No

Analgesic, Narcotic

Analgesic for use during general anesthesia for continued analgesia

C

Not for intrathecal or epidural administration, due to the presence of glycine in the formulation, it is also contraindicated in patients with a known hypersensitivity to remifentanil, fentanyl or fentanyl analogs; interruption of an infusion will result in offset of effects within 5-10 minutes; the discontinuation of remifentanil infusion should be preceded by the establishment of adequate postoperative analgesia orders, especially for patients in whom postoperative pain is anticipated

Remifentanil is not recommended as the sole agent in general anesthesia, because the loss of consciousness cannot be assured and due to the high incidence of apnea, hypotension, tachycardia and muscle rigidity; it should be administered by individuals specifically trained in the use of anesthetic agents and should not be used in diagnostic or therapeutic procedures outside the monitored anesthesia setting; resuscitative and intubation equipment should be readily available

>10%: Gastrointestinal: Nausea, vomiting

1% to 10%:

Cardiovascular: Hypotension, bradycardia, tachycardia, hypertension

Central nervous system: Dizziness, headache, agitation, fever

Dermatologic: Pruritus

Ocular: Visual disturbances

Respiratory: Respiratory depression, apnea, hypoxia

Miscellaneous: Shivering, postoperative pain

Symptoms of overdose include apnea, chest wall rigidity, seizures, hypoxemia, hypotension and bradycardia

Support of patient's airway, establish an I.V. line, administer intravenous fluids and administer naloxone 2 mg I.V. (0.01 mg/kg for children) with repeat administration as needed up to a total of 10 mg; glycopyrrolate or atropine may be useful for the treatment of bradycardia or hypotension

Increased effect with CNS depressants

Stable for 24 hours at room temperature after reconstitution and further dilution to concentrations of 20-250 mcg/mL

Binds with stereospecific mu-opioid receptors at many sites within the CNS, increases pain threshold, alters pain reception, inhibits ascending pain pathways

Onset of effect: I.V.: 1-3 minutes

Protein binding: 92%

Metabolism: Rapid by blood and tissue esterases

Half-life: 10 minutes (dose-dependent)

Elimination: Renal

Adults: I.V. continuous infusion:

During maintenance:

With nitrous oxide (66%): 0.4 mcg/kg/minute (range: 0.1-2 mcg/kg/min)

With isoflurane: 0.25 mcg/kg/minute (range: 0.05-2 mcg/kg/min)

With propofol: 0.25 mcg/kg/minute (range: 0.05-2 mcg/kg/min)

Continuation as an analgesic in immediate postoperative period: 0.1 mcg/kg/minute (range: 0.025-0.2 mcg/kg/min)

Inject slowly over 3-5 minutes

Respiratory and cardiovascular status, blood pressure, heart rate

May cause dizziness or agitation

None reported

No information available to require special precautions

No effects or complications reported

Powder for injection, lyophilized: 1 mg/3 mL vial, 2 mg/5 mL vial, 5 mg/10 mL vial

Hogue CW, Bowdle TA, O'Leary C, et al, "A Multicenter Evaluation of Total Intravenous Anesthesia With Remifentanil and Propofol for Elective Inpatient Surgery," Anesth Analg, 1996, 83(2):279-285.

Kapila A, Glass PS, Jacobs JR, et al, "Measured Context-Sensitive Half-Times of Remifentanil and Alfentanil," Anesthesiology, 1995, 83(5):968-75.

Rosow C, "Remifentanil: A Unique Opioid Analgesic," Anesthesiology, 1993, 79(5):875-6.

Warner DS, Hindman BJ, Todd MM, et al, "Intracranial Pressure and Hemodynamic Effects of Remifentanil Versus Alfentanil in Patients Undergoing Supratentorial Craniotomy," Anesth Analg, 1996, 83:348-353.

Westmoreland CL, Hoke JF, Sebel PS, et al, "Pharmacokinetics of Remifentanil (GI87084B) and Its Major Metabolite (GI90291) in Patients Undergoing Elective Inpatient Surgery," Anesthesiology, 1993, 79(5):893-903.