Sufentanil - IV Flashcards
What is the brand/trade name for sufentanil?
What is the pharmacologic category/class of sufentanil?
- Opioid Analgesic — Synthetic
- Phenylpiperidine
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 4. Classification, Relative Potency & Opioid Abuse
What is the mechanism of action of sufentanil?
Opioid rececptor agonism, especially mu, with resultant increase in pain threshold, altered pain perception, and inhibition ascending pain pathways
- Presynaptic: decreases cAMP-dependent influx of calcium ions → inhibition of neurotransmitter release
- Post synaptic: increased outward K+ conductance → hyperpolarization of nerve cell
Note that these are similar to those of other opioids
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 2. Opioid Receptors
Nagelhout (7th ed.), pp. 141 - Fig. 11.2, 142, 148, 1295-1296, 1298
Stoelting’s Pharmacology (5th ed.), pp. 218-219
Sufentanil can be used to provide surgical analgesia or general anesthesia and the dose varies depending on the length and type of surgery — total doses for each of the following should not exceed
- Minor procedure
- Moderate procedure
- Major procedure
- Minor: 1-2 mcg/kg IV
- Moderate: 2-8 mcg/kg IV
- Major: 8-30 mcg/kg IV
This helps to blunt the SNS response to intubation and provides some coverage for surgical stimulation
~75% administered at induction, remainder PRN or via infusion
The man, the myth, the legend: Dr. C - Opioids PPT, Slide 25
Nagelhout (7th ed.), p. 145 - Table 11.5
Incremental dosing of sufentanil may be administered at a dose of __________ IV PRN when movement and/or changes in vital signs indicate surgical stress or lightening of analgesia
- 10-50 mcg
You can also provide a background infusion, but I didn’t wanna make that card
The man, the myth, the legend: Dr. C - Opioids PPT, Slide 25
Loading/induction doses of sufentanil should be administered as a “slow injection” or infusion over what time frame?
- 2-10 minutes
What is the onset of action for sufentanil?
- 1-2 minutes
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Nagelhout (7th ed.), p. 146 - Table 11.6
What is the duration of action for sufentanil?
- ~15-30 minutes, but varies greatly depending on dose
Of note, it’s context-sensitive T1/2 is more favorable than fentanyl or alfentanil
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Nagelhout (7th ed.), p. 146 - Table 11.6
Stoelting’s Pharmacology (5th ed.), p. 235
What organ(s) are responsible for sufentanil’s clearance (metabolism/elimination)?
- Metabolism: Liver (P450)
- Elimination: Kidneys, Intestines
Very weakly active metabolite — consideration in renal failure
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Stoelting’s Pharmacology (5th ed.), p. 235
Cardiovascular effects of sufentanil include:
- Bradycardia
may be significant enough at large doses to decrease CO - Stable SVR/MAP
no histamine release
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3
Nagelhout (7th ed.), pp. 143
Stoelting’s Pharmacology (5th ed.), p. 236
What are the respiratory effects of sufentanil?
- Dose dependent depression of ventilation — RR affected before Vt
(shifting of the CO2 response curve) - Inhibits hypoxic ventilatory drive
- Apnea at large doses
Note that these are similar to those of other opioids
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3
Nagelhout (7th ed.), p. 142
Stoelting’s Pharmacology (5th ed.), p. 222
What are the effects of sufentanil on the CNS?
- Sedation
- Miosis/pinpoint pupils
- Mild hypothermia
resets hypothalamic temperature setpoint - N/V
Partial dopamine agonists at CTZ
Note that these are similar to those of other opioids
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3
Nagelhout (7th ed.), p. 142
Stoelting’s Pharmacology (5th ed.), p. 223
What is the concentration (mg/mL) of sufentanil vials?
Rapid IV administration of large doses of sufentanil can lead to generalized ______________; the greatest impact is on the ability to ______________
- Skeletal muscle rigidity
- Ventilate
some decrease in chest wall compliance, but this is mostly related to constriction of laryngeal musculature
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 10. Skeletal Muscle Rigidity
Nagelhout (7th ed.), pp. 143-144
Stoelting’s Pharmacology (5th ed.), pp. 223, 236
What are the GI/GU effects of sufentanil?
- Slowed peristalsis → CONSTIPATION
- N/V
- Contraction of sphincter of Oddi → biliary colic
evidence is kind meh on this - Delayed gastric emptying
- Urinary retention (IDGAF)
detrusor relaxation, urinary sphincter constriction
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3
Nagelhout (7th ed.), pp. 143-144
Stoelting’s Pharmacology (5th ed.), pp. 223-224
The experience of pain can be divided into four steps: transduction, transmission, modulation, and perception. Which of these does sufentanil have an effect on?
Along with other opioids, remifentanil effects
- transduction
peripheral nerves - modulation
spinal cord - perception
brain/brainstem
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 1 & 2
As an analgesic, sufentanil is __________ times more potent than morphine and _________ times more potent than fentanyl
- ~1000
- ~10
This number varies slightly between texts
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 4. Classification, Relative Potency & Opioid Abuse
Stoelting’s Pharmacology (5th ed.), p. 235
