Spotlight on Remifentanil for General Anaesthesia

Overview

Journal CNS Drugs

Specialties Neurology
Pharmacology

Date 2005 Dec 8

PMID 16332149

Citations 7

Authors

Lesley J Scott

Caroline M Perry

Affiliations

Soon will be listed here.

Abstract

Remifentanil (Ultiva), a fentanyl derivative, is an ultra-short acting, nonspecific esterase-metabolised, selective mu-opioid receptor agonist, with a pharmacodynamic profile typical of opioid analgesic agents. Notably, the esterase linkage in remifentanil results in a unique and favourable pharmacokinetic profile for this class of agent. Adjunctive intravenous remifentanil during general anaesthesia is an effective and generally well tolerated opioid analgesic in a broad spectrum of patients, including adults and paediatric patients, undergoing several types of surgical procedures in both the inpatient and outpatient setting. Remifentanil is efficacious in combination with intravenous or volatile hypnotic agents, with these regimens generally being at least as effective as fentanyl- or alfentanil-containing regimens in terms of attenuation of haemodynamic, autonomic and somatic intraoperative responses, and postoperative recovery parameters. The rapid offset of action and short context-sensitive half-time of remifentanil, irrespective of the duration of the infusion, makes the drug a valuable opioid analgesic option for use during balanced general inhalational or total intravenous anaesthesia where rapid, titratable, intense analgesia of variable duration, and a fast and predictable recovery are required.

Citing Articles

Remifentanil Promotes PDIA3 Expression by Activating p38MAPK to Inhibit Intestinal Ischemia/Reperfusion-Induced Oxidative and Endoplasmic Reticulum Stress.

Shen J, Zhan Y, He Q, Deng Q, Li K, Wen S Front Cell Dev Biol. 2022; 10:818513.

PMID: 35155431 PMC: 8826554. DOI: 10.3389/fcell.2022.818513.

Remifentanil induces autophagy and prevents hydrogen peroxide-induced apoptosis in Cos-7 cells.

Yoon J, Baek C, Woo M, Kim E, Yoon J, Park C J Dent Anesth Pain Med. 2017; 16(3):175-184.

PMID: 28884150 PMC: 5586554. DOI: 10.17245/jdapm.2016.16.3.175.

Exploring the Pharmacokinetic Profile of Remifentanil in Mid-Trimester Gestations Undergoing Fetal Intervention Procedures.

Smith J, Donepudi R, Argoti P, Giezentanner A, Jain R, Boring N Front Pharmacol. 2017; 8:11.

PMID: 28174536 PMC: 5260009. DOI: 10.3389/fphar.2017.00011.

Independent predictors of delay in emergence from general anesthesia.

Maeda S, Tomoyasu Y, Higuchi H, Ishii-Maruhama M, Egusa M, Miyawaki T Anesth Prog. 2015; 62(1):8-13.

PMID: 25849468 PMC: 4389560. DOI: 10.2344/0003-3006-62.1.8.

Impact of remifentanil introduction on practice patterns in general anesthesia.

Uchida K, Yasunaga H, Miyata H, Sumitani M, Horiguchi H, Kuwajima K J Anesth. 2011; 25(6):864-71.

PMID: 21904781 DOI: 10.1007/s00540-011-1221-5.

References

Dershwitz M, Hoke J, Rosow C, Michalowski P, Connors P, Muir K . Pharmacokinetics and pharmacodynamics of remifentanil in volunteer subjects with severe liver disease. Anesthesiology. 1996; 84(4):812-20. DOI: 10.1097/00000542-199604000-00008. View

Schuttler J, Albrecht S, Breivik H, OSNES S, Prys-Roberts C, Holder K . A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia. 1997; 52(4):307-17. DOI: 10.1111/j.1365-2044.1997.24-az0051.x. View

Straka Z, Brucek P, Vanek T, Votava J, Widimsky P . Routine immediate extubation for off-pump coronary artery bypass grafting without thoracic epidural analgesia. Ann Thorac Surg. 2002; 74(5):1544-7. DOI: 10.1016/s0003-4975(02)03934-6. View

Paris A, Scholz J, von Knobelsdorff G, Tonner P, Schulte Am Esch J . The effect of remifentanil on cerebral blood flow velocity. Anesth Analg. 1998; 87(3):569-73. DOI: 10.1097/00000539-199809000-00013. View

Hoke J, Shlugman D, Dershwitz M, Michalowski P, Connors P, Martel D . Pharmacokinetics and pharmacodynamics of remifentanil in persons with renal failure compared with healthy volunteers. Anesthesiology. 1997; 87(3):533-41. DOI: 10.1097/00000542-199709000-00012. View

Twersky R, Jamerson B, Warner D, Fleisher L, Hogue S . Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. J Clin Anesth. 2001; 13(6):407-16. DOI: 10.1016/s0952-8180(01)00292-6. View

Lang E, Kapila A, Shlugman D, Hoke J, Sebel P, Glass P . Reduction of isoflurane minimal alveolar concentration by remifentanil. Anesthesiology. 1996; 85(4):721-8. DOI: 10.1097/00000542-199610000-00006. View

Geisler F, de Lange S, Royston D, Demeyere R, Duthie D, Lehot J . Efficacy and safety of remifentanil in coronary artery bypass graft surgery: a randomized, double-blind dose comparison study. J Cardiothorac Vasc Anesth. 2003; 17(1):60-8. DOI: 10.1053/jcan.2003.11. View

Gelb A, Salevsky F, Chung F, Ringaert K, McTaggart-Cowan R, Wong T . Remifentanil with morphine transitional analgesia shortens neurological recovery compared to fentanyl for supratentorial craniotomy. Can J Anaesth. 2003; 50(9):946-52. DOI: 10.1007/BF03018745. View

10.

Song D, Whitten C, White P . Remifentanil infusion facilitates early recovery for obese outpatients undergoing laparoscopic cholecystectomy. Anesth Analg. 2000; 90(5):1111-3. DOI: 10.1097/00000539-200005000-00020. View

11.

Lee M, Kua J, Chiu W . The use of remifentanil to facilitate the insertion of the laryngeal mask airway. Anesth Analg. 2001; 93(2):359-62 , 3rd contents page. DOI: 10.1097/00000539-200108000-00025. View

12.

Glass P, Hardman D, Kamiyama Y, Quill T, Marton G, Donn K . Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B). Anesth Analg. 1993; 77(5):1031-40. DOI: 10.1213/00000539-199311000-00028. View

13.

Shinohara K, Aono H, Unruh G, Kindscher J, Goto H . Suppressive effects of remifentanil on hemodynamics in baro-denervated rabbits. Can J Anaesth. 2000; 47(4):361-6. DOI: 10.1007/BF03020954. View

14.

Wilhelm W, Grundmann U, Van Aken H, Haus E, Larsen R . A multicenter comparison of isoflurane and propofol as adjuncts to remifentanil-based anesthesia. J Clin Anesth. 2000; 12(2):129-35. DOI: 10.1016/s0952-8180(00)00125-2. View

15.

Amin H, Sopchak A, Esposito B, Henson L, Batenhorst R, Fox A . Naloxone-induced and spontaneous reversal of depressed ventilatory responses to hypoxia during and after continuous infusion of remifentanil or alfentanil. J Pharmacol Exp Ther. 1995; 274(1):34-9. View

16.

Egan T . Pharmacokinetics and pharmacodynamics of remifentanil: an update in the year 2000. Curr Opin Anaesthesiol. 2006; 13(4):449-55. DOI: 10.1097/00001503-200008000-00009. View

17.

Ropcke H, Konen-Bergmann M, Cuhls M, Bouillon T, Hoeft A . Propofol and remifentanil pharmacodynamic interaction during orthopedic surgical procedures as measured by effects on bispectral index. J Clin Anesth. 2001; 13(3):198-207. DOI: 10.1016/s0952-8180(01)00255-0. View

18.

Klemola U, Mennander S, Saarnivaara L . Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol. Acta Anaesthesiol Scand. 2000; 44(4):465-9. DOI: 10.1034/j.1399-6576.2000.440419.x. View

19.

Koitabashi T, Johansen J, Sebel P . Remifentanil dose/electroencephalogram bispectral response during combined propofol/regional anesthesia. Anesth Analg. 2002; 94(6):1530-3, table of contents. DOI: 10.1097/00000539-200206000-00028. View

20.

Dahaba A, Von Klobucar F, Rehak P, List W . Total intravenous anesthesia with remifentanil, propofol and cisatracurium in end-stage renal failure. Can J Anaesth. 1999; 46(7):696-700. DOI: 10.1007/BF03013962. View