Active Ingredient: Remifentanil
For this indication, competent medicine agencies globally authorize below treatments:
For:
Intravenous, 1 micrograms remifentanil per kilogram of body weight, once every minute. Afterwards, intravenous, between 0.003 micrograms remifentanil per kilogram of body weight and 4.3 micrograms remifentanil per kilogram of body weight, once every minute.
Dosing guidelines for cardiac anaesthesia:
| INDICATION | BOLUS INJECTION (micrograms/kg) | CONTINUOUS INFUSION (micrograms/kg/min) | |
|---|---|---|---|
| Starting Rate | Range | ||
| Induction of anaesthesia | Not recommended | 1 | - |
| Maintenance of anaesthesia in ventilated patients: | |||
| Isoflurane (starting dose 0.4MAC)§ | 0.5 to 1 | 1 | 0.003 to 4 |
| Propofol (Starting dose 50 micrograms/kg/min)§ | 0.5 to 1 | 1 | 0.01 to 4.3 |
| Continuation of post-operative analgesia, prior to extubation | Not recommended | 1 | 0 to 1 |
After endotracheal intubation the infusion rate of remifentanil should be titrated according to patient need. Supplemental slow bolus doses may also be given as required. High risk cardiac patients, such as those with poor ventricular function, should be administered a maximum bolus dose of 0.5 micrograms/kg. These dosing recommendations also apply during hypothermic cardiopulmonary bypass.
At the doses recommended above, remifentanil significantly reduces the amount of hypnotic agent required to maintain anaesthesia. Therefore, isoflurane and propofol should be administered as recommended above to avoid an increase of haemodynamic effects such as hypotension and bradycardia. No data are available for dosage recommendations for simultaneous use of other hypnotics other than those listed in the table with remifentanil.
It is recommended that the infusion of remifentanil should be maintained at the final intra-operative rate during transfer of patients to the post-operative care area. Upon arrival into this area, the patient’s level of analgesia and sedation should be closely monitored and the remifentanil infusion rate adjusted to meet the individual patient’s requirements.
Due to the very rapid offset of action of remifentanil, no residual opioid activity will be present within 5 to 10 minutes after discontinuation. Prior to discontinuation of remifentanil, patients must be given alternative analgesic and sedative agents at a sufficient time in advance to allow the therapeutic effects of these agents to become established. It is therefore recommended that the choice of agent(s), the dose and the time of administration are planned, before weaning the patient from the ventilator.
Due to the very rapid offset of action of remifentanil, hypertension, shivering and aches have been reported in cardiac patients immediately following discontinuation of remifentanil. To minimise the risk of these occurring, adequate alternative analgesia must be established (as described above), before the remifentanil infusion is discontinued. The infusion rate should be reduced by 25% decrements in at least 10 minute intervals until the infusion is discontinued.
During weaning from the ventilator the remifentanil infusion should not be increased and only down titration should occur, supplemented as required with alternative analgesics. Haemodynamic changes such as hypertension and tachycardia should be treated with alternative agents as appropriate.
When other opioid agents are administered as part of the regimen for transition to alternative analgesia, the patient must be carefully monitored. The benefit of providing adequate post-operative analgesia must always be balanced against the potential risk of respiratory depression with these agents.
Liability Disclaimer : RxReasoner has utilized reasonable care in providing content and services that are accurate, complete and up to date. However, RxReasoner does not accept any responsibility or liability about it. The content and services of RxReasoner are for informational purposes only and they are not intended to be a substitute for the knowledge, expertise, skill, and judgment of physicians, pharmacists, nurses, or other healthcare professionals involved in patient care. RxReasoner offers no medical advice. Users are responsible for the use of the provided content. A shown indication or treatment should not be construed to indicate that the medication is safe, appropriate, or effective in any given patient or under any particular circumstances. The absence of an indication or treatment should not roule out the existence of other appropriate medications. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition or medicament. RxReasoner is not liable for any damages allegedly sustained arising out of the use of its content and services.
