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Remifentanil context-sensitive half-time — FRCA Primary MCQ

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ModeratePharmacologyRemifentanil context-sensitive half-timeFRCA Primary

A 38-year-old man receiving a remifentanil infusion for total intravenous anaesthesia wakes rapidly after a prolonged case once the infusion is stopped. Which property best explains this?

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Correct answer: C — High accumulation in adipose tissue

Remifentanil is metabolised rapidly by non-specific esterases, so context-sensitive half-time remains short even after prolonged infusion. Fentanyl and sufentanil are more affected by redistribution and accumulation. Renal excretion of unchanged drug is not the main termination mechanism. The pearl is that rapid offset can be followed by abrupt pain if longer-acting analgesia is not planned.

Reference: RCoA Primary FRCA Syllabus 2026; Peck, Hill & Williams Pharmacology for Anaesthesia