[Remifentanil--could it open a new era in our anesthesia practice in Japan?]

The rapid onset and offset of the effect of remifentanil are absolutely new and different from fentanyl. The clearance of remifentanil is so rapid and extensive, that it prevents the drug from accumulating in the body tissues. For this reason the context-sensitive half-time of remifentanil is only 3-5 min, irrespective of the duration of infusion; it is thus context-INsensitive. This exciting pharmacokinetic profile gives us an improved titration precision that lets us experience the opioids effects when we need them and to avoid the side effects of residual drug concentrations when the analgesic necessity is reduced or vanished. These clinical advantages would also result in pharmacoeconomic benefits. In the near future, the introduction of reliable delivery systems for remifentanil combined with propofol would provide us with a new concept in intravenous anesthesia, the DOUBLE TCI Anesthesia.