The effect of remifentanil on biliary tract drainage into the duodenum

Opioids cause spasm of the sphincter of Oddi. Remifentanil is metabolized e nzymatically throughout the body. Its context-sensitive half-time is 3-4 mi n. The effect of remifentanil on the sphincter of Oddi, is unknown. We stud ied, in six healthy adult volunteers, the effect of remifentanil on the flo w of dye from the gall bladder into the duodenum. Control hepatobiliary ima ging with 5 mCi of technetium-labeled derivatives of iminodiacetic acid was performed on each volunteer. The time from IV dye (radiopharmaceutical) in jection until its appearance in the duodenum was determined by continuous s canning. Two weeks later, each volunteer received remifentanil, 0.1 mu g.kg (-1).min(-1) infused for 30 min IV before the same dose of technetium-label ed derivatives of iminodiacetic acid was injected, and for the time of thei r control scan plus 10 min after the injection. When the dye appeared in th e duodenum, the total time from injection was compared with the control val ue. The time from stopping the infusion until the dye appeared in the duode num was the "recovery time." Control scan time was 20.5 +/- 9.9 min (mean /- SD; range 10-33 min). Total scan time during and after the remifentanil infusion was 50.3 +/- 17.3 min (range 30-81 min) (P < 0002). The recovery t ime was 19.8 +/- 12.4 min (range 5-40 min). We conclude that remifentanil d elays the drainage of dye from the gall bladder into the duodenum, but the delay is shorter than that reported after other studied opioids. Implicatio ns: Radioactive dye was injected IV into healthy volunteers to determine th e time it took for the dye to appear in the duodenum. This was repeated und er the influence of a short-acting narcotic analgesic, remifentanil. Remife ntanil caused a much shorter delay than previously reported after morphine or meperidine.