Remifentanil1995.doc.docVIP

Remifentanil Review, 1995 Remifentanil is a novel opioid that has moved rapidly through the clinical development process. Remifentanil has been approved by the FDA, and commercial release of remifentanil is imminent. Remifentanil offers unique advantages and unique risks, which will be the topic of this presentation. Remifentanil is being developed by Glaxo. Before continuing, the reader should know that Glaxo has funded remifentanil clinical trials in my laboratory, and that I am a paid consultant to Glaxo for the remifentanil development program. Although my remarks are intended to be balanced, the reader must draw his or her own conclusions. Remifentanil is a pure agonist at the ( opioid receptor, with relatively little binding at the (, (, and ( receptors. This is exactly the profile for opioids presently popular in anesthetic practice: fentanyl, alfentanil, and sufentanil. Remifentanil’s pharmacology can be predicted from what we already know about fentanyl, alfentanil, and sufentanil: Remifentanil is a potent analgesic, Remifentanil causes sedation, Remifentanil reduces MAC of inhalational anesthetics, but with a ceiling effect, Remifentanil exhibits modest synergy with intravenous hypnotics at producing a loss of consciousness, Remifentanil exhibits profound synergy with intravenous hypnotics at reducing the movement and hemodynamic response to noxious stimulation, High-dose remifentanil anesthesia will be associated with hemodynamic stability, High-dose remifentanil anesthesia will attenuate the stress response, Remifentanil is a profound ventilatory depressant, The sedating effects of remifentanil are at concentrations close to those that cause ventilatory depression, Remifentanil causes muscle rigidity, Remifentanil causes nausea, Remifentanil causes itching, Remifentanil produces the same effect on the EEG as other opioids, Remifentanil has abuse potential. We can predict these characteristics of remifentanil because they are also the characteris