Sufentanil Overdose

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Sufentanil is the strongest pain medication manufactured for use by humans. It is 5 to 10 times more potent than fentanyl and up to 500 times more potent than morphine. Other stronger medications are produced, but they are only indicated for use with animals. Sufentanil is administered via intravenous or epidural injection.

Sufentanil is used for invasive surgical procedures for pain reduction. It is commonly used for surgeries in which the patient is unconscious and intubated, especially if the patient will need to remain intubated for an extended period following the procedure.

Sufentanil is used when other less potent variations of fentanyl are not strong enough due to extreme opioid-dependency. When people who are heavily opioid-dependent require surgery, standard doses of opioids are not strong enough to overpower the individual’s high drug tolerance. Patients who use buprenorphine for the long-term maintenance of an opioid abuse disorder may require Sufentanil for this reason. Sufentanil is often the only opioid strong enough to break buprenorphine’s bonds to opioid receptors in the body.

Common side effects of Sufentanil include skeletal muscle rigidity, decreased tidal volume, and respiratory depression. Skeletal muscle rigidity tends to focus around the muscles of the neck and extremities. Urinary retention is another possible side effect of Sufentanil use. Upon discontinuation of Sufentanil, the return of normal bladder function is typically delayed.

Sufentanil Overdose
The primary symptoms of Sufentanil overdose include severe respiratory depression, constricted pupils, and significantly decreased levels of consciousness. Severe respiratory depression is the primary risk factor in the event of Sufentanil overdose.

Sufentanil administration is carefully titrated according to the unique metabolic factors of each patient. Doses may need to be adjusted throughout the surgical procedure to account for unforeseen variables. If too much Sufentanil is administered, the result can be a dangerously low respiratory drive.

Sufentanil acts directly on the brainstem to suppress the patient’s innate urge to breathe. The brainstem regulates breathing by reacting to carbon dioxide levels in the blood. When carbon dioxide levels become elevated, the brainstem signals for the lungs to breathe. In the event of severe overdose, this mechanism can become entirely disrupted, potentially resulting in carbon dioxide toxicity and oxygen deprivation.

Constricted pupils are a common side effect of opioid use, even at moderate therapeutic doses. In the event of an overdose, pupils will become “pinpoint,” or maximally constricted. They will also be unresponsive, even to dramatic changes in light. The third primary symptom of opioid overdose is decreased levels of consciousness, but since Sufentanil is only used along with anesthesia during invasive surgical procedures, this symptom is not relevant in the evaluation of Sufentanil overdose.
The amount of Sufentanil necessary to overdose varies dramatically among patients based on several factors. Doses should be individualized according to each patient’s size, body weight, overall physical status, underlying health issues, opioid tolerance, use of other drugs and central nervous system depressants, and the type of surgical procedure being performed.

Pre-existing opioid tolerance is one of the most influential factors, especially in people who are highly tolerant to opioids. Higher doses may be necessary to overpower the patient’s baseline opioid concentrations in the blood. In obese patients, doses should be calculated based on lean body weight. Doses should be reduced for elderly and debilitated patients due to suboptimal organ function.

If an overdose occurs, the priority should be to secure and protect the patient’s airway. This takes priority over the administration of an opioid antagonist. Respiratory depression is the most serious side effect associated with epidural and intravenous injection of Sufentanil. The patient may require assisted or controlled ventilation to address apnea and hypoventilation.

The placement of an endotracheal tube or nasopharyngeal airway will be called for if it has not already been placed. Respiratory depression is made more severe by the skeletal muscle rigidity associated with Sufentanil use. A neuromuscular blocking agent may be needed to facilitate ventilation. Other supportive measures, such as oxygen therapy and the use of vasopressors, may be indicated for the management of pulmonary edema and cardiovascular depression.

Once the patient’s airway is secured, naloxone may be administered to reverse the effects of Sufentanil. Naloxone is a powerful opioid antagonist that rapidly negates the effects of opioids. Several doses of naloxone will likely be necessary due to the potency of Sufentanil.

If you or someone you love is struggling with opioid misuse or abuse, The Recovery Village is available to answer any questions you may have. Visit us online at or call toll-free at 855-548-9825 to learn more about recovery resources in your area.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.