Aliases:
Remifentanyl

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Ultra short acting synthetic phenylpiperidine selective Mu opiod receptor agonist. Undergoes rapid ester hydrolysis. Rapid onset of 1-2min, with short context sensitive half time (4 min). Useful for providing analgesia for noxious, short duration procedures. refl.in/fm

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Oct 16, 2011
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Bolus of 0.5 to 1 mcg/kg can be administered to blunt the sympathetic response to intubation and placement of neurosurgical pins.

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Nov 17, 2011
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In labour analgesia where epidural anesthesia is unable to be used, remifentanil may be administered as a patient controlled analgesia PCA regimen 25mcg/kg dose with 2min lockout www.grhc.org.au/component...

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May 14, 2012
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Remifentanil may be used to reduce patient movement in cases where prolonged muscle relaxation needs to be avoided to allow intra-operative neuromuscular testing.

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Aug 25, 2011
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0.2-0.3mcg/kg/min at extubation to prevent coughing for young patient. 0.1mcg/kg/min if older #ref

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Jun 04, 2011
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A dilution for infusion that doesn't require a TCI pump:

Remifentanil 2mg diluted up to 33ml in normal saline gives a 60mcg/ml concentration. 1ml/hr of this is therefore 1mcg/min.

Eg for 70kg patient, 7ml/hr gives 0.1mcg/kg/min. dx.doi.org/10.1046/j.1365...

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Jun 28, 2013
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Dosing is very much dependent on degree of surgical stimulation at the time.
0.2-0.4 mcg/kg/min is a reasonable dose range during stimulating periods of the procedure, reduced to 0.05-0.2 mcg/kg/min at other other times.

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Dec 17, 2012
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To prevent hyperalgesia following the cessation of a prolonged remifentanil infusion, progressively reduce the remifentanil infusion and replace with boluses of morphine or others opioids 15-20min before the end of the case.

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Be aware of chest wall rigidity with high infusion doses and bolus doses of remifentanil.

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Apr 20, 2012
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A delicate balance exists between the dose required to reduce movement and the dose leading to bradycardia or hypotension.


Case series of 132 patients.
- Probability of movement at 0.1mcg/kg/min Remifentanil was 65%, and at 0.21mcg/kg/min it was 25%.
- Probability of bradycardia was 33% at 0.13 µg/kg/min and almost doubled at 0.19 µg/kg/min.
- Similarly, patients dosed at 0.13 µg/kg/min had a 25% probability of hypotension, which increased to 50% at 0.19 µg/kg/min. refl.in/fj

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Dec 17, 2012
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Consider intra arterial-blood-pressure monitoring as patient is at risk of profound hypotension. More important in elderly patiets or if a bolus dose (eg at induction) is given.

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Dec 17, 2012
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Draw up required vasopressors before administering remifentanil as you may need them in a hurry. #safety

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Jan 09, 2012
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Line deadspace can lead to
1. delayed delivery of infusion
2. accumulation of infusion volume & inadvertant bolus delivery.
Ensure infusion is running through dedicated cannula or 3-way tap close to patient

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Apr 25, 2012
Deadspace on the sidearm of the standard giving set at MMC is 0.7 ml. If you take account of this you can use it safely. Best to aspirate at cessation of infusion rather than flush.
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Good point. I wonder about the several mls of deadspace from the sidearm to the patient though. You would need to ensure continuously running fluid to avoid remifentanil accumulating here. #safety
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This triple lumen V Set peripheral set reduces the risk of remifentanil infusing back up the other lumens as can happen with standard Y-connectors.

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Mar 12, 2012
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Remifentanil is highly lipophilic, but shows no significant change in distribution in obese individuals, so dosage should be calculated on ideal body weight refl.in/4v

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Aug 25, 2011
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Time to peak effect after bolus dose is approx 2 mins. refl.in/gl

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Aug 28, 2011
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Safety data sheet NZ refl.in/fk

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