SUFentanil Citrate

Brand names Sufenta

Medication error ISMP high-alert medication that has an increased risk of causing significant patient harm potential if it is used in error.(1) Look-alike, sound-alike drug names ISMP reports that SUFentanil has been confused with .(2) USP also reports that SUFentanil has been confused with ; no patient harm resulted.(3) USP reports that SUFentanil citrate has been confused with fentaNYL citrate; patient harm resulted.(3)

Contraindications Contraindications: Sufentanil is contraindicated in patients with a hypersensitivity to and warnings the drug or know intolerance to agonists.(5) Warnings: Sufentanil should be administered only by persons specifically trained in the use of IV and epidural and management of the respiratory effects of potent . An , resuscitative and intubation equipment and oxygen should be readily available.(5)

Infusion-related Significant bradycardia, muscle or chest wall rigidity (dose-related),(6) and apnea may cautions occur early in administration of sufentanil or following rapid administration. Pretreatment with atropine and a nondepolarizing neuromuscular blocking agent may aid in minimizing these adverse effects.(5) reverses respiratory depression induced by sufentanil; the respiratory depres- sion induced by sufentanil may last longer than the duration of naloxone, necessitating additional naloxone doses.(5)

Dosage Dosages vary depending on the desired degree of analgesia/anesthesia and adjunctive therapies (e.g., , ). Repeat doses should be increased or decreased based on response to initial dose.(5) Dosing adjustment for obesity: Use body weight when dosing patients whose weight is >20% of their ideal body weight.(5,7) Some authors recommend using total body weight for loading dose, then ideal or lean body weight afterward.(24) (See Appendix B.) Infants and children (<2 years) Anesthesia: Dose of 5–20 mcg/kg (0.5 mcg/kg when combined with halothane and nitric oxide)(6,8,9) followed by a continuous infusion of 1–2 mcg/kg/hr (8) Analgesia (mechanically ventilated patients): Ten neonates with respiratory distress syndrome received 0.28–0.42 mcg/kg over 15 minutes as incremental doses along with a continuous infusion starting at 0.14 mcg/kg/hr (median dose required was 0.4 mcg/kg/hr; median duration 26 hours). The infusion was titrated in increments of 0.07–0.14 mcg/kg/hr.(10) Thirty neonates who underwent cardiac surgery received a postoperative infusion of 2–4 mcg/kg/hr for 24 hours.(8) Fifteen preterm neonates (26–34 weeks gestational age) with respiratory distress received 0.5 mcg/kg over 10 minutes followed by an infusion of 0.2 mcg/kg/hr.(11) Children Anesthesia: Initial 10–25 mcg/kg(5,12); maintenance doses up to 25–50 mcg PRN.(5) Adults(5) Adjunct to anesthesia during brief operative cases (1–2 hours): Total 1–2 mcg/ kg; may give 75% or more before intubation as intermittent dose or continuous infu- sion; maintenance 10–25 mcg PRN. Total dose not to exceed an average of 1 mcg/ kg per hour of the operation.

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Dosage (cont.) Adjunct to anesthesia during operative cases lasting 2–8 hours: Total 2–8 mcg/kg; may give up to 75% prior to intubation as intermittent dose or continuous infusion; maintenance 10–50 mcg PRN. Total dose not to exceed an average of 1 mcg/kg per hour of the operation. Anesthesia (high dose): Total 8–30 mcg/kg; initial dose (which may be given as an intermittent dose or as a titratable infusion) is dependent on desired response (lower end of range produces sleep while higher end of range blocks sympathetic response during major surgical procedures). Maintenance doses 0.5–10 mcg/kg PRN. Not to exceed a total of 30 mcg/kg.

Dosage adjustment No dosage adjustment required in patients with renal dysfunction.(13) The manufacturer in organ dysfunction recommends caution when administering sufentanil to patients with hepatic or renal impairment.(5)

Maximum dosage Doses should be titrated to an appropriate level of anesthesia or pain control with manage- able adverse effects.(5) In adults a maximum dose of 30 mcg/kg has been recommended for anesthesia and 8 mcg/kg for analgesia.(5) For all procedures, the total infusion dose should not exceed 1 mcg/kg/hr of anticipated procedure time.(5)

Additives None

Suitable diluents D5W at final concentration of 5 mcg/mL, NS at final concentrations of 1 or 5 mcg/mL, but data are conflicting. See detailed reference on compatibility and stability.(14)

Maximum 50 mcg/mL(5) concentration

Preparation and Parenteral products should be visually inspected for particulate matter and discoloration delivery before use. Refer to appropriate reference for more information on compatibility with other drugs and solutions, compatibility following Y-site delivery, and suggested storage and extended stability.(14) See the Other Routes of Administration section for comments on intranasal delivery.

IV push ≤50 mcg/mL given over 2–5 minutes(5,6,9,12)

Intermittent infusion ≤50 mcg/mL(5,14)

Continuous infusion ≤50 mcg/mL(5,14)

Other routes of Although sufentanil has been given by IM administration,(14) it is generally not administered administration via this route. It can be given by epidural injection.(5,14) Intranasal sufentanil has been described. Three studies (n = 160 total; 0.5–10 years of age) reported using 1.5–3 mcg/kg as premedication for surgery.(15-17) Three additional studies (n = 60 total; 1–10 years of age) reported combination sufentanil and midazolam, both given intranasally, for dental procedures or laceration repair. Doses of sufentanil ranged from 0.75–1.33 mcg/kg (two studies limited the dose to 20 mcg) and midazolam doses ranged from 0.2–0.3 mg/kg (max 6 mg in one study).(18-20) Authors reported nasal administration techniques as either delivery via a needleless syringe(16-18) or as a nasal spray(20) using a concentration of 50 mcg/mL.(16,20)

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