Severe bradycardia and asystole with low dose sufentanil during induction with sevoflurane: a report of three cases

Document Type


Peer Reviewed


Publication Date


NLM Title Abbreviation

Can J Anaesth

Journal/Book/Conference Title

Canadian journal of anaesthesia = Journal canadien d'anesthesie

PubMed ID


DOI of Published Version


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End Page



OBJECTIVES: In a randomized double blind clinical study using low doses of fentanyl or sufentanil during sevoflurane induction, we observed three cases of severe bradycardia, forcing us to discontinue the study. We wish to describe these three cases. Clinical data: Anesthesia was induced in the three patients, using a single breath technique consisting of a mixture of sevoflurane 8% with a nitrous oxide flow of 3 L x min(-1) and an oxygen flow of 3 L x min(-1). After the patients had lost consciousness, low dose sufentanil was administered (0.025 microg x kg(-1) for the first patient and 0.1 microg x kg(-1) for the other two patients). Heart rate fell to 38, 40 and 42 beats x min(-1) respectively two minutes after the sufentanil injection in these three patients, and progressed to asystole in the third. All the patients responded to atropine 0.6 mg i.v. CONCLUSION: The addition of sufentanil, even at very low doses, during anesthesia induction with sevoflurane using a single breath technique, may be dangerous because of possible bradycardia and even asystole.


Adult, Anesthetics, Combined/adverse effects, Anesthetics, Inhalation/therapeutic use, Anesthetics, Intravenous/adverse effects, Atropine/therapeutic use, Bradycardia/chemically induced/drug therapy, Bronchodilator Agents/therapeutic use, Dose-Response Relationship, Drug, Drug Interactions, Female, Heart Arrest/chemically induced/drug therapy, Heart Rate/drug effects, Humans, Methyl Ethers/therapeutic use, Middle Aged, Randomized Controlled Trials as Topic/statistics & numerical data, Severity of Illness Index, Sufentanil/adverse effects

Published Article/Book Citation

Canadian journal of anaesthesia = Journal canadien d'anesthesie, 51:8 (2004) pp.806-809. DOI:DOI: 10.1007/BF03018453.

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