Sufentanil
Sufenta · Dsuvia (sublingual)
Synthetic phenylpiperidine μ-opioid agonist
Most potent opioid in common clinical use — ~1000× morphine, ~10× fentanyl. High lipid solubility.
Indications
- •Cardiac anesthesia
- •Neuraxial labor/cesarean analgesia
- •High-potency intraop analgesia
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Induction adjunct | 0.1–0.5 mcg/kg IV | — |
| Cardiac anesthesia | 1–8 mcg/kg IV | — |
| Infusion | 0.5–1.5 mcg/kg/hr | — |
| Intrathecal (labor) | 5–10 mcg | — |
| Epidural | 10–20 mcg | — |
Pharmacokinetics
Onset 1–3 min, duration 30–45 min (bolus). Shorter context-sensitive half-time than fentanyl at moderate infusion durations.
Hemodynamic effects
Very stable; bradycardia at high doses.
Respiratory effects
Potent dose-dependent depression; chest wall rigidity.
Side effects
- !Respiratory depression
- !Bradycardia
- !Chest wall rigidity
- !N/V
- !Pruritus (neuraxial)
Contraindications
- ×MAOI within 14 days (relative)
Reversal / antidote
Naloxone
Clinical pearls
- ★Neuraxial sufentanil gives rapid-onset labor analgesia — watch for transient fetal bradycardia.
- ★Extremely small volumes dosed — dilute carefully to avoid overdose.
- ★Most potent option when profound analgesia with hemodynamic stability is needed (e.g. cardiac).
Other drugs in Narcotics & Analgesics
- Fentanyl
μ-opioid receptor agonist. ~100× potency of morphine.
- Remifentanil
μ-opioid agonist. Ester linkage hydrolyzed by nonspecific tissue + plasma esterases — no organ-dependent clearance.
- Morphine
μ-opioid receptor agonist. Active metabolite morphine-6-glucuronide (M6G) is analgesic and renally cleared — accumulates in renal failure → prolonged sedation/respiratory depression. Causes histamine release.
- Hydromorphone
μ-opioid agonist ~5–7× more potent than morphine. No clinically significant active metabolites → safer than morphine in renal failure. Less histamine release.
- Alfentanil
μ-opioid agonist ~1/5–1/10 the potency of fentanyl but FASTEST onset of the family — low pKa means a high non-ionized fraction at physiologic pH.
- Meperidine
μ-opioid agonist ~1/10 morphine, plus κ-agonism (anti-shivering). Active metabolite normeperidine is renally cleared, proconvulsant, and neurotoxic.
- Methadone
μ-opioid agonist with NMDA-receptor antagonism (blunts tolerance + opioid-induced hyperalgesia) and monoamine reuptake inhibition. Very long, variable half-life.
- Nalbuphine
κ-receptor agonist + μ-receptor antagonist. Ceiling on respiratory depression. Reverses μ-mediated pruritus/respiratory depression while preserving some analgesia.
Browse all classes: /reference/drugs
Suggested reading
- •Stoelting & Hines, Pharmacology & Physiology in Anesthetic Practice, 6e
- •Miller's Anesthesia, 9e
- •FDA package insert
