Remifentanil: When and How to Use It
A surprising number of reviews has appeared about the recently introduced 4-anilidopiperidine analgesic, remifentanil. Some are of use [1, 2], most without. One is amused to read over-exaggerated enthusiasm about the short duration of its effect. This may indicate that doctors are still uncomfortable with the fact that most opiates and opioids produce depression of ventilation unless they are titrated against pain. Remifentanil has not brought with itself any essential advantage over the pre-existing opiates or opioids. The notion that it is more potent must be discarded right away because this is merely a matter of dosage per unit body-weight. In a period when there is a tendency to provide adequate analgesia by self-administration (i.e. patient-controlled analgesia) this drug is an anachronism: the gradual sequence of effects of an opiate analgesic is compressed into an all-or-nothing phenomenon. In presence of severe pain, remifentanil does not succeed in producing analgesia followed by sedation, somnolence and, at some distance in time, by depression of respiration. It causes all this at once.
KeywordsAdequate Analgesia Spinal Fusion Surgery Monitor Anesthesia Care Surprising Number Remifentanil Group
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