Remifentanil update: clinical science and utility

Area of Science:

• Anesthesiology
• Pharmacology
• Clinical Pharmacy

Background:

• Remifentanil is an anilidopiperidine opioid with pharmacodynamic properties similar to other opioids.
• Its pharmacokinetic profile is distinct, characterized by rapid metabolism and elimination.
• Unlike other opioids, remifentanil's metabolism is primarily esterase-dependent, not reliant on hepatic or renal function.

Purpose of the Study:

• To highlight the unique pharmacokinetic properties of remifentanil.
• To discuss the clinical implications of these properties in various anesthetic and procedural settings.
• To compare remifentanil's profile with other anilidopiperidine opioids.

Main Methods:

• Review of remifentanil's pharmacokinetic and pharmacodynamic characteristics.
• Comparison of remifentanil's context-sensitive half-time with other opioids.
• Analysis of clinical applications and outcomes in surgical and procedural contexts.

Main Results:

• Remifentanil exhibits rapid clearance due to widespread esterase metabolism, independent of age, renal, or hepatic function.
• Its short context-sensitive half-time (3.2 minutes) ensures rapid dissipation of effect, even after prolonged infusions.
• Clinical use demonstrates benefits in titration, sedation, analgesia, and potentially improved intraoperative hemodynamics, but also risks of hypotension and bradycardia.

Conclusions:

• Remifentanil's unique pharmacokinetics offer advantages in titration and recovery but may require careful postoperative pain management planning.
• Its utility spans various procedures, including awake intubation and regional anesthesia support.
• While offering benefits in certain surgical settings, clinicians must weigh its rapid offset against potential postoperative pain and higher costs.