A Comparison Among Morphine, Fentanyl, and Sufentanil Anesthesia for Open-Heart Surgery. Induction, Emergence, and Extubation

Smith, N. Ty; Dec-Silver, H.; Harrison, Walter K.; Sanford, Theodore J.; Gillig, Jonathan D.

doi:10.1097/00000542-198209001-00291

Cited by 30 publications

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“…The shorter elimination halflife of sufentanil should allow for a shorter duration of action. Clinical studies by de Lange et al (1982b) and Howie et al (1983) using recovery times or time to extubation have not demonstrated significant clinical differences between these 2 drugs, whereas studies by Smith et al (1983) support shorter periods of postoperative ventilation in patients treated with sufentanil.…”

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Clinical Pharmacokinetics of the Newer Intravenous Anaesthetic Agents

Davis

Cook

1986

Clinical Pharmacokinetics

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In the last 15 years the role of opioids in anaesthesia management has undergone dramatic change. Initially used as premedicants, or adjuvants to inhalation anaesthetic agents or as analgesics for postoperative pain relief, narcotics have now evolved into primary anaesthetic agents, primarily because of their ability to maintain cardiovascular stability especially in patients with compromised myocardial function. Sufentanil, alfentanil, and lofentanil are 3 new synthetic congeners of fentanyl. Sufentanil and alfentanil afford not only the haemodynamic stability but also the desirable anaesthetic properties of analgesia, and unconsciousness. Their major advantage lies in their pharmacokinetic behaviour; a rapid onset of action and short elimination half-life, allowing for greater flexibility in anaesthetic management. Sufentanil's pharmacokinetic profile is consistent with a 2-compartment model. Its elimination half-life is 149 minutes and its clearance is 11.3 ml/min/kg. Alfentanil's pharmacokinetic profile has been described by both 2- and 3-compartment models. Its distribution and redistribution are rapid, with an elimination half-life of 83 to 137 minutes and a clearance of 4.37 to 6.47 ml/min/kg in adult patients. Lofentanil, however, is an extremely long-acting narcotic analgesic. Presently, its use is justified only when prolonged mechanical ventilation is anticipated. Etomidate, a carboxylated imidazole, is rapidly distributed within a central compartment and then to peripheral compartments; its slow distribution and terminal elimination half-lives are 28 and 273 to 330 minutes, respectively, and its clearance (11.6 to 25 ml/min/kg) is equal to its hepatic plasma flow. Its ability to maintain cardiovascular stability in patients with compromised myocardial function make it a useful induction agent. However, reports of increased mortality and inhibition of steroidogenesis in patients receiving either single injections or constant infusions have created controversies regarding its use. Minaxolone is a water-soluble steroid whose pharmacokinetic profile is consistent with a 2-compartment model. Distribution is rapid with a mean half-life of 2.1 minutes and an elimination half-life of 47 minutes. There do not appear to be any cumulative effects. Plasma levels on recovery were similar in those patients receiving single bolus or continuous infusions. Midazolam and flunitrazepam are two new benzodiazepines. As a class of drugs, benzodiazepines provide the pharmacological properties of anxiolysis, sedation, hypnosis, muscle relaxation, amnesia and anticonvulsant activity.(ABSTRACT TRUNCATED AT 400 WORDS)

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confidence: 99%

Clinical Pharmacokinetics of the Newer Intravenous Anaesthetic Agents

Davis

Cook

1986

Clinical Pharmacokinetics

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Alfentanil and sufentanil: Towards a more specific use of narcotics in anesthesia

Bussche

Noorduin

1986

Drug Development Research

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Vanden Bussche, G., and H. Noorduin: Alfentanil and sufentanil: Towards a more specific use of narcotics in anesthesia. Drug Dev. Res. 8:341-346, 1986 Molecular redesign of existing compounds has led to the development of narcotic agents such as alfentanil and sufentanil, which may allow a greater and more specific use of narcotics in clinical anesthesia. The rapid onset and short duration of action makes alfentanil very suitable in those situations where rapid suppression of reflex responses is required (e.g., peroperative supplementation during stressful moments) or where longer acting compounds are iess appropriate (e.g., short surgical procedures). The high specificity and potency of sufentanil provide deeper analgesia and a more complete stress protection than existing narcotics, without increasing postoperative depression. These characteristics make sufentanil especially beneficial in those situations where high doses are required (e.g., major surgical procedures such as cardiac surgery).

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Sufentanil Citrate: A New Opioid Analgesic for Use in Anesthesia

Rosow

1984

Pharmacotherapy

111

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Sufentanil citrate is a potent analogue of fentanyl that has been evaluated primarily for use in opioid anesthesia. It is a pure mu receptor agonist and produces the typical spectrum of opioid effects. The major side effects are truncal rigidity and prolonged respiratory depression. In doses of 4-30 micrograms/kg sufentanil produces hypnosis and suppresses most hemodynamic and hormonal responses to surgery without producing significant cardiovascular depression. In this respect sufentanil and fentanyl have clear advantages over morphine, meperidine and potent inhalation anesthetics. Compared to fentanyl, sufentanil has a more rapid onset and shorter duration of action. The relatively high concentration of commercially available sufentanil injection will make it much more convenient for its intended application than fentanyl injection. This new agent will be used primarily for open-heart surgery and major operations in patients with severe cardiovascular compromise.

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A Comparison Among Morphine, Fentanyl, and Sufentanil Anesthesia for Open-Heart Surgery. Induction, Emergence, and Extubation

Cited by 30 publications

References 0 publications

Clinical Pharmacokinetics of the Newer Intravenous Anaesthetic Agents

Clinical Pharmacokinetics of the Newer Intravenous Anaesthetic Agents

Alfentanil and sufentanil: Towards a more specific use of narcotics in anesthesia

Sufentanil Citrate: A New Opioid Analgesic for Use in Anesthesia

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