Remifentanil is a highly effective opioid, which is used in particular in the context of anesthesia. The anesthetic or sedative has an effect that is about 200 times stronger than that of morphine.
What is remifentanil?
Remifentanil is a highly potent opioid that is used particularly in anesthesia. Remifentanil belongs to the group of active substances that are often used if the proven morphine does not achieve sufficient effect in the course of pain treatment or as an anesthetic. Opium is used both as a sedative and in the course of anesthesia, which is partly due to the excellent controllability of the active ingredient. In practice, therefore, the drug is often used in the course of surgery. One of the key properties of the drug is that it contains glycine. For this reason, the drug must not be used in the course of spinal anesthesia. Remifentanil is not only used for anesthesia, but is also frequently used in practice for sedation. The drug is also used more frequently for respiratory depression. Because the drug is broken down independently of the organs, it is not necessary to adjust the dosage of remifentanil if liver or kidney function is impaired.
Pharmacologic effects
The action of remifentanil is primarily characterized by the fact that the drug has both analgesic and strong sedative (tranquilizing) effects. As a so-called selective µ-opioid agonist, the effect consists primarily in the fact that its onset is very rapid and easily calculated. Normally, the desired effect occurs within one minute after administration of the drug. Equally characteristic of the effect is that it is only of short duration. The half-life is usually given as between two and ten minutes. For this reason, for example in the course of anesthesia, it is important that the active ingredient be administered continuously. The effect on the organism can be reversed by so-called opiod antagonists, such as naloxone. Because of the effect described, remifentanil is often also referred to as a “soft drug”. With regard to the effect, it is important to note that the dosage of remifentanil must absolutely be adapted to the respective age of the patient.
Medical application and use
The opioid remifentanil is used in a variety of ways in practice. Most commonly, it is used in the course of anesthesia administered in connection with surgical procedures. In this context, the active ingredient is primarily used in total intravenous anesthesia. In most cases, it is then combined with propofol. In addition, remifentanil is also used if analgesia is to be continued in the course of an immediate postoperative period. In any case, remifentanil is often used for analgesia as well as for sedation in the context of intensive care. Because of the relatively short half-life already mentioned, the opioid is generally administered via a so-called syringe pump. One advantage of this short duration of action is that there is normally no excess effect. Particularly because of this very good controllability, remifentanil is very widespread today, especially in the field of outpatient anesthesia, and is frequently used. However, remifentanil can also be used for somewhat less painful procedures, such as lithotripsy (treatment of bladder and kidney stones).
Risks and side effects
Because remifentanil is an effective and targeted agent, side effects may well occur after administration in some cases. Primarily, these are side effects that are generally very typical of opioids. It should be noted that thoracic rigidity can be more pronounced, especially when compared to many other opioids. Basically, for example, respiratory depression, dizziness, nausea, vomiting, and constipation are among the typical side effects that can occur after remifentanil administration. Other possible side effects of remifentanil also include hypotension or muscle rigidity. The attending physician can provide information on all possible side effects.
