From the FDA Drug Label
Remifentanil hydrochloride for injection is an opioid agonist indicated for intravenous administration: As an analgesic agent for use during the induction and maintenance of general anesthesia for inpatient and outpatient procedures For continuation as an analgesic into the immediate postoperative period in adult patients under the direct supervision of an anesthesia practitioner in a postoperative anesthesia care unit or intensive care setting. Sufentanil is an opioid agonist. When used in balanced general anesthesia, sufentanil has been reported to be as much as 10 times as potent as fentanyl.
The latest opioid used for anesthesia mentioned in the provided drug labels is remifentanil and sufentanil, both of which are opioid agonists used for analgesia during general anesthesia 1 2.
- Remifentanil is indicated for use in the induction and maintenance of general anesthesia.
- Sufentanil is reported to be as much as 10 times as potent as fentanyl when used in balanced general anesthesia.
From the Research
Remifentanil is currently considered the latest and most advanced opioid used in anesthesia practice. It is an ultra-short-acting synthetic opioid with a rapid onset (about 1 minute) and extremely short context-sensitive half-time (3-5 minutes) regardless of infusion duration 3. Remifentanil is typically administered as a continuous infusion at 0.05-2.0 mcg/kg/min, often with a loading dose of 0.5-1 mcg/kg. Its unique pharmacokinetic profile is due to metabolism by nonspecific blood and tissue esterases, allowing for rapid clearance independent of liver or kidney function. This makes remifentanil particularly valuable for procedures requiring intense analgesia with rapid recovery, such as outpatient surgeries, neurological procedures requiring intraoperative awakening, or cases where postoperative respiratory depression must be minimized 4. However, because of its rapid offset, transitioning to longer-acting analgesics before discontinuation is essential to prevent immediate postoperative pain. Remifentanil also causes dose-dependent respiratory depression, hypotension, and bradycardia similar to other opioids, requiring appropriate monitoring and careful titration during administration.
Some key points to consider when using remifentanil include:
- Its rapid onset and short context-sensitive half-time make it ideal for procedures requiring quick recovery
- It is typically administered as a continuous infusion, often with a loading dose
- Its unique pharmacokinetic profile allows for rapid clearance independent of liver or kidney function
- It is particularly valuable for outpatient surgeries, neurological procedures, and cases where postoperative respiratory depression must be minimized
- Transitioning to longer-acting analgesics before discontinuation is essential to prevent immediate postoperative pain
It's worth noting that while other opioids, such as sufentanil and alfentanil, are also used in anesthesia practice, remifentanil's unique pharmacokinetic profile makes it a valuable option for certain procedures 5, 6, 7. However, the most recent and highest quality study available 3 supports the use of remifentanil as the latest and most advanced opioid used in anesthesia practice.