Remifentanil

How it works

Remifentanil is a potent mu-opioid receptor agonist that is rapidly broken down by non-specific plasma and tissue esterases, giving an extremely short, context-insensitive duration of action.

Prescribing in practice

• Profound respiratory depression, apnoea and marked bradycardia or hypotension occur readily, and chest-wall rigidity can impair ventilation — give only by infusion with airway control and full monitoring by an anaesthetist.
• Because its effect ceases almost immediately when stopped, plan alternative longer-acting analgesia before emergence to avoid abrupt severe pain.
• Administer through a dedicated, carefully primed line as the rapid offset makes infusion errors and dead-space boluses clinically significant; acute opioid tolerance and hyperalgesia may occur.

Monitoring

Continuously monitor ventilation, oxygenation, heart rate and blood pressure throughout the infusion and during the transition to post-operative analgesia.

Counselling the patient

• This is a powerful, very short-acting painkiller used during your anaesthetic.
• Other pain relief will be arranged for when you wake, as this one wears off almost instantly.

Evidence & guidelines

Remifentanil is a well-established intraoperative opioid valued for its precise, rapidly reversible effect.