbital, phenytoin, sodium bicarbonate, sodium chloride. Y-site: Lorazepam, phenytoin, thiopental.

  • Store at 15°–30° C (59°–86° F) unless otherwise directed; protect from light.

Adverse Effects (≥1%)

CV: Bradycardia, tachycardia, hypotension, hypertension, arrhythmias. GI: Nausea, vomiting, constipation. Respiratory: Bronchospasm, respiratory depression, apnea. Body as a Whole: Skeletal muscle rigidity (especially of trunk), chills, itching, spasms of sphincter of Oddi, urinary retention.

Interactions

Drug: beta-adrenergic antagonists increase incidence of bradycardia; alcohol and other cns depressants such as barbiturates, tranquilizers, opiates, and inhalation general anesthetics add to CNS depression; cimetidine increases risk of respiratory depression.

Pharmacokinetics

Onset: 1.5–3 min. Duration: 40 min. Distribution: Crosses blood–brain barrier. Metabolism: In liver (CYP3A4) and small intestine. Elimination: In urine and feces. Half-Life: 2–3 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor vital signs. Observe for skeletal muscle rigidity, especially of chest wall, and respiratory depression, particularly in older adults, and in patients who are obese, debilitated, or who have received high doses.
  • Bear in mind that if naloxone is given to reverse respiratory depression, the duration of sufentanil-induced respiratory depression may exceed the duration of naloxone.

Patient & Family Education

  • Avoid activities which require mental alertness for at least 24 h after receiving this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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