Parenteral Manual

Remifentanil

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ULTIVA
Classification: 
Narcotic analgesic
Original Date: 
March 2010
Revised Date: 
February 2012
Indications: 
  • Pain relief component of monitored anesthesia
  • Adjunct to general or regional anesthesia
  • RESTRICTED FOR USE in PICU by STAFF ANAESTHESIOLOGISTS in mechanically ventilated patients
Reconstitution and Stability: 
  • Store at room temperature.  Protect from light.
  • Diluted solutions 20 - 250 mcg/mL stable 24 hours at room temperature
Compatibility: 

-Solutions Compatible:  D5W, 0.9% NaCl, 0.45% NaCl, D5W NS, sterile water for injection

-Y-site Compatible:  acyclovir, aminophylline, ampicillin, calcium gluconate, cefazolin, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, cisatracurium, clindamycin, dexamethasone, digoxin, diphenhydramine, dobutamine, dopamine, enalaprilat, epinephrine, esmolol,  fentanyl, fluconazole, furosemide, gentamicin, heparin, hydrocortisone sodium succinate, hydromorphone, imipenem/cilastatin, ketorolac, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, meperidine, methylprednisolone sodium succinate, metoclopramide, metronidazole, midazolam, morphine, nalbuphine, nitroglycerin, norepinephrine, ondansetron, piperacillin, piperacillin/tazobactam, potassium chloride, prochlorperazine, propofol, ranitidine,sodium bicarbonate, thiopental, tobramycin, trimethoprim/sulfamethoxazole, vancomycin

-Incompatible:  amphotericin B, chlorpromazine, diazepam

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion NO
IV Continuous Infusion

YES  -must be on an infusion pump
Standard concentrations in PICU:  20 mcg/mL, 50 mcg/mL, 250 mcg/mL
RESTRICTED for use in PICU by STAFF ANAESTHESIOLOGISTS

 

 

Pharmacokinetics:

 

 

  • Onset IV:  1 minute
  • Maximum effect: 3 - 5 minutes
  • Duration IV:  3 - 10 minutes
  • Half-life:   Terminal: 10-20 minutes; effective: 3-10 minutes
  • Metabolized rapidly via blood and tissue esterases; not metabolized by plasma cholinesterase (pseudocholinesterase) and is not appreciably metabolized by the liver
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Analgesia:

IV infusion:

  • Children: 0.025-0.3 mcg/kg/min for analgesia and sedation ; titrate up in 0.025 mcg/kg/min increments
Potential hazards of parenteral administration: 
  • Respiratory depression, hypotension, bradycardia
  • CNS depression, drowsiness, sedation, dizziness
  • ADH release, hypersensitivity reactions
  • Nausea, vomiting, constipation, biliary tract spasm, urinary tract spasm
  • Muscle rigidity

Opiod reversal: 

  • Administer 02 immediately
  • Naloxone (see Naloxone monograph)
Notes: 
  • Monitor RR, BP, HR, 02 saturation, bowel sounds, and abdominal distention

NURSING MONITORING GUIDELINES:

  • Check physician's order against guidelines; question dosage if higher.
  • Safely prepare and administer medication as per Medication Administration Policy.
  • Continuous infusion must be on a pump.
  • 02 and suction must be available at bedside
  • Patient may need to be on a respiratory monitor (or Oximeter )if there are concerns
  • IV solution without the added narcotic must be available at bedside with tubing primed, ready to be hooked to patient in case of an emergency.
  • Naloxone must be available in the patient care area as ward stock

- Monitor: Level of consciousness, respiratory rate, BP and pulse:

  • Just prior to beginning therapy
  • Then every 5 minutes for 15 minutes after the initial dose or an increase in infusion rate
  • Then monitor respiratory rate and pulse q1h × 4 hours thereafter as directed.

SIGNS & SYMPTOMS OF COMPLICATIONS:

  • Respiratory depression (RR <10 breaths/minute)
  • Somnolence, difficulty in arousing
  • Orthostatic hypotension with bradycardia
  • Nausea and vomiting
  • Allergic reaction.

ACTIONS:   Notify physician if:

  • Respiratory rate below 10 breaths per minute
  • Blood pressure decreased by 25% from baseline
  • Patient difficult to rouse
  • Allergic reaction

- Stop infusion of narcotic and start plain IV solution.  Notify physician.

- Maintain patient airway and administer O2 as indicated.

- Contact Pharmacy, Anaesthesia, or Poison Information Centre if after hours, for appropriate dose of naloxone (Narcan)

 

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