Sufentanil And Muscular Rigidity

Similar as all other potent opioid agents (fentanyl, alfentanil, remifentanil) sufentanil can induce muscular rigidity when administered intravenously as a bolus injection. This rigidity mostly affects striatal muscles of the trunk [120] resulting in difficulty of expanding the thoracic aperture and inflation of the lungs [121]. The incidence of rigidity depends upon:

1. The speed of injection. Bolus injection is more likely to induce this phenomenon.

2. The dose of the administered opioid. High doses will induce muscular rigidity.

3. The age of the patient, since rigidity is seldom seen in the younger patient population; it is, however, regularly seen in patients > 65 years of age.

Muscular rigidity is not due to an epileptogenic action of sufentanil, because in the EEG no spike-and-wave activity is present [122, 123].

The following procedures are proposed in order to prevent/terminate the phenomenon of muscular rigidity:

1. Slow injection of the potent opioid over a period of 2 min.

2. A low dose of a competitive muscle relaxant, before opioid administration, as this partially blocks the increase of neuromuscular transmission.

3. The simultaneous administration of sufentanil and a muscle relaxant.

4. Once muscular rigidity has been established it quickly can be reversed by the intravenous administration of a small dose (20-40 mg/70 kg body weight) of succinylcholine [121].

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