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Minerva Anestesiologica 2000 May;66(5):417-23

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: Italian

Remifentanil. A perioperative study

Mastronardi P., Cafiero T., De Cillis P.

Università degli Studi «Federico II» - Napoli Dipartimento di Scienze Chirurgiche, Anestesiologiche e dell’Emergenza *Azienda Ospedaliera «G. Rummo» - Benevento Servizio di Anestesia e Rianimazione

Remifentanil (R) is a nov­el ­short-act­ing mu-recep­tor opi­oid. R is in the ­same struc­tu­ral fam­i­ly as fen­ta­nyl and the oth­er phe­nyl­pi­per­i­dines, but it dif­fers ­from fen­ta­nyl ­because of its phar­ma­cok­i­net­ic pro­file and its metab­olism: R under­goes extra­he­pat­ic metab­olism by ­blood and tis­sue non­spe­cif­ic este­ras­es. For ­these rea­sons the ­time ­required for decreas­es of any per­cent­age plas­mat­ic con­cen­tra­tions of R ­after ter­mi­na­tion of the infu­sion is inde­pen­dent of infu­sion dura­tion. The phar­ma­cok­i­net­ic pro­file of R is ­organ-inde­pen­dent and the dos­ing reg­i­men ­must be reg­u­lat­ed in eld­er­ly ­patients by reduc­ing the ­bolus and infu­sion dos­es, and in ­obese sub­jects by cal­cu­lat­ing the intra­ve­nous dos­ag­es as a func­tion of age and ­lean ­body ­mass. The pla­cen­tal trans­fer of R ­doesn’t ­affect the new­born as recent­ly ­described in lit­er­a­ture but fur­ther and wid­er clin­i­cal expe­ri­enc­es are need­ed for assess­ing the use of R in obstet­ric anes­the­sia. R caus­es ­either a reduc­tion in the MAC of vol­a­tile anes­thet­ics or a ­decrease in pro­pof­ol require­ments but it can­not be ­used as a ­sole anes­thet­ic ­agent. R can be uti­lized to facil­i­tate tra­cheal intu­ba­tion with­out ­using mus­cle relax­ants, to man­age anal­ge­sia and seda­tion ­also in asso­ci­a­tion ­with mid­az­o­lam and/or pro­pof­ol, fur­ther­more as anal­ge­sic ­agent for mon­i­tored anes­the­sia ­care, for the crit­i­cal ­patient in ICU and for the post­op­er­a­tive anal­ge­sia if a prop­er anal­ge­sic strat­e­gy had not ­been ­planned.