Remifentanil Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Anesthesia

Induction of Anesthesia: Continuous IV infusion: 0.5 to 1 mcg/kg/min. If endotracheal intubation is to occur in less than 8 minutes, an initial dose of 1 mcg/kg may be administered over 30 to 60 seconds.

Maintenance of Anesthesia: With Nitrous Oxide, 0.4 mg/kg/min by continuous IV infusion.
Infusion dose range: 0.1 to 2 mcg/kg/min.
Supplemental IV bolus: 1 mcg/kg every 2 to 5 minutes.

With Isoflurane or Propofol: 0.25 mg/kg/min by continuous IV infusion.
Infusion dose range. 0.05 to 2 mcg/kg/min.
Supplemental IV bolus: 1 mcg/kg dose.

Continuation into Postoperative Period: Continuous IV infusion: 0.1 mcg/kg/min.
Infusion dose range: 0.025 to 0.2 mcg/kg/min.

Monitored Anesthesia Care: Single IV dose: 1 mcg/kg over 30 to 60 seconds, given 90 seconds before local anesthetic or 0.5 mcg/kg with midazolam 2 mg.

Continuous IV infusion: 0.1 mcg/kg/min beginning 5 minutes before local anesthetic. Then, decrease to 0.05 mcg/kg/min (range 0.025 to 0.2 mcg/kg/min) after local anesthetic or
0.05 mcg/kg/min given with midazolam 2 mg, beginning 5 minutes before local anesthetic . Then, decrease to 0.025 mcg/kg/min (range 0.025 to 0.2 mcg/kg/min) after local anesthetic.

Usual Pediatric Dose for Anesthesia

Neonatal:
Maintenance of anesthesia with nitrous oxide (70%):
IV continuous infusion: 0.4 mcg/kg/minute (range: 0.4 to 1 mcg/kg/minute)
Supplemental bolus dose of 1 mcg/kg may be administered; smaller bolus dose may be required with potent inhalation agents, potent neuraxial anesthesia, significant comorbidities, significant fluid shifts, or without atropine pretreatment.
Clearance in neonates is highly variable. Dose should be carefully titrated.
Endotracheal intubation (nonemergent): IV: 1 to 3 mcg/kg/dose; may repeat dose in 2 to 3 minutes if needed.

IV continuous infusion: Dose should be based on ideal body weight (IBW) in obese patients (greater than 30% over IBW).

Infants 1 to 2 months: Maintenance of anesthesia with nitrous oxide (70%): 0.4 mcg/kg/minute (range: 0.4 to 1 mcg/kg/minute).
Supplemental bolus dose of 1 mcg/kg may be administered, smaller bolus dose may be required with potent inhalation agents, potent neuraxial anesthesia, significant comorbidities, significant fluid shifts, or without atropine pretreatment.

Children 1 to 12 years: Maintenance of anesthesia with halothane, sevoflurane, or isoflurane: 0.25 mcg/kg/minute (range: 0.05 to 1.3 mcg/kg/minute)
Supplemental bolus dose of 1 mcg/kg may be administered every 2 to 5 minutes. Consider increasing concomitant anesthetics with infusion rate greater than 1 mcg/kg/minute. Infusion rate can be titrated upward in increments up to 50% or titrated downward in decrements of 25 to 50%. May titrate every 2 to 5 minutes.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

Calculate the starting dose using ideal body weight (IBW) in obese patients (>30% over IBW).

Precautions

Remifentanil is not recommended as the sole agent in general anesthesia because loss of consciousness cannot be assured and because of a high incidence of apnea, muscle rigidity and tachycardia.

Remifentanil should only be administered by clinicians specifically trained to use intravenous anesthetics. It is essential that qualified personnel and adequate facilities are available for the treatment of postoperative respiratory depression. Respiratory depression will abate approximately 10 minutes after the discontinuance of a remifentanil infusion. Administration of the narcotic antagonist, naloxone, has not been shown to be more effective or more prompt in reversing respiratory depression than the discontinuation of remifentanil. Naloxone can be used to manage severe respiratory depression or muscle rigidity, however.

Bolus doses of remifentanil should not be administered to patients who are spontaneously breathing and also receiving a continuous infusion of remifentanil.

Administration of remifentanil at a rate greater than 0.2 mcg/kg/min is usually associated with hypoventilation (respiratory rate of less than 8 breaths/minute). The manufacturer strongly recommends that supplemental oxygen be supplied whenever remifentanil is administered.

Analgesic effects will dissipate within 5 to 10 minutes after discontinuation of remifentanil. Adequate postoperative analgesia should be established prior to discontinuation of remifentanil.

The intravenous tubing supplying the remifentanil infusion should be cleared of residual drug after the discontinuation of therapy.

Dialysis

Data not available

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