Related Experiment Videos

The safety of remifentanil by bolus injection

Scott P Richardson1, Talmage D Egan

  • 1Department of Anesthesiology, University of Utah, 3C 444 SOM, 30 N. 1900 E., Salt Lake City, Utah 84132-2304, USA. scott.richardson@hsc.utah.edu

Expert Opinion on Drug Safety
|July 14, 2005
PubMed

Insights

Remifentanil, a short-acting opioid, offers profound analgesia but its rapid offset requires careful administration. This review focuses on managing adverse effects of remifentanil when given by bolus injection.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Clinical Practice

Background:

  • Remifentanil is a short-acting phenylpiperidine derivative opioid.
  • It acts as a pure agonist at mu-opioid receptors, similar to fentanyl, alfentanil, and sufentanil.
  • Its unique rapid offset pharmacology has led to its use in brief, intense opioid effect procedures.

Purpose of the Study:

  • To review the adverse effects of remifentanil when administered by bolus injection.
  • To highlight potential therapeutic misadventures associated with remifentanil's pharmacokinetic profile.
  • To differentiate management strategies for bolus versus continuous infusion administration.

Main Methods:

  • Literature review focusing on adverse events of remifentanil.
  • Analysis of pharmacokinetic and pharmacodynamic properties.
  • Comparison of adverse effects from bolus injection versus continuous infusion.

Main Results:

  • Clinical effects and adverse events are consistent with other fentanyl congeners.
  • Rapid effect site equilibration presents a risk for therapeutic misadventure.
  • Adverse effects from continuous infusion are well-documented and manageable.

Conclusions:

  • Remifentanil's unique pharmacokinetic profile necessitates careful consideration of administration methods.
  • Adverse effects from bolus injection require specific attention and management strategies.
  • Understanding these effects is crucial for safe clinical application.

Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Drug Delivery: Enteral Route01:18

Drug Delivery: Enteral Route

The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
Drugs in...
Prevention of Further Absorption of Poison01:14

Prevention of Further Absorption of Poison

In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...
Routes of Drug Administration: Parenteral01:25

Routes of Drug Administration: Parenteral

The administration of drugs via parenteral routes allows for direct drug introduction into the systemic circulation, resulting in high bioavailability because the medication bypasses the harsh conditions of the gastrointestinal tract and hepatic metabolism.
The intravenous route (IV) of drug administration can be further categorized into two types. The bolus injection administers the entire dose rapidly, while an intravenous infusion slowly delivers smaller doses steadily.
The IV route is often...
Nonlinear Pharmacokinetics: Drug Elimination for IV Bolus Injection00:59

Nonlinear Pharmacokinetics: Drug Elimination for IV Bolus Injection

In pharmacokinetics, the elimination rate of a drug following a capacity-limited model is primarily controlled by two parameters: Vmax and KM. These parameters are crucial in how the drug behaves inside the body after administration.
Following the administration of a single intravenous (IV) bolus injection, we can determine the concentration of the drug in the plasma at any given time. This calculation is achieved using a specific equation that integrates the values of Vmax and KM.
We can also...
Additional Routes of Drug Administration01:18

Additional Routes of Drug Administration

Choosing the appropriate route of drug administration is significantly influenced by two key factors: the therapeutic objectives and the inherent properties of the drug being used.
Administering drugs via inhalation allows for the direct delivery of gaseous, volatile substances or droplets to different parts of the respiratory tract. One of the advantages of the inhalation route is the rapid absorption of drugs into the circulatory system, which is possible because of the large surface area of...