Sufentanil (Sufenta) is the most powerful narcotic (~1000x more potent than morphine) approved for use in humans. In fact, it’s so potent and has such a strong affinity for mu-opioid receptors that I routinely use sufentanil for patients on buprenorphine (a PARTIAL opioid agonist) to make sure they have adequate analgesia in the perioperative and ICU settings.
Most commonly, I’ll use infusions of sufentanil as an adjunct to my cardiothoracic anesthetics to facilitate rapid extubation at the end of the operation or soon after in the ICU. Sufentanil’s context-sensitive half-time increases more than remifentanil’s with longer infusions; however it is nowhere near as prolonged as the half times I see with extended infusions of fentanyl. After turning off the infusion in the OR, I use the “analgesic tail” to help smooth out hemodynamics and facilitate rapid emergence from the anesthetic.
In the ICU, I think sufentanil is a much better option than fentanyl from a pharmacokinetic standpoint for patients on mechanical ventilation requiring sedation/analgesia refractory to intermittent boluses.
As with any narcotic, it’s important to be conscientious about safety and the comfort of other providers in handling such a potent medication. Always have naloxone available!
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