Nurses Compass
Drug Guide
Remifentanil Hydrochloride
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.