REMIFENTANIL HYDROCHLORIDE
| REMIFENTANIL HYDROCHLORIDE (rem-i-fent'a-nil) Ultiva Classifications: analgesic; narcotic (opiate) agonist; general anesthesia; Therapeutic: narcotic (opiate) analgesic; general anesthesia Prototype: Morphine Pregnancy Category: C Controlled Substance: Schedule II |
Availability
1 mg/mL, 2 mg/mL, 5 mg/mL injection
Action
Synthetic, potent narcotic agonist analgesic similar to fentanyl. Rapidly metabolized; therefore respiratory depression is of shorter duration than fentanyl analogs when discontinued.
Therapeutic Effect
Used as the analgesic component of an anesthesia regime.
Uses
Analgesic during induction and maintenance of general anesthesia, as the analgesic component of monitored anesthesia care.
Contraindications
Hypersensitivity to fentanyl analogs, epidural or intrathecal administration; pregnancy (category C).
Cautious Use
Head injuries, increased intracranial pressure; older adults, debilitated, morbid obesity, poor-risk patients; COPD, other respiratory problems, bradyarrhythmia; lactation. Safety in labor and delivery has not been demonstrated.
Route & Dosage
| Adjunct to Anesthesia Adult: IV 0.5–1 mcg/kg/min or 1 mcg/kg bolus Child: IV Birth–2 mo, 0.4–1 mcg/kg/min; 1–12 y, 0.5–1 mcg/kg/min or 1 mcg/kg bolus Obesity Dose based on IBW. |
Administration
Note: See manufacturer's guidelines for reconstitution information and infusion rates.
| Intravenous PREPARE: Direct/Continuous Infusion: ??Reconstitute by adding 1 mL of sterile water for injection, D5W, NS, D5NS, ?NS, or D5RL to each 1 mg of remifentanil to yield 1 mg/mL. Shake well to dissolve. ??Further dilute to a final concentration of 20, 25, 50, or 250 mcg/mL by adding the required dose to the appropriate amount of IV solution. ADMINISTER: Direct/Continuous Infusion: Give at the ordered rate according to patient's weight. INCOMPATIBILITIES Solution/additive: Unknown. Y-site: Amphotericin B, amphotericin B cholesteryl, cefoperazone, chlorpromazine, diazepam.
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Adverse Effects (≥1%)
Body as a Whole: Muscle rigidity, shivering. CNS: Dizziness, headache. CV: Hypotension, hypertension, bradycardia. GI: Nausea, vomiting. Respiratory: Respiratory depression, apnea. Skin: Pruritus.Interactions
Drug: Alcohol and other cns depressants potentiate effects; mao inhibitors may precipitate hypertensive crisis.Pharmacokinetics
Duration: 12 min. Distribution: 70% protein bound. Metabolism: Hydrolyzed by nonspecific esterases in the blood and tissues. Elimination: In urine. Half-Life: 3–10 min.Nursing Implications
Assessment & Drug Effects
- Monitor vital signs during postoperative period; observe for and immediately report any S&S of respiratory distress or respiratory depression, or skeletal and thoracic muscle rigidity and weakness.
- Monitor for adequate postoperative analgesia.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug