Remifentanil (Ultiva) is a fast-acting, synthetic opioid pain medication given intravenously during surgery to block pain and support general anesthesia.
It is a potent, ultra-short-acting synthetic opioid analgesic in the fentanyl family.
Potency is roughly 100–200 times that of morphine.
It is given only by intravenous infusion (or bolus in some settings) by trained medical professionals in hospital/operating-room environments with full respiratory and cardiovascular monitoring and support available:
It attaches to mu-opioid receptors in the brain and spinal cord to shut off pain signals.
It is a selective μ-opioid receptor agonist.
Fast onset: It starts to work within 1 to 2 minutes after injection.
Unlike other opioids, blood and tissue enzymes break it down instead of the liver.
It is metabolized by nonspecific tissue and plasma esterases (not primarily by the liver or kidneys), so it does not accumulate even with prolonged infusion. Its context-sensitive half-life stays around 3–4 minutes.
Quick recovery: Its half-life is only 3 to 10 minutes, meaning its effects wear off very fast after the infusion stops.
Uses:
General surgery: Used alongside other anesthetics to keep patients unconscious and pain-free.
Analgesia during induction and maintenance of general anesthesia.
Adjunct to other anesthetics.
Analgesia and sedation in mechanically ventilated intensive-care patients.
Airway management: Helps prevent a sudden stress response when a breathing tube is inserted.
Post-surgery care: Used for short-term pain relief right after an operation.
Used in a wide range of surgeries (cardiac, neurosurgical, spinal, etc.) and sometimes in electroconvulsive therapy or other procedures.
It is not intended for routine postoperative pain control outside of closely supervised settings, nor for use without mechanical ventilation support when respiratory depression is a risk.
Common Side Effects
Can cause temporary respiratory depression. May cause blood pressure to drop. Can lower the heart rate (bradycardia). Can make muscles rigid, making breathing support necessary during administration. Dizziness and vomiting can happen as it wears off. Postoperative shivering
Serious risks include life-threatening respiratory depression, which is why it is restricted to controlled clinical environments.
Effects can be reversed with naloxone, though the short half-life of remifentanil usually means effects wear off quickly once the infusion is stopped.
It is a controlled substance (Schedule II in the United States).
Contraindicated for epidural or intrathecal (spinal) use because the formulation contains glycine.
Requires continuous monitoring; misuse can cause overdose, addiction, or death.