Remifentanil Concentration during Target-controlled Infusion of Propofol

Crankshaw, D. P.; Chan, Cangel Pui-yee; Leslie, Kate; Bjorksten, Andrew R.

doi:10.1177/0310057x0203000505

Cited by 14 publications

(4 citation statements)

References 24 publications

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“…As a result, there is a possibility of opioid overdose during the induction period of MAC. Moreover, the presence of propofol in the body could result in a significantly greater remifentanil concentration compared with remifentanil infusion alone [7]. For these reasons, the target concentration must be carefully selected to avoid overdose of remifentanil.…”

Section: Discussionmentioning

confidence: 99%

Masseter Muscle Rigidity After Initiating Monitored Anaesthesia Care of Propofol and Remifentanil

Kim¹,

Kim²,

Sun³

et al. 2020

SCR

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Masseter muscle rigidity can be seen following administration of opioids, succinylcholine, and nondepolarizing muscle relaxants. We report a case of a 56-year-old male patient in a “Cannot Intubate Cannot Ventilate Situation” due to masseter muscle rigidity after initiating monitored anaesthesia care (MAC) with remifentanil and propofol using target-controlled infusion in procedural cardiology. For rapid effect and equilibrium between plasma-concentration and effect site-concentration using target-controlled infusion, remifentanil overdose is possible during the induction period of MAC. Moreover, the presence of propofol could result in a significantly greater remifentanil concentration. To manage masseter muscle rigidity, muscle relaxants and emergent ventilation systems should be prepared to secure airway maintenance. In addition, alternative airway management devices and techniques should be on hand even if no airway difficulties are expected.

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Section: Discussionmentioning

confidence: 99%

Masseter Muscle Rigidity After Initiating Monitored Anaesthesia Care of Propofol and Remifentanil

Kim¹,

Kim²,

Sun³

et al. 2020

SCR

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“…Remifentanil is rapidly metabolized to an inactive metabolite (remifentanil acid) by plasma and tissue esterases, and it is eliminated completely by tissue esterases in 9-10 minutes after administration. [28][29][30] Due to its rapid metabolism and elimination, it does not accumulate even after prolonged use.…”

Section: Mechanisms Of Action Metabolism and Pharmacokinetic Profilementioning

confidence: 99%

Efficacy and Safety of Remifentanil as an Alternative Labor Analgesic

Devabhakthuni

2013

Clin Med�Insights�Womens�Health

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The objective of this review was to evaluate the clinical efficacy and safety of remifentanil in the management of labor pain. Although neuraxial analgesia is the best option during labor, alternative analgesic options are needed for patients with contraindications. Using a systematic literature search, clinical outcomes of remifentanil for labor pain have been summarized. Also, comparisons of remifentanil to other options including meperidine, epidural analgesia, fentanyl, and nitrous oxide are provided. Based on the literature review, remifentanil is associated with high overall maternal satisfaction and favorable side-effect profile. However, due to the low reporting of adverse events, large, randomized controlled trials are needed to evaluate maternal and neonatal safety adequately and determine the optimal dosing needed to provide effective analgesia. While remifentanil is a feasible alternative for patients who cannot or do not want to receive epidural analgesia, administration should be monitored closely for potential adverse effects.

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“…As a pure m-receptor agonist drug, it retains all of the pharmacodynamic properties of its class. The pharmacokinetics of remifentanil have been extensively studied because of its unique features, including rapid onset of effect (approximately 1 min), rapid degradation by plasma and tissue esterase to inactive metabolites, and a constant context-sensitive half-life of approximately 3 min with a T 1/2 Keo (the time required for the biophase concentration to reach 50% of the plasma concentration) of 1.3 min [25][26][27]. Therefore, it does not accumulate even after prolonged administration.…”

Section: Remifentanilmentioning

confidence: 99%