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Remifentanil Offset — FRCA Final MCQ

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EasyGeneral AnaesthesiaRemifentanil OffsetFRCA Final

A 35-year-old man (ASA I, 90 kg) is undergoing an appendicectomy. Anaesthesia is maintained with desflurane and remifentanil infusion. At the end of surgery, remifentanil is stopped. Within what time frame will the clinical effect of remifentanil dissipate?

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Correct answer: A — 3-5 minutes

Remifentanil is an ultra-short-acting opioid metabolised by non-specific tissue and plasma esterases (not plasma cholinesterase). Its context-sensitive half-time is approximately 3-4 minutes regardless of infusion duration. Clinical effect dissipates within 3-5 minutes of stopping the infusion. This predictable offset is its key advantage but also requires that transitional analgesia (longer-acting opioid, multimodal analgesia, regional block) is established before or immediately upon discontinuation to prevent severe rebound pain.

Reference: RCOA – 2023 – Final FRCA curriculum: opioid pharmacology; Peck TE – 2014 – Pharmacology for Anaesthesia