Aspects of pharmacokinetics and pharmacodynamics of sufentanil in pediatric practice.
Sufentanil is a potent synthetic opioid. Like other opioids, sufentanil creates a stable hemodynamic environment in cardiovascularly compromised pediatric patients. Clearance, expressed as per kilogram, is increased in children compared to adults. The P450 CYP3A4 enzyme is responsible for the major metabolic N-dealkylation pathway. Enzyme activity is reduced in neonates but the maturation of sufentanil clearance is not described. The free active fraction is affected by age because of the reduced α(1) -acid glycoprotein plasma concentrations in neonates. Intranasal administration of sufentanil is a possible option for premedication, procedural sedation and analgesia in children, as this option has been found to be safe and effective. Studies concerning the pharmacokinetics and dynamics of sufentanil administered as a bolus or continuous infusion in children are few.
Lundeberg
Stefan
S
Department of Pediatric Anesthesia and Intensive Care, Pain Treatment Service, Astrid Lindgren Children's Hospital, Stockholm, Sweden. stefan.lundeberg@karolinska.se
Roelofse
James A
JA
D000281:Administration, Intranasal; D000375:Aging / Q000378:metabolism; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000494:pharmacology*; D000767:Anesthesia, Epidural; D000771:Anesthesia, Intravenous; D001798:Blood Proteins / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D051544:Cytochrome P-450 CYP3A; D006207:Half-Life; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D007676:Kidney Failure, Chronic / Q000378:metabolism; D011485:Protein Binding; D012016:Reference Values; D017409:Sufentanil / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000494:pharmacology*
D000701:Analgesics, Opioid; D001798:Blood Proteins; D017409:Sufentanil; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human