J. Gagnon, Kate Elliott March '08
Description of the Drug
Manufacturer's Package Insert
|In the next few weeks remifentanil will be available in the OR pyxis for use in the main OR. At this point we anticipate using remifentanil only in cases where its unique pharmacokinetics will be useful—specifically
Due to the presence of glycine in the formulation, Remifentanil is contraindicated for epidural or intrathecal administration.
|Remifentanil is a mu-agonist opioid that is roughly equipotent to fentanyl but equilibrates with the brain more rapidly (like
It contains a structurally unique ester linkage and is hydrolyzed by nonspecific esterases to non-active metabolites. Remi's unique, rapid metabolism and low volume of distribution yields a drug that is rapidly
titratable, noncumulative and has a rapid complete recovery. Bolus doses reach peak effect within several minutes and infusions reach equilibrium in about ten minutes. The rate of decline of plasma concentration is nearly independent of the duration of infusion—the context sensitive half time is 4 minutes is constant
regardless of the length of the infusion. Remifentanil's opioid effect will vanish in approx 5-10 minutes after the infusion is stopped.
|The complete manufacturer's Package Insert, current as of August 2006, is available for downloading in pdf format by clicking here.|
remifentanil is easy, on the back of both the MAC and GA SmartLabel plates the directions for mixing are present.
We have remifentanil Smartlabels for our Baxter
InfusOR pumps (the ones we use for propofol). Currently only labels for the GA dose range are available.
Another way to use it is with general TIVA cases with LMAs or ETTs. A second infusion of propofol is used at 100-200 mcg/kg/min.. This is good for a GA case where the surgeon is VERY good at local for postop pain and the patient has PONV issues or fasttrack is desired for an outpatient. Inguinal hernias, breast biopsies, lumpectomies, etc. Some see this technique as the future for outpatient anesthesia eliminating vapor and decreasing PONV and PACU stay time. One thing about this technique is when the patientt is waking up they will often look like they are coming around eyes open etc BE CAREFUL they may still be apneic. Sometimes it seems that the propofol is gone and the remifentanil is still there. You need to really make sure their respirations are adequate prior to removing LMA or ETT.
Do not transfer extubated patients on remifentanil infusions to PACU or
SCU. The nursing staff is not familiar with the drug and the potential for accidental respiratory depression exists in an extubated patient.
is available in the MMC Pyxis, currently just in 1mg vials, which must
be mixed and diluted. The manufacturer also supplies it in 2mg and 5mg
vials, but we are not stocking these.
Currently remifentanil costs approx $10/mg, (about enough for a one hour case in an adult). Please be mindful of the expense and use this drug only in a situation in which it is specifically indicated.
Return excess drug as you do now, fitting a 60 cc syringe into a brown envelope may require a little tape to secure things. Lastly please check the box "other" under analgesics on the QA form.