Classes
DEA Class; Rx
Common Brand Names; Ultiva
- Opioid Analgesics;
- Synthetic, Opioids
Description
Opiate agonist for use during anesthesia with inhaled anesthetics and/or hypnotics; attenuates hemodynamic response to intubation and helps maintain cardiovascular stability during anesthesia; rapid onset, peak effect and ultra-short duration of action; metabolized by blood esterases; administration only by one trained in the use of intravenous and general anesthetics.
Indications
Indicated for general anesthesia induction (through intubation).
For general anesthesia maintenance .
Contraindications
Epidural or intrathecal administration
Known hypersensitivity to fentanyl analogs
Adverse Effects
- Nausea
- Vomiting
- Respiratory depression
- Bradycardia (dose dependent)
- Hypertension
- Hypotension (dose dependent)
- Tachycardia
- Skeletal muscle rigidity (dose dependent)
- Postoperative pain
- Shivering
- Apnea
- Hypoxia
- Respiratory depression
- Biliary tract disease
- Serotonin syndrome
Warnings
In patients who may be susceptible to intracranial effects of CO2 retention (e.g., those with evidence of increased intracranial pressure or brain tumors), therapy may reduce respiratory drive, and resultant CO2 retention can further increase intracranial pressure; monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy; opioids may obscure clinical course in a patient with a head injury; avoid the use in patients with impaired consciousness or coma
Profound sedation, respiratory depression, coma, and death may result from concomitant administration with benzodiazepines or other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol); because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate
Cases of serotonin syndrome, a potentially life-threatening condition, reported with concomitant use of serotonergic drugs; this may occur within the recommended dosage range; the onset of symptoms generally occur within several hours to a few days of concomitant use, but may occur later than that; discontinue therapy immediately if serotonin syndrome is suspected
Muscle rigidity occurring during induction of can be treated by decreasing rate or discontinuing infusion of drug or by administering a neuromuscular blocking agent; neuromuscular blocking agents used should be compatible with patient’s cardiovascular status
Bradycardia may occur; monitor heart rate during dosage initiation and titration; responsive to ephedrine or anticholinergic drugs
Pregnancy and Lactation
Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome; available data in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage
The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy; capsules and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition
Maximum Dosage
IV opioid dosage should be individualized based on clinical response and cardiorespiratory parameters.
For anesthesia, 1 mcg/kg/dose IV; continuous infusion rates greater than 2 mcg/kg/minute IV should be administered only after careful consideration.
For anesthesia, 1 mcg/kg/dose IV; continuous infusion rates greater than 2 mcg/kg/minute IV should be administered only after careful consideration. Starting doses should be decreased by 50%.
For general anesthesia maintenance, 1 mcg/kg/dose IV; continuous infusion rates greater than 1.3 mcg/kg/minute IV should be administered only after careful consideration. Safety and efficacy have not been established for other indications; however, doses up to 1.25 mcg/kg/dose IV have been used off-label for intubation.
For general anesthesia maintenance, 1 mcg/kg/dose IV; continuous infusion rates greater than 1.3 mcg/kg/minute IV should be administered only after careful consideration. Safety and efficacy have not been established for other indications; however, doses up to 4 mcg/kg/dose IV have been used off-label for intubation.
For general anesthesia maintenance, 1 mcg/kg/dose IV; continuous infusion rates greater than 1 mcg/kg/minute IV should be administered only after careful consideration. Safety and efficacy have not been established for other indications; however, doses up to 4 mcg/kg/dose IV have been used off-label for intubation.
Neonates: For general anesthesia maintenance, 1 mcg/kg/dose IV; continuous infusion rates greater than 1 mcg/kg/minute IV should be administered only after careful consideration. Safety and efficacy have not been established for other indications; however, doses up to 3 mcg/kg/dose IV have been used off-label for intubation.
Premature Neonates 28 weeks gestation and older: Safety and efficacy have not been established; however, doses up to 2 mcg/kg/dose IV have been used off-label for intubation.
How supplied
Remifentanil hydrochloride
powder for injection: Schedule II
- 1mg/vial
- 2mg/vial
- 5mg/vial
