REMIFENTANIL - WHEN AND HOW TO USE IT

Remifentanil is a new potent mu-agonist with a unique pharmacokinetic profile due to a rapid metabolism by nonspecific tissue esterases. As a consequence, remifentanil pharmacokinetics are not modified by sever e renal or hepatic dysfunction. During general anaesthesia, any dosage of remifentanil may be used without undue lengthening of emergence ti mes. In cardiac surgery, remifentanil combines the requirement for int ra-operative control of stress responses and rapid recovery. The rapid termination of remifentanil action warrants modifications of the curr ent practice concerning early postoperative pain control. Remifentanil may be used as a sedative during monitored analgesia, or as a postope rative analgesic in spontaneously breathing patients, provided bolus d oses are avoided. Remifentanil may increase patients' safety by elimin ating the risk of delayed respiratory depression, but its correct use requires major changes in our prescribing habits.