General Surgery (with nitrous oxide/oxygen in whom endotracheal intubation and mechanical ventilation required)
- 1-2 mcg/kg IV (expected duration of anesthesia 1 to 2 hours)
- Maintenance: 10-25 mcg IV increments as needed when movement and/a changes in vital signs indicate surgical stress or lightening of analgesia
- Max: 1 mcg/kg/hr of expected surgical time
- Administer 75% or more of total dosage prior to intubation by either slow injection or infusion titrated to individual patient response
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose in elderly and debilitated patients
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
- Titrate the dose as per individual patient response
Major surgery (with nitrous oxide/oxygen in whom endotracheal intubation and mechanical ventilation required)
- 2 -8 mcg/kg IV (expected duration of anesthesia 2-8 hours)
- Maintenance: 10 to 50 mcg IV increments as needed when movement and/a changes in vital signs indicate surgical stress or lightening of analgesia
- Max: 1 mcg/kg/hr of expected surgical time
- Administer 75% or less of the total calculated dosage by slow injection or infusion prior to intubation, titrated to individual patient response
- At above mentioned dosage there is attenuation of sympathetic reflex activity in response to surgical stimuli, provide hemodynamic stability, and provide relatively rapid recovery
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose in elderly and debilitated patients
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
Complicated/prolonged major surgery
- Start: 8-30 mcg/kg IV
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose in elderly and debilitated patients
- Administer higher doses only if qualified personnel and adequate facilities are available for the management of postoperative respiratory depression
- Dosage in this range of up to 25 mcg/kg attenuate catecholamine release
- Dosage of 25-30 mcg/kg block sympathetic response including catecholamine release
- Higher doses indicated in patients undergoing major surgical procedures requiring endotracheal intubation and mechanical ventilation (e.g. cardiovascular surgery and neurosurgery)
- Observe postoperatively and give mechanical ventilation at higher dose range (risk of extended postoperative respiratory depression)
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
- Titrate the dose as per individual patient response
- 0.5-10 mcg/kg IV
- Max: 30 mcg/kg/procedure (maintenance infusion rate should be based upon the induction dose)
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose in elderly and debilitated patients
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
- Titrate the dose as per individual patient response
- 10-15 mcg epidural qhr with 10 mL bupivacaine 0.125% with or without epinephrine
- Max: 3 doses
- Slowly inject while administering epidurally
- Mix sufentanil and bupivacaine together before administration
- Ensure proper placement of the needle or catheter in the epidural space before administration to avoid unintentional intravascular or intrathecal administration
- Unintentional intravascular injection could result in a potentially serious overdose, including acute truncal muscular rigidity and apnea
- Unintentional intrathecal injection of full sufentanil, bupivacaine epidural doses and volume can cause effect of high spinal anesthesia including prolonged paralysis and delayed recovery
- Verify placement and integrity of the catheter prior to administration of any additional epidural medications if inadequate analgesia
- Closely monitor respiration following each administration of epidural injection of sufentanil
- Monitor vital signs routinely
- Reduce the dose in elderly and debilitated patients
General Surgery (with nitrous oxide/oxygen in whom endotracheal intubation and mechanical ventilation required)
12-18 yrs
- 1-2 mcg/kg IV (expected duration of anesthesia 1 to 2 hours)
- Maintenance: 10-25 mcg IV increments as needed when movement and/a changes in vital signs indicate surgical stress or lightening of analgesia
- Max: 1 mcg/kg/hr of expected surgical time
- Administer 75% or more of total dosage prior to intubation by either slow injection or infusion titrated to individual patient response
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose in elderly and debilitated patients
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
- Titrate the dose as per individual patient response
Major surgery (with nitrous oxide/oxygen in whom endotracheal intubation and mechanical ventilation required)
12-18 yrs
- 2-8 mcg/kg IV (expected duration of anesthesia 2 to 8 hours)
- Maintenance: 10-50 mcg IV increments as needed when movement and/a changes in vital signs indicate surgical stress or lightening of analgesia
- Max: 1 mcg/kg/hr of expected surgical time
- Administer 75% or more of total dosage prior to intubation by either slow injection or infusion titrated to individual patient response
- At above mentioned dosage there is attenuation of sympathetic reflex activity in response to surgical stimuli, provide hemodynamic stability, and provide relatively rapid recovery
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
Complicated/prolonged major surgery
12-18 yrs
- Start: 8-30 mcg/kg IV
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose in elderly and debilitated patients
- Administer higher doses only if qualified personnel and adequate facilities are available for the management of postoperative respiratory depression
- Dosage in this range of up to 25 mcg/kg attenuate catecholamine release
- Dosage of 25-30 mcg/kg block sympathetic response including catecholamine release
- Higher doses indicated in patients undergoing major surgical procedures requiring endotracheal intubation and mechanical ventilation (e.g. cardiovascular surgery and neurosurgery)
- Observe postoperatively and give mechanical ventilation at higher dose range (risk of extended postoperative respiratory depression)
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
- Titrate the dose as per individual patient response
<12 yrs (Undergoing CV surgery)
- 10-25 mcg/kg IV with 100% oxygen
- Half life is increased in neonates and more with cardiovascular disease
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
- Titrate the dose as per individual patient response
- 0.5-10 mcg/kg IV
- Max: 30 mcg/kg/procedure (maintenance infusion rate should be based upon the induction dose)
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose in elderly and debilitated patients
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
- Titrate the dose as per individual patient response
< 12 yrs (Undergoing CV surgery)
- 25-50 mcg IV
- Half life is increased in neonates and more with cardiovascular disease
- Use with neuromuscular blocking agent
- Monitor vital signs routinely
- Reduce the dose if benzodiazepines, barbiturates, inhalation agents, other opioids or other central nervous system depressants are used concomitantly
- Titrate the dose as per individual patient response
