Sufenta

SUFentanil

Sufenta

Indications

Action

Pharmacokinetics

Time/action profile (analgesia†)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• confusion
• paradoxical excitation/delirium
• postoperative depression
• postoperative drowsiness

Ear, Eye, Nose, Throat

• blurred/double vision

Respiratory

• apnea (life-threatening)
• cardiac arrest (life-threatening)
• laryngospasm (life-threatening)
• allergic bronchospasm
• respiratory depression

Cardiovascular

• arrhythmias
• bradycardia
• circulatory depression
• hypotension

Gastrointestinal

• biliary spasm
• nausea/vomiting
• constipation

Dermatologic

• facial itching

Musculoskeletal

• skeletal and thoracic muscle rigidity

Miscellaneous

• allergic reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor respiratory rate and BP frequently throughout therapy. Report significant changes immediately. The respiratory depressant effects of sufentanil may last longer than the analgesic effects. Monitor closely.
• Intravenous: Epidural: Assess type, location, and intensity of pain before and 3–5 min after IV administration when sufentanil is used to treat pain.
• Lab Test Considerations: May cause ↑ serum amylase and lipase concentrations.
Symptoms of toxicity include respiratory depression, hypotension, arrhythmias, bradycardia, and asystoleAtropine may be used to treat bradycardia. If respiratory depression persists after surgery, prolonged mechanical ventilation may be required. If an opioid antagonist is required to reverse respiratory depression or coma, naloxone (Narcan) is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by direct IV push every 2 min. For children and patients weighing <40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 1–2 min. Titrate dose to avoid withdrawal, seizures, and severe pain. Administration of naloxone in these circumstances, especially in cardiac patients, has resulted in hypertension and tachycardia, occasionally causing left ventricular failure and pulmonary edema.

Potential Nursing Diagnoses

Implementation

• high alert: Accidental overdosage of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order, dose calculations, and infusion pump settings.
• Do not confuse sufentanil with fentanyl.
  • Benzodiazepines may be administered before or after administration of sufentanil to reduce the induction dose requirements, decrease the time to loss of consciousness, and produce amnesia. This combination may also increase the risk of hypotension.
  • high alert: Opioid antagonists, oxygen, and resuscitative equipment should be readily available during the administration of sufentanil. Sufentanil should be administered IV only in monitored anesthesia care settings (operating room, emergency department, ICU) with immediate access to life support equipment and should be administered only by personnel trained in resuscitation and emergency airway management.

• Intravenous Administration

• Diluent: Administer undiluted.
• Rate: Administer slowly over 1–3 min. Slow IV administration may reduce the incidence and severity of muscle rigidity, bradycardia, or hypotension. Neuromuscular blocking agents may be administered concurrently to decrease muscle rigidity.
• Intermittent Infusion: Diluent: May be diluted with D5W or 0.9% NaCl.
• Rate: Adjust rate based upon the induction dose so that total dose does not exceed 1 mcg/kg per hour of expected surgical time.
• Y-Site Compatibility: acyclovir, alemtuzumab, alfentanil, amikacin, aminocaproic acid, aminophylline, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, azathioprine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, cisatracurium, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin, doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etomidate, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, idarubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketamine, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, miconazole, midazolam, milrinone, minocycline, mitoxantrone, morphine, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, pemetrexed, penicillin G, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, scopolamine, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vancomycin, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, voriconazole, zoledronic acid
• Y-Site Incompatibility: amphotericin B colloidal, dantrolene, daptomycin, diazoxide, indomethacin, lorazepam, phenytoin, thiopental, trimethoprim/sulfamethoxazole

Patient/Family Teaching

• Discuss the use of anesthetic agents and the sensations to expect with the patient before surgery.
• Explain pain assessment scale to patient.
• Caution patient to change positions slowly to minimize orthostatic hypotension.
• May causes dizziness and drowsiness. Advise patient to call for assistance during ambulation and transfer and to avoid driving or other activities requiring alertness for 24 hr after administration during outpatient surgery.
• Instruct patient to avoid alcohol or other CNS depressants for 24 hr after administration for outpatient surgery.

Evaluation/Desired Outcomes

• General quiescence.
  • Reduced motor activity.
• Pronounced analgesia.