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remifentanyl (Ultiva)
Tradename: Ultiva. DEA-controlled substance: class 2
Indications:
- analgesic component of monitored general anesthesia
- treatment of acute pain
Contraindications: (& cautions)
1) NOT for epidural/intrathecal administration due to glycine component
2) due to potency of drug, clear all IV lines which may contain drug prior to step-down care
3) concurrent use of MAO inhibitors is contraindicated
4) endotracheal intubation: inferior to neuromuscular blockers [2]
Dosage:
- general anesthesia:
a) induction: 0.5-1 ug/kg IV over 30-60 seconds
b) maintenance: 0.05-2.0 ug/kg/minute IV infusion
Pharmacokinetics:
1) rapid onset of action
2) metabolized by blood & tissue esterase
3) 95% metabolized to an inactive metabolite that is cleared by the kidney
4) 1/2life is 3-10 minutes
5) recovery is 5-10 mintues
Adverse effects:
1) rash
2) headache
3) shivering
4) bradycardia
5) hypotension
6) nausea/vomiting
7) respiratory depression (dose-related)
8) drowsiness
9) constipation
10) muscle rigidity (dose & rate-related)
Drug interactions:
1) benzodiazepines, barbiturates, alcohol in combination increase adverse CNS effects
2) MAO inhibitors in combination is contraindicated: fatal reactions have occurred
3) naloxone is a direct opiate antagonist
4) scorpion venom in combination increases toxic effects of the venom
Mechanism of action:
1) opiate agonist
2) phenylpiperidine derivative
3) 5-10 times as potent as fentanyl
General
opiate
Properties
MISC-INFO: elimination route PLASMA
1/2life 3-10 MINUTES
Database Correlations
PUBCHEM correlations
References
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Grillot N, Lebuffe G, Huet O et al
Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence
Intubation on Successful Intubation Without Major Complications Among
Patients at Risk of Aspiration. A Randomized Clinical Trial.
JAMA. 2023;329(1):28-38.
PMID: 36594947
https://jamanetwork.com/journals/jama/fullarticle/2800025