Comparison of sufentanil versus fentanyl in ventilated term neonates.
BACKGROUND
Increasingly frequent applications of opioid analgesics in neonatal intensive care require the evaluation of efficacy and side effects.


METHODS
Mechanically ventilated term neonates were consecutively enrolled.


METHODS
In a double-blind randomized trial 20 newborns received a continuous intravenous infusion of fentanyl (n=10) or sufentanil (n=10) in an assumed equipotent dose of 7:1. The analgesic dose was individually adjusted according to sedation scores. The period between cessation of analgesic medication and successful extubation (weaning time), adverse drug effects and urinary cortisol concentrations were evaluated.


RESULTS
No significant difference of weaning time was seen between fentanyl and sufentanil group (mean weaning time (+/-SD) of fentanyl group 520+/-381 min, median 380 min; sufentanil group 585+/-531 min, median 405 min, p=0.78, 2-tailed U-Test, Mann and Whitney). The mean opioid dose resulted in a 10:1 ratio (fentanyl 4.11 microg/(kg x h) vs sufentanil 0.41 microg/(kg x h)). We found no marked differences in sedation levels, blood pressure, heart rate, oxygenation index, co-medication or urinary cortisol levels. In both groups similar adverse effects were assessed including respiratory depression, mild withdrawal symptoms or decrease of gastrointestinal motility.


CONCLUSIONS
In our study sufentanil did not reduce the weaning period in ventilated term neonates when compared to fentanyl. The equipotent dose ratio for fentanyl/sufentanil was 10:1. According to sedation scores both substances provided effective pain and stress protection.
Schmidt
B
B
Department of Neonatology and Pediatric Intensive Care Medicine, Children's Hospital, University of Cologne.
Adelmann
C
C
Stützer
H
H
Welzing
L
L
Hünseler
C
C
Kribs
A
A
Roth
B
B
D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000493:pharmacokinetics; D001143:Arousal / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005283:Fentanyl / Q000493:pharmacokinetics; D006207:Half-Life; D006801:Humans; D007231:Infant, Newborn; D007384:Intermittent Positive-Pressure Breathing; D007385:Intermittent Positive-Pressure Ventilation; D010102:Oxygen Inhalation Therapy; D010147:Pain Measurement / Q000187:drug effects; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D017409:Sufentanil / Q000493:pharmacokinetics; D015300:Ventilator Weaning
D018686:Anesthetics, Intravenous; D017409:Sufentanil; D005283:Fentanyl