Pharmacokinetics of sufentanil in the elderly surgical patient

Matteo, Richard S.; Schwartz, Arthur E.; Ornstein, Eugene; Young, William L.; Chang, Winjing

doi:10.1007/bf03006620

Cited by 48 publications

(2 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are a number of publications available covering the effects of aging on the pharmacokinetics of acute opioid application in humans; however it must be emphasized that the relevance of these results to chronic opioid prescription is limited. In general, the reduction of volume of distribution with increased age results in higher initial plasma levels, with no major aging effects demonstrable thereafter (Singleton et al, 1988; Sear et al, 1989; Lemmens et al, 1990; Matteo et al, 1990). A study of dihydrocodeine demonstrated no significant pharmacokinetic effects of aging for single dosing, but with multiple repeat dosing demonstrated age‐related increases of ca.…”

Section: Summary Of Available Human Clinical Datamentioning

confidence: 99%

Opioid use in the elderly

Wilder–Smith

2005

European Journal of Pain

View full text Add to dashboard Cite

Pain treatment in the elderly is an important challenge to Western societies due to increasing numbers of old persons, their higher incidence of pain, and their greater susceptibility to adverse effects of pain medication. We provide an overview of the factors liable to influence opioid action in the elderly population. A major challenge for the physician prescribing opioids in the elderly is their greater risk of medication-associated problems. Thus, older patients suffer increased vulnerability to adverse drug effects and interactions, higher rates of polypharmacy, and more comorbidity. These problems are compounded by a relative lack of definitive published information. There is clearly a need for more research in this area. Aging affects opioid pharmacokinetics via altered body composition (distribution volumes) and organ function (liver=metabolism, kidney=excretion). Pharmacodynamics is affected via impaired neurotransmitter/peptide production and changed receptor affinities/populations. Older women may need less morphine analgesia postoperatively, while pain sensitivity tends to increase particularly in older men. However, the net effects of changes in opioid pharmacology with age on clinical opioid analgesia remain unclear, probably due to the significantly greater variability in body function with increasing age. Practical recommendations for opioid prescription in the elderly include meticulous review of indication for opioid use, not only initially but also at regular intervals thereafter. A policy of careful titration should be followed, with conservative choice of dosage on starting. Dosing intervals may need to be lengthened subsequently. Finally, it should be remembered that old persons do not necessarily need less opioid than younger ones.

show abstract

Section: Summary Of Available Human Clinical Datamentioning

confidence: 99%

Opioid use in the elderly

Wilder–Smith

2005

European Journal of Pain

View full text Add to dashboard Cite

show abstract

“…This reflects the, well known, age related, pharmacokinetic modifications, especially for lipophilic drugs like Sufentanil. [15] Global reduction of body water and relative increase in fat of aged, results in a faster onset and in a prolonged half-life, with an apparent increase of potency of the drug. [16] The older patients, obtained same effects by reducing the doses.…”

Section: Discussionmentioning

confidence: 99%

Sufentanil sublingual tablet system (Zalviso^®) as an effective analgesic option after thoracic surgery: An observational study

et al. 2019

View full text Add to dashboard Cite

Introduction: Sufentanil sublingual tablet system (SSTS) (Zalviso ® ) is a sublingual system for patient controlled analgesia, demonstrated to be an effective strategy for pain control after major abdominal and orthopedic surgery. We present a prospective observational study on the use of SSTS for the management of postoperative pain after thoracic surgery. The aim of this study was to assess the efficacy of Zalviso ® in reducing pain scores and increasing respiratory ability during postoperative period. Materials and Methods: There were about 40 patients underwent video assisted thoracoscopy were included in the study. All the enrolled patients signed the informed consent were educated to the use of the device. Pain numeric rating scale values (NRS) were recorded at awakening from anesthesia (T0) and during the next hours, both at rest and with cough. We evaluate the time to obtain a mean NRS value ≤3 and difference in pain scores between first and subsequent measurements as the primary outcomes. The ability to use incentive spirometer and eventual drug adverse effect were evaluated as secondary outcomes. Results: All patients in recovery room experienced moderate to severe pain. Pain score at rest and coughing decreased to a mean NRS value ≤3 (mild pain) respectively after 2 and 6 hours and the pain score difference continued to increase significantly after repeated measurements. 67.5% of patients resumed the original spirometric ability in pod 1; 9.5% in pod 2; 12% in pod 3. Only three patients out of forty (7,5%) experienced nausea; one patient (2,5%) had a vomiting episode. Conclusion: Our study showed SSTS as an effective option for postoperative pain management in thoracic surgery, improving pain scores and respiratory ability.

show abstract