Sufentanil Citrate

A to Z Drug Facts

Sufentanil Citrate

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(sue-FEN-tuh-nill SIH-trate)

Sufenta, Sufentanil Citrate

Class: Narcotic analgesic

Action 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.

Indications 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.

Route/Dosage

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 < 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 ³ 1 hr intervals until delivery.

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.

Lab Test Interferences Increased amylase and lipase for up to 24 hr after dose may occur.

Adverse Reactions

CV: Hypotension; orthostatic hypotension; hypertension; bradycardia; tachycardia; arrhythmias. CNS: Sedation. DERM: Pruritus. GI: Nausea; vomiting. RESP: Bronchospasm; depression of cough reflex; respiratory depression; postoperative respiratory depression; chest wall rigidity. OTHER: Chills; intraoperative muscle movement; tolerance.

Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy have been demonstrated in limited number of children < 2 yr undergoing cardiovascular surgery. Elderly or debilitated patients: May require dosage reduction. Special risk patients: Use drug with caution in patients with decreased respiratory reserve, head injury or 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 > 20% above ideal weight, dose must be adjusted based on ideal body weight. Renal or hepatic impairment: Duration of action may be prolonged; dosage reduction may be required. Skeletal muscle rigidity: May cause skeletal muscle rigidity, particularly of the truncal muscles. The incidence and severity of muscle rigidity is usually dose-related.

PATIENT CARE CONSIDERATIONS

Administration/Storage

For direct IV administration, administer slowly over 1 to 2 min.
Store at room temperature. Protect from light.
Limit epidural or intrathecal administration of preservative free sufentanil to the lumbar area.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Assess patient for head injury, pulmonary disease or decreased respiratory reserve.
Maintain narcotic antagonist and resuscitative equipment at bedside.
Monitor respiratory rate and BP closely during administration.
Observe for evidence of effective induction of anesthesia.
Monitor vital signs at frequent intervals postoperatively.

OVERDOSAGE: SIGNS & SYMPTOMS
	Miosis, respiratory and CNS depression, circulatory collapse, seizures, cardiopulmonary arrest, death

Patient/Family Education

Inform patient that nausea, vomiting or constipation may occur and advise patient to notify physician should these symptoms become prominent.
Advise patient to ask for assistance with ambulation.
Instruct patient to report these symptoms to physician: shortness of breath or difficulty breathing.
Caution patient to avoid sudden position changes to prevent orthostatic hypotension.