[Remifentanil in anesthesia and intensive care]

Area of Science:

• Anesthesiology
• Pharmacology
• Critical Care Medicine

Background:

• Remifentanil (R) is a novel ultra-short-acting mu-receptor opioid.
• It shares structural similarities with fentanyl but possesses a unique pharmacokinetic and metabolic profile.
• R undergoes rapid extrahepatic metabolism by nonspecific esterases, leading to organ-independent pharmacokinetics.

Purpose of the Study:

• To review the pharmacokinetic and pharmacodynamic properties of Remifentanil.
• To discuss its applications in various anesthetic and critical care settings.
• To highlight considerations for dosing in specific patient populations.

Main Methods:

• Literature review of Remifentanil's pharmacokinetic and pharmacodynamic data.
• Analysis of clinical studies on its use in anesthesia and intensive care.
• Evaluation of its efficacy and safety in different patient groups.

Main Results:

• Remifentanil's metabolism by esterases ensures predictable concentration decline, irrespective of infusion duration.
• Dosing requires adjustment in elderly (reduced bolus/infusion) and obese (lean body mass calculation) patients.
• Placental transfer appears safe for newborns, though further obstetric anesthesia data is needed.
• Remifentanil reduces MAC of volatile anesthetics and propofol requirements; it's not a sole anesthetic agent.

Conclusions:

• Remifentanil is a versatile opioid for anesthesia and critical care, facilitating intubation and providing analgesia/sedation.
• Its predictable pharmacokinetics and metabolism allow for controlled use in diverse clinical scenarios.
• Careful dose titration is essential in specific populations like the elderly and obese.