Spotlight on Remifentanil for General Anaesthesia
Scott LJ, Perry CM.
Adis International Limited,
Auckland, New Zealand.
CNS Drugs. 2005;19(12):1069-1074.


Remifentanil (Ultiva trade mark), a fentanyl derivative, is an ultra-short acting, nonspecific esterase-metabolised, selective mu-opioid receptor agonist, with a pharmacodynamic profile typical of opioid analgesic agents. Notably, the esterase linkage in remifentanil results in a unique and favourable pharmacokinetic profile for this class of agent.Adjunctive intravenous remifentanil during general anaesthesia is an effective and generally well tolerated opioid analgesic in a broad spectrum of patients, including adults and paediatric patients, undergoing several types of surgical procedures in both the inpatient and outpatient setting. Remifentanil is efficacious in combination with intravenous or volatile hypnotic agents, with these regimens generally being at least as effective as fentanyl- or alfentanil-containing regimens in terms of attenuation of haemodynamic, autonomic and somatic intraoperative responses, and postoperative recovery parameters. The rapid offset of action and short context-sensitive half-time of remifentanil, irrespective of the duration of the infusion, makes the drug a valuable opioid analgesic option for use during balanced general inhalational or total intravenous anaesthesia where rapid, titratable, intense analgesia of variable duration, and a fast and predictable recovery are required.
Nitrous oxide
Inhaled anaesthetics
Remifentanil (Ultiva)
Obstetric anaesthesia
Molecular mechanisms
Chloroform anaesthesia
A thalamocortical switch?
Anaesthesia and the spinal chord
History of anaesthesia apparatus
Consciousness, anaesthesia and anaesthetics
Anaesthesia: mutants in yeast, nematodes, fruit flies and mice

and further reading
Future Opioids
BLTC Research
Utopian Surgery?
The Good Drug Guide
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World