REMIFENTANIL HYDROCHLORIDE

Medical Diagnosis and Drugs, Medications

REMIFENTANIL HYDROCHLORIDE
(rem-i-fent'a-nil)
Ultiva
Classifications: analgesic; narcotic (opiate) agonist; general anesthesia;
Therapeutic: narcotic (opiate) analgesic; general anesthesia
Prototype: Morphine
Pregnancy Category: C
Controlled Substance: Schedule II

Availability

1 mg/mL, 2 mg/mL, 5 mg/mL injection

Action

Synthetic, potent narcotic agonist analgesic similar to fentanyl. Rapidly metabolized; therefore respiratory depression is of shorter duration than fentanyl analogs when discontinued.

Therapeutic Effect

Used as the analgesic component of an anesthesia regime.

Uses

Analgesic during induction and maintenance of general anesthesia, as the analgesic component of monitored anesthesia care.

Contraindications

Hypersensitivity to fentanyl analogs, epidural or intrathecal administration; pregnancy (category C).

Cautious Use

Head injuries, increased intracranial pressure; older adults, debilitated, morbid obesity, poor-risk patients; COPD, other respiratory problems, bradyarrhythmia; lactation. Safety in labor and delivery has not been demonstrated.

Route & Dosage

Adjunct to Anesthesia
Adult: IV 0.5–1 mcg/kg/min or 1 mcg/kg bolus
Child: IV Birth–2 mo, 0.4–1 mcg/kg/min; 1–12 y, 0.5–1 mcg/kg/min or 1 mcg/kg bolus

Obesity
Dose based on IBW.

Administration

Note: See manufacturer's guidelines for reconstitution information and infusion rates.

Intravenous

PREPARE: Direct/Continuous Infusion: • Reconstitute by adding 1 mL of sterile water for injection, D5W, NS, D5NS, ?NS, or D5RL to each 1 mg of remifentanil to yield 1 mg/mL. Shake well to dissolve. • Further dilute to a final concentration of 20, 25, 50, or 250 mcg/mL by adding the required dose to the appropriate amount of IV solution.

ADMINISTER: Direct/Continuous Infusion: Give at the ordered rate according to patient's weight.

INCOMPATIBILITIES Solution/additive: Unknown. Y-site: Amphotericin B, amphotericin B cholesteryl, cefoperazone, chlorpromazine, diazepam.

Clear IV tubing completely of the drug following discontinuation of remifentanil infusion to ensure that inadvertent administration of the drug will not occur at a later time.
Reconstituted solution is stable for 24 h at room temperature. Store vials of powder at 2°–25° C (36°–77° F).

Adverse Effects (≥1%)

Body as a Whole: Muscle rigidity, shivering. CNS: Dizziness, headache. CV: Hypotension, hypertension, bradycardia. GI: Nausea, vomiting. Respiratory: Respiratory depression, apnea. Skin: Pruritus.

Interactions

Drug: Alcohol and other cns depressants potentiate effects; mao inhibitors may precipitate hypertensive crisis.

Pharmacokinetics

Duration: 12 min. Distribution: 70% protein bound. Metabolism: Hydrolyzed by nonspecific esterases in the blood and tissues. Elimination: In urine. Half-Life: 3–10 min.

Nursing Implications

Assessment & Drug Effects

Monitor vital signs during postoperative period; observe for and immediately report any S&S of respiratory distress or respiratory depression, or skeletal and thoracic muscle rigidity and weakness.
Monitor for adequate postoperative analgesia.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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