Remifentanil Anesthesia: Efficacy and the Prevention of Adverse Effects

Abstract

  It has been demonstrated that remifentanil anesthesia suppresses noxious stimulation induced endocrine responses. However, remifentanil-related adverse effects such as bradycardia, hypotension, shivering, acute tolerance, hyperalgesia, and vocal cord closure have also been recognized.
  Bradycardia during anesthetic induction using 0.5μg/kg/min of remifentanil has occurred in 20% of patients. Either atropine pretreatment or decreased remifentanil administration was effective in preventing bradycardia. Non-thermo-regulatory response might contribute to shivering. Both mechanisms and prevention of acute tolerance and hyperalgesia are not understood fully, although many studies have performed. Rapid offset of remifentanil has been considered to be responsible for some adverse effects. Therefore, appropriate administration of transitional opioids is necessary. Morphine at 0.15 mg/kg or 200-300 μg of fentanyl is recommended.