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Spotlight on Remifentanil for General Anaesthesia

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Abstract

Remifentanil (Ultiva™), a fentanyl derivative, is an ultra-short acting, nonspecific esterase-metabolised, selective μ-opioid receptor agonist, with a pharmacodynamic profile typical of opioid analgesic agents. Notably, the esterase linkage in remifentanil results in a unique and favourable pharmacokinetic profile for this class of agent.

Adjunctive intravenous remifentanil during general anaesthesia is an effective and generally well tolerated opioid analgesic in a broad spectrum of patients, including adults and paediatric patients, undergoing several types of surgical procedures in both the inpatient and outpatient setting. Remifentanil is efficacious in combination with intravenous or volatile hypnotic agents, with these regimens generally being at least as effective as fentanyl- or alfentanil-containing regimens in terms of attenuation of haemodynamic, autonomic and somatic intraoperative responses, and postoperative recovery parameters. The rapid offset of action and short context-sensitive half-time of remifentanil, irrespective of the duration of the infusion, makes the drug a valuable opioid analgesic option for use during balanced general inhalational or total intravenous anaesthesia where rapid, titratable, intense analgesia of variable duration, and a fast and predictable recovery are required.

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Notes

  1. 2 The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

The full text article in Drugs 2005; 65 (13): 1793-1823 was reviewed by: J. Ard, Department of Anesthesiology, New York University Medical Center, New York, New York, USA; D.C.H. Cheng, Department of Anaesthesia and Perioperative Medicine, London Health Science Centre and St Joseph Health Care, University of Western Ontario, London, Ontario, Canada; L. Fleisher, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA; R.H. Friesen, Cardiac Anaesthesia, The Children’s Hospital, University of Colorado School of Medicine, Denver, Colorado, USA; L.H. Garvey, Department of Anesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark; E.M. Gruber, Department of Cardiothoracic Anaesthesia, Vienna General Hospital, University of Vienna, Vienna, Austria; A.S. Habib, Duke University Medical Center, Durham, North Carolina, USA; J.E. Mandel, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; D. Royston, Department of Cardiothoracic Anaesthesia, Harefield Hospital, Harefield, Middlesex, England.

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    Lesley J. Scott & Caroline M. Perry

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This spotlight is derived from abstract and summary text of an Adis Drug Evaluation originally published in Drugs 2005; 65 (13): 1793–1823

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Scott, L.J., Perry, C.M. Spotlight on Remifentanil for General Anaesthesia. CNS Drugs 19, 1069–1074 (2005). https://doi.org/10.2165/00023210-200519120-00010

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