Remifentanil Opioid: Dosage and Precautions

The use of this opioid is approved for both children and adults. However, depending on the intended use, and also on the patient's characteristics, doses will vary.
Remifentanil Opioid: Dosage and Precautions

Last update: 04 October, 2021

Remifentanil opioid is a drug that belongs to the opioid family and has short-lasting analgesic and sedative properties. Therefore, doctors prescribe it and mainly use it during surgery and painful procedures.

It’s a synthetic drug that’s a selective agonist of opioid receptors; specifically, the μ-opioid receptors. We’ll get into more detail about this later, but it has an action up to 15 times faster than fentanyl, another opioid drug from which remifentanil derives.

A doctor in a hospital.

The use of this remifentanil opioid is approved for both children and adults. However, depending on the intended use, and also depending on the patient’s characteristics, the doses will vary.

In this regard, we have to differentiate whether remifentanil is to induce anesthesia, for maintenance of anesthesia, or for postoperative pain relief. Health professionals can also use it for analgesia in monitored anesthetic care and in coronary by-pass surgery.

Therefore, let’s see the different doses used for each situation.

Inducing anesthesia

To achieve this goal, specialists administer remifentanil intravenously at a dose of 0.5-1 mcg (microgram) per kilogram of patient weight per minute.

Maintaining anesthesia

In this case, we should clarify the distinction between children and adults. In children, doctors will administer remifentanil to infants older than two months, along with nitrous oxide through a continuous intravenous infusion of a dose between 0.4 mcg/kg/min and 1 mcg/kg/min.

Children aged 1 to 12 years will take remifentanil with other inhalation agents by continuous infusion at a dose between 0.05 to 1.3 mcg/kg/min.

For adults, it’s administered by supplemental intravenous bolus doses that can be given approximately every 3 minutes. In addition, doctors can prescribe it together with a hypnotic or other volatile medication by continuous infusion at doses between 0.05 and 2 mcg/kg/min.

Analgesia during the immediate postoperative period

During this period, specialists don’t recommend using oral administration. Remifentanil is administered by continuous intravenous infusion, as in the other situations, with a dose range between 0.025 to 0.2 mcg/kg/min.

Specialists can administer remifentanil in 3 different ways when used in this situation:

  • With a single dose intravenously over 90 seconds at a dose of 1 mcg/kg.
  • By continuous intravenous infusion started 5 minutes before administration of the local anesthetic at a dose of 0.1 mcg/kg/min.
  • By continuous intravenous infusion after administration of the local anesthetic at a dose of 0.05 mcg/kg/min with a range of 0.025 to 0.2 mcg/kg/min.

Coronary by-pass surgery

Coronary by-pass surgery is a technique that specialists use to improve the circulation of arteries and other blood vessels when atheroma plaque has developed.

During this intervention, remifentanil can be administered with the aim of inducing analgesia at a dose of 1 mcg/kg/min. Doctors also use this drug as maintenance by intravenous infusion. Its dose is equal to the induction dose, but ranges from 0.125 to 4 mcg/kg/min.

In addition, during maintenance of analgesia, doctors can supplemental bonus doses of 0.5 to 1 mcg/kg. Lastly, let’s talk about the postoperative period in the ICU. In this case, doctors administer remifentanil as an intravenous infusion at a dose of 1 mcg/kg/min with a dose range of 0.05 to 1 mcg/kg/min.

Precautions for use of remifentanil

Health professionals operating.

When using this drug, doctors should take a series of precautions, such as:

  • In patients presenting spontaneous breathing, remifentanil cannot be administered.
  • Doctors should be careful when administering it to morbidly obese patients.
  • This drug has adverse effects that affect the circulatory system, so debilitated patients may have more problems. Doctors should take special precautions with these types of patients.
  • Specialists recommend administering other analgesic drugs one hour before withdrawing treatment with remifentanil.

Conclusion on remifentanil opioid

Health professionals use remifentanil in the hospital setting in order to induce, maintain and control pain, as is the case with many types of surgery.

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  • González Cárdenas, V. H., González, F. D. M., Barajas, W. J. G., Cardona, A. M., Rosero, B. R., & Manrique, Á. J. (2014). Remifentanil vs. epidural analgesia for the management of acute pain associated with labour. Systematic review and meta-analysis. Colombian Journal of Anesthesiology.
  • Tafur, L. A., & Lema, E. (2010). Anestesia total intravenosa. Revista Colombiana de Anestesiología.
  • Partida Figuerola, C., Rodríguez Pérez, A., Gil Bedia, F., Mena Hernández, C., Hussein González, Z., & Ojeda Betancor, N. (2003). Hiperalgesia postoperatoria. Actualizaciones En Anestesiologia y Reanimacion.