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The Use of Ultra-Short-Acting Opioids in Paediatric Anaesthesia

The Role of Remifentanil

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Abstract

Remifentanil is a synthetic opioid that was developed in the early 1990s and introduced into clinical use in 1996. It is a methyl ester and is metabolised by nonspecific tissue and plasma esterases. Consequently, it is a drug that undergoes rapid elimination and has a reported terminal elimination half-life of between 10 and 35 minutes. Because there is no drug accumulation, the context-sensitive half-time remains constant; thus the pharmacokinetics of the drug do not change regardless of the duration of infusion. The organ-independent elimination of remifentanil, coupled with the fact that its clearance is greater in infants and neonates compared with older age groups, make its pharmacokinetic profile different from any other opioid. In addition, its unique metabolism confers predictability in its clinical use. Like other opioid μ, receptor agonists, remifentanil provides dose-dependent analgesia, while the adverse effects of this drug, e.g. respiratory depression, are also thought to be dose related. The incidence of nausea and vomiting appear similar to other opioids. Its rapid and consistent metabolism regardless of duration of infusion has made remifentanil an attractive analgesic/anaesthetic option for paediatric care providers.

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Acknowledgements

Dr Peter J. Davis has undertaken research/consultancy work for Abbott Laboratories, Baxter Health Care Corporation and GlaxoSmithKline. No sources of funding were used to assist in the preparation of this review.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, Pennsylvania, 15213-2583, USA

    Peter J. Davis & Franklyn P. Cladis

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  1. Peter J. Davis
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  2. Franklyn P. Cladis
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Correspondence to Peter J. Davis.

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Davis, P.J., Cladis, F.P. The Use of Ultra-Short-Acting Opioids in Paediatric Anaesthesia. Clin Pharmacokinet 44, 787–796 (2005). https://doi.org/10.2165/00003088-200544080-00002

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