Skip to main content
SpringerLink
Log in

Remifentanil Update

Clinical Science and Utility

  • Review Article
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

The anilidopiperidine opioid remifentanil has pharmacodynamic properties similar to all opioids; however, its pharmacokinetic characteristics are unique. Favourable pharmacokinetic properties, minimally altered by extremes of age or renal or hepatic dysfunction, enable easy titration and rapid dissipation of clinical effect of this agent, even after prolonged infusion.

Remifentanil is metabolised by esterases that are widespread throughout the plasma, red blood cells, and interstitial tissues, whereas other anilidopiperidine opioids (e.g. fentanyl, alfentanil and sufentanil) depend upon hepatic biotransformation and renal excretion for elimination. Consequently, remifentanil is cleared considerably more rapidly than other anilidopiperidine opioids. In addition, its pKa (the pH at which the drug is 50% ionised) is less than physiological pH; thus, remifentanil circulates primarily in the non-ionised moiety, which quickly penetrates the lipid blood-brain barrier and rapidly equilibrates across the plasma/effect site interface. By virtue of these distinctive pharmacokinetic properties, the context-sensitive half-time (i.e. the time required for the drug’s plasma concentration to decrease by 50% after cessation of an infusion) of remifentanil remains consistently short (3.2 minutes), even following an infusion of long duration (≥8 hours).

Remifentanil, a clinically versatile opioid, is useful for intravenous analgesia and sedation in spontaneously breathing patients undergoing painful procedures. Profound analgesia may be achieved with minimal effect on cognitive function. Remifentanil may also provide sedation and analgesia during placement of regional anaesthetic blocks, and in conjunction with topical anaesthesia and airway nerve blocks, it may be useful for blunting reflex responses and facilitating ‘awake’ fibreoptic intubation.

Compared with fentanyl and alfentanil in a day-surgery setting, remifentanil supplementation of general anaesthesia may improve intraoperative haemodynamic control. Both emergence time and the incidence of respiratory depression during post-anaesthetic recovery may be reduced. However, outcomes such as home discharge time, post-emergence adverse effect profile, and patient and provider satisfaction are not significantly improved, and the incidence of intraoperative hypotension and bradycardia is greater. In addition, drug acquisition costs for remifentanil are higher and clinicians may need extra time to familiarise themselves with the drug’s unique pharmacokinetics.

Ironically, the quick dissipation of opioid analgesic effect following remifentanil discontinuation may be a significant clinical disadvantage. Unless little or no postoperative pain is anticipated, the clinician may wish to treat prospectively using local or regional anaesthesia, non-opioid analgesics, or longer-acting opioid analgesics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Fig. 2
Fig. 3
Table II

Similar content being viewed by others

References

  1. Glass PSA, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg 1999; 89(4 Suppl.): S7–14

    Article  PubMed  CAS  Google Scholar 

  2. Kapila A, Glass PSA, Jacobs JR, et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 1995; 83: 968–75

    Article  PubMed  CAS  Google Scholar 

  3. Michelsen LG, Hug CC. The pharmacokinetics of remifentanil. J Clin Anesthesia 1996; 8: 679–82

    Article  CAS  Google Scholar 

  4. Bailey JM. Context-sensitive half-times: what they are and how valuable are they to anesthesiologists? Clin Pharmacokinet 2002; 41: 793–9

    Article  PubMed  Google Scholar 

  5. Egan TD, Lemmens HJ, Fiset P, et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers. Anesthesiology 1993; 79: 881–92

    Article  PubMed  CAS  Google Scholar 

  6. Dershwitz M, Hoke JF, Rosow CE, et al. Pharmacokinetics and pharmacodynamics of remifentanil in volunteer subjects with severe liver disease. Anesthesiology 1996; 84: 812–20

    Article  PubMed  CAS  Google Scholar 

  7. Hoke JF, Shulgman D, Dershwitz M, et al. Pharmacokinetics and pharmacodynamics of remifentanil in persons with renal failure compared with healthy volunteers. Anesthesiology 1997; 87: 533–41

    Article  PubMed  CAS  Google Scholar 

  8. Minto CF, Schnider TW, Egan TD. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I: model development. Anesthesiology 1997; 86: 10–23

    CAS  Google Scholar 

  9. Ross AK, Davis PJ, Dear Gd GL, et al. Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery of diagnostic procedures. Anesth Analg 2001; 93: 1393–401

    Article  PubMed  CAS  Google Scholar 

  10. Egan TD, Huizinga B, Gupta SK, et al. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology 1998; 89: 562–73

    Article  PubMed  CAS  Google Scholar 

  11. Bovill JG. Targeting the effect site. In: Vuyk J, Engbers F, Groen-Mulder S, editors. On the study and practice of intravenous anaesthesia. Dordrect: Kluwer, 2000: 17–26

    Google Scholar 

  12. Kapila A, Glass PSA, Jacobs JR, et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 1995; 83: 968–75

    Article  PubMed  CAS  Google Scholar 

  13. Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. II: model application. Anesthesiology 1997; 86: 24–33

    CAS  Google Scholar 

  14. Thurlow JA, Laxton CH, Dick A, et al. Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour. Br J Anaesth 2002; 88: 374–8

    Article  PubMed  CAS  Google Scholar 

  15. Eger EI, Saidman LJ, Brandstater B, et al. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. Anesthesiology 1965; 26: 756–63

    Article  PubMed  Google Scholar 

  16. Selbel PS, Glass PSA, Fletcher JE, et al. Reduction of the MAC of desflurane with fentanyl. Anesthesiology 1992; 76: 52–9

    Article  Google Scholar 

  17. Lang E, Kapila A, Shlugman D, et al. Reduction of isoflurane minimal alveolar concentration by remifentanil. Anesthesiology 1996; 85: 721–8

    Article  PubMed  CAS  Google Scholar 

  18. Song D, White PF. Remifentanil as an adjuvant during desflurane anesthesia facilitates early recovery after ambulatory surgery. J Clin Anesth 1999; 11: 364–7

    Article  PubMed  CAS  Google Scholar 

  19. Katoh T, Kazuyuki I. The effects of fentanyl on sevoflurane requirements for loss of consciousness and skin incision. Anesthesiology 1998; 88: 18–24

    Article  PubMed  CAS  Google Scholar 

  20. McEwan AI, Smith C, Dyar O, et al. Isoflurane minimum alveolar concentration reduction by fentanyl. Anesthesiology 1993; 78: 864–9

    Article  PubMed  CAS  Google Scholar 

  21. Wilhelm W, Biedler A, Huppert A, et al. Comparison of the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate. Eur J Anaesthesiol 2002; 19: 350–6

    PubMed  CAS  Google Scholar 

  22. Conway DH, Hasan SK, Simpson ME. Target-controlled propofol requirements at induction of anaesthesia: effect of remifentanil and midazolam. Eur J Anaesthesiol 2002; 19: 580–4

    PubMed  CAS  Google Scholar 

  23. Mertens MJ, Olofsen E, Engbers FHM, et al. Propofol reduces perioperative remifentanil requirements in a synergistic manner. Anesthesiology 2003; 99: 347–59

    Article  PubMed  CAS  Google Scholar 

  24. Johansen JW, Sebel PS. Development and clinical application of EEG bispectrum monitoring. Anesthesiology 2000; 92: 1336–44

    Article  Google Scholar 

  25. Koitabashi T, Johansen JW, Sebel PS. Remifentanil dose/electroencephalogram bispectral response during combined propofol/regional anesthesia. Anesth Analg 2002; 94: 1530–3

    PubMed  CAS  Google Scholar 

  26. Hodgson PS, Liu SS. Epidural lidocaine decreases sevoflurane requirement for adequate depth of anesthesia as measured by the bispectral index monitor. Anesthesiology 2001; 94: 799–803

    Article  PubMed  CAS  Google Scholar 

  27. Petersen KL, Jones B, Segredo V, et al. Effect of remifentanil on pain and secondary hyperalgesia associated with the heat-capsaicin sensitization model in healthy volunteers. Anesthesiology 2001; 94: 15–20

    Article  PubMed  CAS  Google Scholar 

  28. Guignard B, Bossard AE, Coste C, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000; 93: 409–17

    Article  PubMed  CAS  Google Scholar 

  29. Hood DD, Curry R, Eisenach JC. Intravenous remifentanil produces withdrawal hyperalgesia in volunteers with capsaicin-induced hyperalgesia. Anesth Analg 2003; 97: 810–5

    Article  PubMed  CAS  Google Scholar 

  30. Cortínez LI, Brandes V, Muñoz HR, et al. No clinical evidence of acute tolerance after remifentanil-based anaesthesia. Br J Anaesth 2001; 87: 866–9

    Article  PubMed  Google Scholar 

  31. Beloeil H, Corsia G, Coriat P, et al. Remifentanil compared with sufentanil during extracorporeal shock wave lithotripsy with spontaneous ventilation: a double-blind, randomized study. Br J Anaesth 2002; 89: 567–70

    Article  PubMed  CAS  Google Scholar 

  32. Tablov V, Tablov B, Partenov P. Analgesia with remifentanil or remifentanil / midazolam for minor gynecologic surgery: efficacy and patient comfort [abstract]. Eur J Anaesthesiol 2001; 18: 14

    Article  Google Scholar 

  33. Drogheti L, Zopellari R, Morghen I, et al. Remifentanil in pump versus alfentanil in bolus in outpatient anaesthesia [abstract]. Eur J Anaesthesiol 2001; 18: 14

    Article  Google Scholar 

  34. Smith I, Avramov MN, White PF. A comparison of propofol and remifentanil during monitored anesthesia care. J Clin Anesth 1997; 9: 148–54

    Article  PubMed  CAS  Google Scholar 

  35. Bowdle TA, Camporesi EM, Maysick L, et al. A multi-center evaluation of remifentanil for early postoperative analgesia. Anesth Analg 1996; 83: 1292–7

    PubMed  CAS  Google Scholar 

  36. Schüttler J, Albrecht S, Breivik H, et al. A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia 1997; 52: 307–17

    Article  PubMed  Google Scholar 

  37. Hall AP, Thompson JP, Leslie NAP, et al. Comparison of different doses of remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth 2000; 84: 100–2

    Article  PubMed  CAS  Google Scholar 

  38. Servin FS, Raeder JC, Merle JC, et al. Remifentanil sedation compared with propofol during regional anaesthesia. Acta Anaesthesiol Scand 2002; 46: 309–15

    Article  PubMed  CAS  Google Scholar 

  39. Bailey PI, Pace NL, Ashburn MA, et al. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990; 73: 826–30

    Article  PubMed  CAS  Google Scholar 

  40. Avramov MN, Smith I, White PF. Interactions between midazolam and remifentanil during monitored anesthesia care. Anesthesiology 1996; 85: 1283–9

    Article  PubMed  CAS  Google Scholar 

  41. Ahmad S, Leavell M, Fragen RJ, et al. Use of remifentanil for analgesia during placement of ophthalmologic nerve blocks [abstract]. Anesth Analg 1996; 82: S3

    Google Scholar 

  42. Egan TD, Minto CF, Hermann DJ. Remifentanil versus al-fentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers. Anesthesiology 1996; 84: 821–33

    Article  PubMed  CAS  Google Scholar 

  43. Mingus ML, Monk TG, Gold MI, et al. Remifentanil versus propofol as adjuncts to regional anesthesia. J Clin Anesth 1998; 10: 46–53

    Article  PubMed  CAS  Google Scholar 

  44. Holas A, Krafft P, Marcovic M, et al. Remifentanil, propofol, or both for conscious sedation during eye surgery under regional anaesthesia. Eur J Anaesthesiol 1999; 16: 741–8

    PubMed  CAS  Google Scholar 

  45. Puchner W, Obwegeser J, Puhringer FK. Use of remifentanil for awake fiberoptic intubation in a morbidly obese patient with severe inflammation of the neck. Acta Anaesthesiol Scand 2002; 46: 473–6

    Article  PubMed  CAS  Google Scholar 

  46. Machata AM, Gonano C, Holzer A, et al. Awake nasotracheal fiberoptic intubation: patient comfort, intubating conditions, and hemodynamic stability during conscious sedation with remifentanil. Anesth Analg 2003; 97: 904–8

    Article  PubMed  CAS  Google Scholar 

  47. Hans P, Bonhomme V, Born JD, et al. Target-controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy. Anaesthesia 2000; 55: 255–9

    Article  PubMed  CAS  Google Scholar 

  48. Elliott P, O’Hare R, Bill KM, et al. Severe cardiovascular depression with remifentanil. Anesth Analg 2000; 91: 58–61

    PubMed  CAS  Google Scholar 

  49. Murdoch JAC, Hyde RA, Kenny GNC. Target-controlled remifentanil in combination with propofol for spontaneously breathing day-case patients. Anaesthesia 1999; 54: 1028–31

    Article  PubMed  CAS  Google Scholar 

  50. Dershwitz M, Michalowski P, Chang YC, et al. Postoperative nausea and vomiting after total intravenous anesthesia with propofol and remifentanil or alfentanil: how important is the opioid? J Clin Anesth 2002; 14: 275–8

    Article  PubMed  CAS  Google Scholar 

  51. Joshi GP, Warner DS, Twersky RS, et al. A comparison of the remifentanil and fentanyl adverse effect profile in a multi-center phase IV study. J Clin Anesth 2002; 14: 494–9

    Article  PubMed  CAS  Google Scholar 

  52. Beers RA, Calimlim JR, et al. A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery. Anesth Analg 2000; 91: 1420–5

    Article  PubMed  CAS  Google Scholar 

  53. Suttner S, Boldt J, Schmidt C, et al. Cost analysis of target-controlled infusion-based anesthesia compared with standard anesthesia regimens. Anesth Analg 1999; 88: 77–82

    PubMed  CAS  Google Scholar 

  54. Joshi GP, Jamerson BD, Roizen MF, et al. Is there a learning curve associated with the use of remifentanil? Anesth Analg 2000; 91: 1049–55

    PubMed  CAS  Google Scholar 

  55. Maguire AM, Kumar N, Parker JL, et al. Comparison of the effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anaesth 2001;86: 90–3

    Article  PubMed  CAS  Google Scholar 

  56. Habib AS, Parker JL, Maguire AM, et al. Effects of remifentanil and alfentanil on the cardiovascular responses to the induction of anaesthesia and tracheal intubation on the elderly. Br J Anaesth 2002; 88: 430–2

    Article  PubMed  CAS  Google Scholar 

  57. Alexander R, Olufolabi AJ, Booth J, et al. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia 1999; 54: 1037–40

    Article  PubMed  CAS  Google Scholar 

  58. Klemola UM, Mennander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol. Acta Anaesthesiol Scand 2000; 44: 465–9

    Article  PubMed  CAS  Google Scholar 

  59. McNeil IA, Culbert B, Russell I. Comparison of intubating conditions following propofol and succinylcholine with propofol and remifentanil 2μg/kg or 4μg/kg. Br J Anaesth 2000; 85: 623–5

    Article  PubMed  CAS  Google Scholar 

  60. Breslin DS, Reid JE, Mirakhur RK, et al. Sevoflurane nitrous oxide anaesthesia supplemented with remifentanil: effect on recovery and cognitive function. Anaesthesia 2001; 56: 11–9

    Article  Google Scholar 

  61. Wilhelm W, Grundmann U, van Aken H, et al. A multi-center comparison of isoflurane and propofol as adjuncts to remi-fentanil-based anesthesia. J Clin Anesth 2000; 12: 129–35

    Article  PubMed  CAS  Google Scholar 

  62. Grundmann U, Silomon M, Bach F, et al. Recovery profile and side effects of remifentanil-based anaesthesia with desflurane or propofol for laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2001; 45: 320–6

    Article  PubMed  CAS  Google Scholar 

  63. Chung F, Mulier JP, Scholz J, et al. A comparison of anaesthesia using remifentanil combined with either propofol, en-flurane, or isoflurane in patients undergoing gynaecological laparoscopy, varicose vein or arthroscopic surgery. Acta Anaesthesiol Scand 2000; 44: 790–8

    Article  PubMed  CAS  Google Scholar 

  64. O’Hare RA, Mirakhur RK, Reid JE, et al. Recovery from propofol anesthesia supplemented with remifentanil. Br J Anaesth 2001; 86: 361–5

    Article  PubMed  Google Scholar 

  65. Van Delden PG, Houweling PL, Bencini AF, et al. Remi-fentanil-sevoflurane anaesthesia for laparoscopic cholecystectomy: comparison of three dose regimens. Anaesthesia 2002; 57: 212–7

    Article  PubMed  Google Scholar 

  66. Montes FR, Trillos JE, Rincon IE, et al. Comparison of total intravenous anesthesia and sevoflurane: fentanyl anesthesia for outpatient otorhinolaryngeal surgery. J Clin Anesth 2002; 14: 324–8

    Article  PubMed  CAS  Google Scholar 

  67. Mackey JJ, Parker SD, Nass CM, et al. Effectiveness of remifentanil versus traditional fentanyl-based anesthetic in high-risk outpatient surgery. J Clin Anesth 2000; 12: 427–32

    Article  PubMed  CAS  Google Scholar 

  68. Ozkose Z, Cok OY, Tuncer B, et al. Comparison of hemodynamics, recovery profile, and early postoperative pain control and costs of remifentanil versus alfentanil-based total intravenous anesthesia (TIVA). J Clin Anesth 2002; 14: 161–8

    Article  PubMed  CAS  Google Scholar 

  69. Casati A, Albertin A, Fanelli G, et al. A comparison of remifentanil and sufentanil as adjuvants during sevoflurane anesthesia with epidural analgesia for upper abdominal surgery: effects on postoperative recovery and respiratory function. Anesth Analg 2000; 91: 1269–73

    PubMed  CAS  Google Scholar 

  70. Andersen FA, Arsland D, Holst-Larsen H. Effects of combined methohexitone-remifentanil anaesthesia in electroconvulsive therapy. Acta Anaesthesiol Scand 2001; 45: 830–3

    Article  PubMed  CAS  Google Scholar 

  71. Mouren S, De Winter G, Guerrero SP, et al. The continuous recording of blood pressure in patients undergoing carotid surgery under remifentanil versus sufentanil analgesia. Anesth Analg 2001; 93: 1402–9

    Article  PubMed  CAS  Google Scholar 

  72. Doyle PW, Coles JP, Leary TM, et al. A comparison of remifentanil and fentanyl in patients undergoing carotid endarterectomy. Eur J Anaesthesiol 2001; 18: 13–9

    PubMed  CAS  Google Scholar 

  73. Wilhelm W, Schlaich N, Harrer J, et al. Recovery and neurologic examination after remifentanil-desflurane or fentanyl-desflurane anesthesia for carotid artery surgery. Br J Anaesth 2001; 86: 44–9

    Article  PubMed  CAS  Google Scholar 

  74. Gerhardt MA, Grichnik KP. Early extubation and neurologic examination following combined carotid endarterectomy and coronary artery bypass grafting using remifentanil. J Clin Anesth 1998; 10: 249–52

    Article  PubMed  CAS  Google Scholar 

  75. Krenn H, Deusch E, Jellinek H, et al. Remifentanil or propofol for sedation during carotid endarterectomy under cervical plexus block. Br J Anaesth 2002; 87: 637–40

    Article  Google Scholar 

  76. Engelhard K, Werner C, Mollenberg O, et al. Effects of remifentanil/propofol in comparison with isoflurane on dynamic cerebrovascular autoregulation in humans. Acta Anaesthesiol Scand 2001; 45: 971–6

    Article  PubMed  CAS  Google Scholar 

  77. Sloan TB, Heyer EJ. Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol 2002; 19: 430–43

    Article  PubMed  Google Scholar 

  78. Pechstein U, Nadstawek J, Zentner J, et al. Isoflurane plus nitrous oxide versus propofol for recording of motor evoked potentials after high frequency repetitive electrical stimulation. Electroencephalogr Clin Neurophysiol 1998; 108: 175–81

    Article  PubMed  CAS  Google Scholar 

  79. Wass CT, Grady RE, Fessier AJ, et al. The effects of remi-fentanil on epileptiform discharges during intraoperative electrocorticography in patients undergoing epilepsy surgery. Epilepsia 2001; 42: 1340–4

    Article  PubMed  CAS  Google Scholar 

  80. Bacon R, Chandrasekan V, Haigh A, et al. Early extubation after open heart surgery with total intravenous anaesthetic technique [letter]. Lancet 1995; 345: 133–4

    Article  PubMed  CAS  Google Scholar 

  81. Wang JYY, Winship SM, Thomas SD, et al. Induction of anaesthesia in patients with coronary artery disease: a comparison between sevoflurane-remifentanil and fentanyl-etomidate. Anaesth Intensive Care 1999; 27: 363–8

    PubMed  CAS  Google Scholar 

  82. Mollhoff T, Herregods L, Moerman A, et al. Comparative efficacy and safety of remifentanil and fentanyl in “fast-track” coronary artery bypass graft surgery: a randomized, double-blind study. Br J Anaesth 2001; 87: 718–26

    Article  PubMed  CAS  Google Scholar 

  83. Myles PS, Hunt JO, Fletcher H, et al. Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. Anesth Analg 2002; 95: 805–12

    PubMed  CAS  Google Scholar 

  84. Cheng DCH, Newman MF, Duke P, et al. The efficacy and resource utilization of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: a prospective randomized, double-blinded controlled, multi-center trial. Anesth Analg 2001; 92: 1094–102

    Article  PubMed  CAS  Google Scholar 

  85. Michelsen LG, Holford NHG, Lu W, et al. The pharmacokinetics of remifentanil in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Anesth Analg 2001; 93: 1100–5

    Article  PubMed  CAS  Google Scholar 

  86. Blair JM, Hill DA, Fee JPH. Patient-controlled analgesia for labour using remifentanil: a feasibility study. Br J Anaesth 2001; 87: 415–20

    Article  PubMed  CAS  Google Scholar 

  87. Volmanen P, Akural EI, Raudaskoski T, et al. Remifentanil in obstetric analgesia: a dose-finding study. Anesth Analg 2002; 94: 913–7

    Article  PubMed  CAS  Google Scholar 

  88. Olufolabi AJ, Booth JV, Wakeling HG, et al. A preliminary investigation of remifentanil as a labor analgesic. Anesth Analg 2000; 91: 60–8

    Article  Google Scholar 

  89. Albrecht S, Fechner J, Geisslinger G, et al. Postoperative pain control following remifentanil-based anesthesia for major abdominal surgery. Anaesthesia 2000; 55: 315–22

    Article  PubMed  CAS  Google Scholar 

  90. Kochs E, Cote D, Deruyck L, et al. Postoperative pain management and recovery after remifentanil-based anesthesia with isoflurane or propofol for major abdominal surgery. Br J Anaesth 2000; 84: 169–73

    Article  PubMed  CAS  Google Scholar 

  91. Muñoz HR, Guerrero ME, Brandes V, et al. Effect of timing of morphine administration during remifentanil-based anaesthesia on early recovery from anaesthesia and postoperative pain. Br J Anaesth 2002; 88: 814–8

    Article  PubMed  Google Scholar 

  92. Sommer M, Riedel J, Fusch C, et al. Intravenous anaesthesia with remifentanil in a preterm infant. Paediatr Anaesth 2001; 11: 252–3

    Article  PubMed  CAS  Google Scholar 

  93. Muñoz HR, Cortínez LI, Altermatt FR, et al. Remifentanil requirements during sevoflurane administration to block somatic and cardiovascular responses to skin incision in children and adults. Anesthesiology 2002; 97: 1142–5

    Article  PubMed  Google Scholar 

  94. Chambers N, Lopez T, Thomas J, et al. Remifentanil and the tunneling phase of paediatric ventriculoperitoneal shunt insertion: a double-blind, randomized, prospective study. Anaesthesia 2002; 57: 133–9

    Article  PubMed  CAS  Google Scholar 

  95. Prys-Roberts C, Lerman J, Murat I, et al. Comparison of remifentanil versus regional anaesthesia in children anaesthetized with isoflurane/nitrous oxide: International Remifentanil Paediatric Anaesthesia Study Group. Anaesthesia 2000; 55: 870–6

    Article  PubMed  CAS  Google Scholar 

  96. Foubert L, Reyntjens K, DeWolf D,et al. Remifentanil infusion for cardiac catheterization in children with congenital heart disease. Acta Anaethesiol Scand 2002; 46: 355–60

    Article  CAS  Google Scholar 

  97. Keidan I, Berkenstadt H, Sidi A, et al. Propofol/remifentanil versus propofol alone for bone marrow aspiration in paediatric haemato-oncological patients. Paediatr Anaesth 2001; 11: 297–301

    Article  PubMed  CAS  Google Scholar 

  98. Reyle-Hahn M, Niggemann B, Max M, et al. Remifentanil and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy. Paediatr Anaesth 2000; 10: 59–63

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

There were no sources of funding for this article. The authors have no potential conflicts of interest directly related to the contents of this manuscript.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, New York, USA

    Richard Beers & Enrico Camporesi

Authors
  1. Richard Beers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enrico Camporesi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard Beers.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beers, R., Camporesi, E. Remifentanil Update. CNS Drugs 18, 1085–1104 (2004). https://doi.org/10.2165/00023210-200418150-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-200418150-00004

Keywords

Search

Navigation