lBREAST FEEDINGPresent in milk—withhold breast-
feeding for 24 hours.
lRENAL IMPAIRMENTAvoid use or reduce dose; opioid
effects increased and prolonged and increased cerebral
sensitivity occurs.
lDIRECTIONS FOR ADMINISTRATION 5 mg/mL injection to be
diluted before use. Forcontinuous or intermittent
intravenous infusiondilute in Glucose 5 %orSodium
Chloride 0. 9 %.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection
Solution for injection
▶Alfentanil (Non-proprietary)
Alfentanil (as Alfentanil hydrochloride) 500 microgram per
1mlAlfentanil 1 mg/ 2 ml solution for injection ampoules|
10 ampouleP£ 5. 95 b
Alfentanil 25 mg/ 50 ml solution for injection vials| 1 vialP
£ 14. 90 b
Alfentanil 5 mg/ 10 ml solution for injection ampoules|
5 ampouleP£ 13. 90 b
Alfentanil (as Alfentanil hydrochloride) 5 mg per 1 mlAlfentanil
5 mg/ 1 ml solution for injection ampoules| 10 ampouleP£ 21. 95
DT = £ 23. 19 b
▶Rapifen(Piramal Critical Care Ltd)
Alfentanil (as Alfentanil hydrochloride) 500 microgram per
1mlRapifen 5 mg/ 10 ml solution for injection ampoules|
5 ampouleP£ 14. 50 b
Rapifen 1 mg/ 2 ml solution for injection ampoules| 10 ampouleP
£ 6. 34 b
Alfentanil (as Alfentanil hydrochloride) 5 mg per 1 mlRapifen
Intensive Care 5 mg/ 1 ml solution for injection ampoules|
10 ampouleP£ 23. 19 DT = £ 23. 19 (Hospital only)b
eiiiiF 273
Remifentanil
lINDICATIONS AND DOSE
Analgesia and enhancement of anaesthesia at induction
(initial bolus injection)
▶BY INTRAVENOUS INJECTION
▶Child 12–17 years:Initially 0. 25 – 1 microgram/kg, dose to
be administered over at least 30 seconds, if child is to
be intubated more than 8 minutes after start of
intravenous infusion, initial bolus intravenous
injection dose is not necessary
Analgesia and enhancement of anaesthesia at induction
with or without initial bolus dose
▶BY INTRAVENOUS INFUSION
▶Child 12–17 years: 30 – 60 micrograms/kg/hour, if child is
to be intubated more than 8 minutes after start of
intravenous infusion, initial bolus intravenous
injection dose is not necessary
Assisted ventilation: analgesia and enhancement of
anaesthesia during maintenance of anaesthesia (initial
bolus injection)
▶BY INTRAVENOUS INJECTION
▶Child 1 month–11 years:Initially 0. 1 – 1 microgram/kg,
dose to be administered over at least 30 seconds
(omitted if not required)
▶Child 12–17 years:Initially 0. 1 – 1 microgram/kg, dose to
be administered over at least 30 seconds (omitted if not
required)
Assisted ventilation: analgesia and enhancement of
anaesthesia during maintenance of anaesthesia with or
without initial bolus dose
▶BY INTRAVENOUS INFUSION
▶Neonate: 24 – 60 micrograms/kg/hour, additional doses of
1 microgram/kg can be givenby intravenous injection
during the intravenous infusion.▶Child 1 month–11 years: 3 – 78 micrograms/kg/hour, dose
to be administered according to anaesthetic technique
and adjusted according to response, additional doses
can be givenby intravenous injectionduring the
intravenous infusion
▶Child 12–17 years: 3 – 120 micrograms/kg/hour, dose to
be administered according to anaesthetic technique
and adjusted according to response, additional doses
can be givenby intravenous injectionduring the
intravenous infusion
Spontaneous respiration: analgesia and enhancement of
anaesthesia during maintenance of anaesthesia
▶BY INTRAVENOUS INFUSION
▶Child 12–17 years:Initially 2. 4 micrograms/kg/hour,
adjusted according to response; usual dose
1. 5 – 6 micrograms/kg/hour
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.lUNLICENSED USENot licensed for use in children under
1 year.
lCONTRA-INDICATIONSAnalgesia in conscious patients
lINTERACTIONS→Appendix 1 : opioids
lSIDE-EFFECTS
▶Common or very commonApnoea.muscle rigidity.post
procedural complications
▶UncommonHypoxia
▶Rare or very rareCardiac arrest
▶Frequency not knownAgitation.atrioventricular block.
hypertension.seizure
SIDE-EFFECTS, FURTHER INFORMATIONIn contrast to other
opioids which are metabolised in the liver, remifentanil
undergoes rapid metabolism by plasma esterases; it has
short duration of action which is independent of dose and
duration of infusion.
Muscle rigidityRemifentanil can cause muscle rigidity
that can be managed by the use of neuromuscular blocking
drugs.
lPREGNANCYNo information available.
lBREAST FEEDINGAvoid breast-feeding for 24 hours after
administration—present in milk inanimalstudies.
lRENAL IMPAIRMENT
Dose adjustmentsNo dose adjustment necessary in renal
impairment.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
injection, reconstitute to a concentration of 1 mg/mL; for
continuous intravenous infusion, dilute further with Glucose
5 % or Sodium Chloride 0. 9 % to a concentration of
20 – 25 micrograms/mL for child 1 – 12 years or
20 – 250 micrograms/mL (usually 50 micrograms/mL) for
child 12 – 18 years.
lPRESCRIBING AND DISPENSING INFORMATION
Remifentanil should not be given by intravenous injection
intra-operatively, but it is well suited to continuous
infusion; a supplementary analgesic is given before
stopping the infusion of remifentanil.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for injection
▶Remifentanil (Non-proprietary)
Remifentanil (as Remifentanyl hydrochloride) 1 mgRemifentanil
1 mg powder for concentrate for solution for injection vials|
5 vialP£ 25. 60 (Hospital only)b
Remifentanil (as Remifentanyl hydrochloride) 2 mgRemifentanil
2 mg powder for concentrate for solution for injection vials|
5 vialP£ 51. 13 (Hospital only)b
Remifentanil (as Remifentanyl hydrochloride) 5 mgRemifentanil
5 mg powder for concentrate for solution for injection vials|
5 vialP£ 127. 90 (Hospital only)bBNFC 2018 – 2019 Peri-operative analgesia 819
Anaesthesia15