Howtouseremifentanilingeneralanaesthesia.pptVIP

How to use remifentanil in general anaesthesia How to use remifentanil in general anaesthesia Properties of remifentanil Intra-operative control Recovery Reconstitution Dosing protocol for general anaesthesia Hypnotic sparing effects in general anaesthesia Post-operative pain management Summary References Prescribing information Properties of remifentanil Intra-operative control Remifentanil is suitable for use in many different types of surgery1–5 Remifentanil’s fast onset and short duration of action enables rapid titration to effect6 Remifentanil offers a unique approach to the management of surgical patients by providing: More effective control of intra-operative responses than alfentanil or fentanyl7,8 More effective at maintaining haemodynamic stability than alfentanil or fentanyl5,9 Control in difficult-to-treat patients with renal or hepatic impairment, with no initial dose adjustment needed10-12 Recovery Remifentanil provides fast, clear-headed recovery1–3 Recovery with remifentanil is more rapid than with fentanyl or alfentanil2,3 Remifentanil facilitates rapid extubation and reduces the need for ICU admission1–5 Remifentanil enables early post-operative neurological assessment1–3 Post-operative pain can be effectively managed6 Reconstitution Available as lyophilised powder for reconstitution in 1mg, 2mg and 5mg vials To reconstitute add recommended diluent to powder in vial and shake well After reconstitution, further dilute to recommended dilution 50μg/ml is the recommended dilution for adults Dosing protocol for general anaesthesia – induction Remifentanil is indicated as an analgesic agent for use during induction and/or maintenance of general anaesthesia under close supervision1 Induction of anaesthesia in adults:* Remifentanil: continuous infusion 0.5–1μg/kg/min1 Mackey et al used an infusion rate of 0.5μg/kg/min for 2 minutes prior to intubation2 Warner et al used an infusion rate of 0.5–1μg/kg/min for 1 minute prior to intubation3 Isoflurane: sta