スフェンタニル
**スフェンタニル**は、非常に強力な合成オピオイド鎮痛薬です（フェンタニルの約5〜10倍、モルヒネの500〜1000倍の効力）。 獣医療では主に**麻酔補助薬**や**硬膜外鎮痛**として使用されます。 臨床上の重要なポイント： * **効力：** 他の多くの麻酔薬と比較して、深い鎮痛効果と優れた心血管系の安定性を提供します。 * **発現と回復：** 作用発現が早く（1〜3分）、フェンタニルよりも回復時間が短いのが特徴です。 * **リスク：** 用量依存的な呼吸抑制および中枢神経系抑制の重大なリスクを伴うため、患者の継続的なモニタリングが必要です。
作用機序: Sufentanil acts as a highly selective and potent **mu-opioid receptor (MOR)** agonist in the central nervous system. * Binding to the G-protein coupled mu-receptor → inhibits adenylate cyclase → decreases intracellular cAMP. * This leads to the opening of inward-rectifying potassium channels (causing hyperpolarization) and the closing of voltage-gated calcium channels. * Result → **decreased release of nociceptive neurotransmitters** (such as Substance P and glutamate), interrupting pain transmission pathways in the dorsal horn of the spinal cord and altering pain perception in the brain.
動物種別の用量
- Acute pain relief in an emergency · 0.1-0.5 micrograms/kg IV ; constant rate infusion of 0.5-1 micrograms/kg/hour · IV · CRI
- As a pre-med · 3 micrograms/kg IV · IV · Single dose · As a combination for induction: Sufentanil 3 micrograms/kg IV first, then diazepam or midazolam 0.2-0.5 mg IV.
- For epidural analgesia · 0.7-1 micrograms/kg diluted to a volume of 0.26 mL/kg with sterile saline · Epidural · Single dose · 1-4 hours · Onset of action in 10-15 minutes.
- Acute pain relief in an emergency · 0.75-2 micrograms/kg IV ; constant rate infusion of 1-2 micrograms/kg/hour · IV · CRI
- For surgical pain · 5 micrograms/kg IV prior to a CRI. CRI (post-operative) of 0.1 micrograms/kg/hour · IV · CRI · 2-6 hours · Duration of effect: 2-6 hours.
用量は獣医療従事者向けの臨床リファレンスです。必ず最新の添付文書と個々の患者で確認してください。
投与経路
禁忌
- Hypersensitivity to sufentanil or other opioids
有害事象
- Respiratory depression (dose-related)
- CNS depression
- Bradycardia
- Skeletal muscle rigidity
- Asystole (rare)
- Hypercarbia (rare)
- Hypersensitivity reactions (rare)
薬物相互作用
- Beta-adrenergic blockers · May increase bradycardia and hypotension
- Calcium-channel blockers · May increase bradycardia and hypotension
- CNS depressants (e.g., barbiturates) · Additive effects can occur, exacerbating CNS or respiratory depression
- Nitrous oxide · Can cause cardiovascular depression if used with high dose sufentanil
モニタリング
- Anesthetic and/or analgesic efficacy
- Cardiac rate
- Respiratory rate
- Pulse oximetry or other methods to measure blood oxygenation
過量投与
In dogs, the LD50 of intravenous sufentanil is 10.1-19.5 mg/kg. **Clinical Signs of Severe Overdose:** * Apnea * Circulatory collapse * Pulmonary edema * Seizures * Cardiac arrest and death **Treatment:** Consists of a combination of supportive therapy (ventilation, cardiovascular support) and administration of an opiate antagonist such as **naloxone**. Although sufentanil has a fairly rapid half-life, multiple doses of naloxone may be necessary. > **Clinical Pearl:** Because of the drug's extreme potency, use a tuberculin syringe to measure dosages less than 1 mL, and employ a dosage calculation/measurement double-check system.
VetSheet の薬剤リファレンスは、獣医療従事者向けの臨床意思決定支援を目的としており、専門的判断やメーカーの最新添付文書に代わるものではありません。