Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital 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): 
Narcotic analgesic
Original Date: 
September 2017
  • Premedication for non-urgent endotracheal intubation in neonates, when a fast onset of action and short duration narcotic is desired.
  • IV direct: over 1 - 2 minutes
  • Rapid sequence intubation:
    • 2 mcg/kg/dose


Side Effects: 
  • CNS: depression, dizziness, drowsiness, sedation
  • CVS: bradycardia, hypotension
  • Respiratory: depression, respiratory muscle stiffness
Parameters to Monitor: 
  • BP
  • HR
  • RR
  • O2 requirements
Reconstitution and Stability: 

IV direct:

  • Remifentanil 1 mg (1000 mcg) vial
    • Add 1 mL of SWFI
    • Take 0.1 mL (100 mcg) and add to 9.9 mL of 0.9%NaCl
    • Final concentration: 10 mcg/mL

- Solution Compatible: D5W, 0.9% NaCl, 0.45% NaCl, D5W/0.9% NaCl

- Y-site Compatible: calcium gluconate, dobutamine, dopamine, epinephrine, fentanyl, heparin, midazolam, morphine, potassium chloride

- Incompatible: amphotericin B, chlorpromazine, diazepam


- Choong et al.  Remifentanil for endotracheal intubation in neonates: a randomised controlled trial.  Arch Dis Fetal Neonatal Ed 2010; 95: F80- F84

- Avino et al.  Remifentanil versus Morphine-Midazolam Premedication on the Quality of Endotracheal Intubation in Neonates: A Noninferiority Randomised Trial. J. Pediat 2014; 164: 1032-7

- Welzing et al.  Remifentanil for INSURE in preterm infants: a pilot study for evaluation of efficacy and safety aspects. Acta Ped 2009; 98: 1416-20

- Yerkes et al.  Morphine versus remifentanil for intubating preterm neonates. Arch Dis Child Fetal Neonatal Ed 2007; 92: F293-294

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