Is an infusion pump necessary to safely administer remifentanil?

We sought to determine if remifentanil could be administered as safely and effectively from an IV drip as from a calculator pump, because not all anes thesiologists have access to a calculator pump. Forty healthy adults underg oing outpatient knee arthroscopy were premedicated with midazolam, 2 mg. To tal TV anesthesia was induced with propofol by bolus (2 mg/kg) and maintain ed by a continuous infusion of propofol and remifentanil. On a randomized, double-blinded basis, they received, TV, either remifentanil (50 mu g/mL) b y syringe from an infusion pump or from a bag of saline containing remifent anil 20 mu g/mL through a minidrip set. The remifentanil infusion syringe p ump rate was 0.4 mu g.kg(-1).min(-1) until skin incision and then 0.2 mu g. kg(-1).min(-1), whereas that from the bag/minidrip set was set to approxima te the delivery rate from the pump. Both a syringe pump and bag/minidrip se t infusion were administered to each patient but only one contained remifen tanil, that one being determined in a randomized, double-blinded manner. Th ere were no differences in demographic data, time to recovery of open eyes, response to command, ability to speak (approximately 7 min), total dose an d time of administration of propofol and remifentanil, the incidence of int raoperative hypotension and bradycardia, and postoperative shivering. We de monstrated that remifentanil can be administered as safely and effectively from a bag with a minidrip set as from a syringe in a calculator infusion p ump, provided the anesthesiologist is paying attention to the drip rate fro m the bag. Implications: Because remifentanil is rapidly degraded in the bo dy, it can be safely and effectively administered from a bag through a mini drip set. We showed that there was no difference with this less expensive m ethod of administration than from the more precise method of a calculator i nfusion pump.