Remifentanil
Mechanism :
Binds with stereospecific mu-opioid receptors at many sites within the CNS, increases pain threshold, alters pain reception, inhibits ascending pain pathways.
Indication :
- Analgesic for use during the induction and maintenance of general anaesthesia
- Off-label: Pain management in mechanically-ventilated patients
Contraindications :
Hypersensitivity to remifentanil or any component of the formulation; intrathecal or epidural administration.
Dosing :
Continuous IV infusion:
Neonates and Infants to 2 months:
Maintenance of anaesthesia with nitrous oxide (70%): 0.4 mcg/kg/minute (range: 0.4 to 1 mcg/kg/minute); supplemental bolus dose of 1 mcg/kg may be administered.
≥3 months to ≤12 years:
Maintenance of anaesthesia with
halothane,
sevoflurane, or isoflurane: 0.25 mcg/kg/minute (range: 0.05 to 1.3 mcg/kg/minute); supplemental bolus dose of 1 mcg/kg may be administered every 2 to 5 minutes.
Adverse Effect :
Hypotension, bradycardia, shivering, flushing, headache, pruritus, nausea, vomiting, muscle rigidity, respiratory depression, apnea, fever.
Interaction :
Amphetamines: May enhance the analgesic effect of Opioid Analgesics.
Anticholinergic Agents: May enhance the adverse/toxic effect of Opioid Analgesics.
Beta-Blockers: Opioids may enhance the bradycardic effect of Beta-Blockers.
Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents.
CNS Depressants: May enhance the CNS depressant effect of Opioid Analgesics.
Diuretics: Opioid Analgesics may enhance the adverse/toxic effect of Diuretics.
Opioid Analgesics: CNS Depressants may enhance the CNS depressant effect of Opioid Analgesics.
Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Unlikely to be dialysed. Dose as in normal renal function |
| CAV/VVHD | Unknown dialysability. Dose as in normal renal function |
Hepatic Dose :
No dose adjustment recommended.