remifentanil hydrochloride: clinical use

Prescribing considerations

• Restrict administration to settings with continuous observation and immediate airway, ventilation, cardiovascular and resuscitation capability.
• Plan longer-acting postoperative analgesia before discontinuation because residual opioid analgesia disappears rapidly.
• Consider increased respiratory sensitivity in impaired pulmonary function or severe hepatic impairment.
• Older, debilitated or hypovolaemic patients may be more susceptible to hypotension and bradycardia.
• Assess concurrent CNS depressants, gabapentinoids, cardiac depressants and serotonergic medicines.
• Repeated or prolonged opioid exposure may cause tolerance, hyperalgesia, dependence or withdrawal.

Contraindications and cautions

• Hypersensitivity to remifentanil, fentanyl analogues or any formulation component.
• Epidural or intrathecal administration because the formulation contains glycine.
• Use as the sole agent for induction of anaesthesia.

Monitoring

• Ventilation, respiratory rate, oxygenation and airway patency.
• Blood pressure, heart rate and cardiac rhythm.
• Sedation, analgesic effect and muscle rigidity.
• Infusion-line integrity and residual medicine within line dead space.
• Adequate consciousness and spontaneous ventilation during recovery.
• Maternal, fetal and neonatal observations when used around childbirth.

Clinical pharmacology

A selective mu-opioid receptor agonist with rapid onset and an effective biological half-life of approximately 3–10 minutes. It is metabolised by non-specific blood and tissue esterases to an essentially inactive metabolite; rapid recovery from the parent medicine is largely unaffected by renal function.

Formulation and product differences

• The selected product is a preservative-free powder for concentrate that must be reconstituted and usually further diluted before intravenous administration.
• It contains glycine and hydrochloric acid for pH adjustment.
• The vial is for single use; prepared solution should be clear, colourless and particle-free.
• It must not be mixed with blood products or other medicines except as specifically documented; compatibility through a running intravenous catheter differs from admixture compatibility.

Injection

Route: Parenteral

Strengths: 1 mg, 2 mg, 5 mg