Title: Comparison of Key Characteristics for Fentanyl, Alfentanil, Sufentanil, and Remifentanil

CharacteristicFentanylAlfentanilSufentanilRemifentanil
Analgesic PotencyPotent, reference opioidLess potentHighly potentSimilar to Fentanyl
Duration of ActionModerate (1-2 hours)Short (10-15 minutes)Prolonged (2-4 hours)Very short (3-10 minutes)
Onset of ActionRapid (1-2 minutes)Rapid (1-2 minutes)Rapid (1-2 minutes)Rapid (1-2 minutes)
Dosage per kg (IV)1-2 mcg/kg5-20 mcg/kg0.1-0.4 mcg/kg1-2 mcg/kg (induction)
Blood-Brain EquilibrationRapidRapidRapidRapid (similar to Alfentanil)
MetabolismHepaticHepatic and RenalHepaticRapid ester hydrolysis
ClearanceModerateModerateModerateExtraordinary (very rapid)
Volume of Distribution (Vd)LargeModerateSmallSmall (minimal accumulation)
Context-Sensitive Half-TimeDuration-dependentDuration-dependentDuration-dependentIndependent (approx. 4 minutes)
Clinical UsesAnesthesia, chronic painAnesthesia (rapid onset), sedationAnesthesia, labor & deliveryAnesthesia, sedation
Unique FeatureHigh potency, prolonged actionRapid onset, short durationVery high potencyVery rapid onset and offset
Potential Side EffectsNausea, vomiting, respiratory depressionNausea, vomiting, respiratory depressionNausea, vomiting, respiratory depressionNausea, vomiting, respiratory depression, hyperalgesia
Hepatic Dysfunction ImpactMay impact clearanceMay impact clearanceMay impact clearanceUsually not affected
Renal Dysfunction ImpactMay impact clearanceMay impact clearanceMay impact clearanceUsually not affected
Intraoperative Dosing VersatilityMay require accumulation timeRapid onset and offsetRequires accumulation timeRapid titration to desired effect
Risk of AccumulationYesYesYesMinimal or none

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