Remifentanil use in intensive care units: Current evidence and future perspectives

Pain management in intensive care units (ICUs) is crucial for improving patient outcomes. Remifentanil, an ultra-short-acting opioid, is metabolized independently of renal and hepatic function, making it an attractive analgesic. This article discusses the pharmacological effects of remifentanil, its usage, and potential side effects in the ICU, current evidence, and clinical situations where its use is preferred. Currently, patients for whom remifentanil use might be considered include (1) post-cardiac surgery patients, (2) patients requiring frequent neurological assessments, (3) patients with hepatic or renal failure, and (4) patients with acute respiratory distress syndrome who are at high risk of self-inflicted lung injury. In these patient groups, remifentanil's unique properties may contribute to effective pain management. However, data on its long-term use in ICUs remains limited. To establish appropriate usage, further research is needed, particularly on withdrawal symptoms, opioid-induced hyperalgesia, and optimal transition strategies following prolonged administration. Furthermore, cost-effectiveness analyses are essential to assess its economic feasibility in ICU settings.