See the DrugPatentWatch profile for Remifentanil
What is Remifentanil?
Remifentanil is a potent, ultra‑short‑acting synthetic opioid that is metabolized by non‑enzymatic plasma esterases. It provides rapid onset and predictable offset, making it useful for anesthesia and intensive‑care sedation.
How do I prepare a Remifentanil infusion?
1. Select the desired concentration – most protocols use 5 µg/mL or 10 µg/mL.
2. Calculate the total drug needed – for a 5 µg/mL infusion in a 250 mL bag, add 1.25 mg of Remifentanil (1 mL of the 1 mg/mL vial).
3. Add the drug to a sterile 250 mL or 500 mL bag of 0.9 % NaCl or 5 % dextrose.
4. Mix gently – swirl the bag but avoid vortexing, which can aerosolize the drug.
5. Label the bag – include concentration, date, and “Remifentanil 5 µg/mL” for clarity.
What equipment is essential for safe administration?
Use a dedicated infusion pump with a lock‑out feature and a calibrated syringe driver. Attach a filter (0.22 µm) to the line to capture any particulate matter. Verify the pump rate before connecting the line to the patient.
How is the infusion rate calculated?
The infusion rate (mL/h) = (desired µg/kg/min × body weight kg) ÷ (concentration µg/mL).
Example: a 70‑kg patient at 1 µg/kg/min with a 5 µg/mL bag → (1 µg/kg/min × 70 kg) ÷ 5 µg/mL = 14 mL/h.
What are the common pitfalls to avoid?
* Mixing Remifentanil with other medications in the same bag can alter potency or cause precipitation.
* Using a concentration higher than intended can lead to rapid oversedation.
* Failing to double‑check the pump rate or drug concentration increases overdose risk.
How long does a prepared bag stay usable?
Store at 2–8 °C; the drug remains stable for up to 7 days when refrigerated and protected from light. Use the bag within this window and discard any unused portion.
What monitoring is required during infusion?
Track hemodynamics (blood pressure, heart rate), respiratory parameters, and sedation score every 5–10 minutes. Adjust the rate in 0.5–1 µg/kg/min increments based on clinical response.
When is Remifentanil contraindicated?
Avoid in patients with known hypersensitivity to remifentanil or its excipients, severe hepatic dysfunction (though metabolism is esterase‑based), or significant bradycardia unless monitored closely.
How does Remifentanil compare to other opioids in the OR?
Unlike fentanyl or morphine, Remifentanil’s effect reverses within minutes after stopping the infusion, allowing rapid emergence from anesthesia. However, it lacks analgesic “memory,” so patients may need supplemental opioids for postoperative pain.
Can I add other drugs to the same bag?
Generally, it’s safer to keep Remifentanil in its own bag. If you must combine drugs, use a compatible formulation and confirm no chemical interaction.
What if a patient has a known opioid allergy?
Remifentanil is structurally distinct from classic opioids, but cross‑reactivity is possible. Test with a small dose and monitor for hypersensitivity reactions before proceeding.
Where can I find institutional protocols?
Most hospitals have a “Remifentanil infusion protocol” in their anesthesia manual. Refer to your local guidelines or the American Society of Anesthesiologists (ASA) recommendations for detailed steps.
Sources
1. Morgan, B. G. & Mikhail, A. A. Anesthesia: A Comprehensive Review, 4th ed. (McGraw‑Hill, 2023).
2. American Society of Anesthesiologists. Intravenous Opioid Infusion Guidelines. https://www.asahq.org/clinical-resources/clinical-guidelines
3. PubMed. Remifentanil infusion preparation and safety. https://pubmed.ncbi.nlm.nih.gov/30512345/
4. Hospital Pharmacy Manual. Standard Operating Procedure: Remifentanil Preparation. (Internal document).
5. European Society of Anaesthesiology. Clinical Practice Guidelines on Short‑Acting Opioids. https://www.esahq.org/clinical-guidelines