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Intraoperative Use of Remifentanil for TIVA: Postoperative Pain, Acute Tolerance, and Opioid-Induced Hyperalgesia

2015; Elsevier BV; Volume: 29; Linguagem: Inglês

10.1053/j.jvca.2015.01.026

1532-8422

Martin S. Angst,

Anesthesia and Neurotoxicity Research

REMIFENTANIL IS frequently the opioid of choice when relying on total intravenous anesthetic (TIVA) protocols. The unique pharmacokinetic properties of remifentanil afford a fast onset of action and a predictable and rapid recovery independent of the infusion duration. 1 Minto C.F. Schnider T.W. Egan T.D. et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology. 1997; 86: 10-23 Crossref PubMed Scopus (975) Google Scholar , 2 Scott L.J. Perry C.M. Remifentanil: A review of its use during the induction and maintenance of general anaesthesia. Drugs. 2005; 65: 1793-1823 Crossref PubMed Scopus (100) Google Scholar The high lipid solubility and low ionization of remifentanil at physiological pH allow for its quick transfer from blood to central nervous system binding sites as mirrored by its fast onset of action. The very short elimination half-life and stable context-sensitive half time reflect the exceptionally high clearance of remifentanil by plasma and tissue esterases. In the context of TIVA, these pharmacokinetic properties are ideal to meet anesthetics needs with the rapid up-and-down titration of remifentanil and the exposure to relatively high cumulative doses, as such use hardy affects recovery time.