Home Drug Guide Remifentanil Hydrochloride

Drug Guide

Generic Name

Remifentanil Hydrochloride

Brand Names Ultiva

Classification

Therapeutic: Anesthetic adjunct, analgesic

Pharmacological: Mu-opioid receptor agonist, opioid

FDA Approved Indications

  • Anesthesia induction and maintenance during surgery
  • Analgesia for procedures requiring analgesic sedation

Mechanism of Action

Remifentanil binds to mu-opioid receptors in the central nervous system, inhibiting ascending pain pathways, producing analgesia and sedation. Its rapid metabolism results in a very short duration of action.

Dosage and Administration

Adult: Bolus: 0.5–1 mcg/kg over 30–60 seconds, followed by continuous infusion of 0.05–2 mcg/kg/min, titrated to response.

Pediatric: Dosage must be individualized; typical initial infusion rate: 0.05–1 mcg/kg/min, with adjustments based on clinical response.

Geriatric: Initial dose should be reduced; start at lower infusion rates with careful titration.

Renal Impairment: Use with caution; no specific dose adjustment, but monitor closely.

Hepatic Impairment: Use with caution; no specific dose adjustment, due to metabolism by plasma esterases rather than liver.

Pharmacokinetics

Absorption: Rapid intravenous absorption with immediate effect.

Distribution: Widely distributed; Vd ~0.25 L/kg.

Metabolism: Rapid hydrolysis by plasma esterases to inactive metabolites.

Excretion: Metabolites excreted renally; parent drug cleared rapidly from plasma.

Half Life: Approximately 3–10 minutes, allowing quick adjustments.

Contraindications

  • Known hypersensitivity to remifentanil or other opioids.

Precautions

  • Use with caution in patients with COPD, head injury, or increased intracranial pressure. Monitor respiratory function closely. Not recommended for opioid-naive patients without adequate sedation and airway management.

Adverse Reactions - Common

  • Nausea (Frequent)
  • Vomiting (Frequent)
  • Respiratory depression (Common)
  • Hypotension (Common)

Adverse Reactions - Serious

  • Apnea (Rare)
  • Serious respiratory depression (Rare)
  • Allergic reactions including anaphylaxis (Rare)

Drug-Drug Interactions

  • Other CNS depressants (e.g., benzodiazepines, barbiturates) enhance respiratory depression.

Drug-Food Interactions

  • No significant interactions documented.

Drug-Herb Interactions

  • Potential for increased sedation with sedative herbs; caution advised.

Nursing Implications

Assessment: Monitor vital signs closely, especially respiratory rate, oxygen saturation, and blood pressure. Assess pain levels.

Diagnoses:

  • Risk of respiratory depression
  • Impaired comfort

Implementation: Administer as per protocol. Ensure airway management equipment is available. Use infusion pump for precise dosing.

Evaluation: Regularly assess for adequate analgesia and sedation, monitor for adverse effects.

Patient/Family Teaching

  • Report any difficulty breathing, excessive drowsiness, or unusual symptoms.
  • Do not operate machinery or drive after sedation.

Special Considerations

Black Box Warnings:

  • Potential for life-threatening respiratory depression.

Genetic Factors: No significant genetic considerations specific to remifentanil.

Lab Test Interference: No known interference.

Overdose Management

Signs/Symptoms: Respiratory depression, hypotension, sedation, coma.

Treatment: Discontinue infusion immediately. Provide respiratory support (e.g., oxygen, ventilatory assistance). Administer opioid antagonists like naloxone if needed.

Storage and Handling

Storage: Store at room temperature, protected from light and moisture.

Stability: Stable until expiration date indicated on the package.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.