Remifentanil For A High Risk Patient

The commonly used opiates have limitations like accumulation, unpredictable metabolism, active metabolites and unwanted side effects, like vasodilation, respiratory depression, GI-motility depression and confusion. Their clearance from the body is organ dependent morphine clearance depends on kidney and that of fentanyl on liver function, respectively. Remifentanil, a new and novel opiate is a selective m agonist with uniquely predictable effects and organ independent metabolism[ 1, 2 ]. Generally there is no accumulation of drug or metabolites after it's use. It's major metabolite G1 90291, around 4000 times weaker than the parental drug, did accumulated after prolonged use in a group of patients with severe renal failure, but without clinical implications [ 3 ]. Remifentanil is considered a potent tool in the operating theatre and recently in ICU setting as well [ 3, 4 ]. We would like to present the use of Remifentanil as a component of total intravenous anesthetic technique for a high-risk patient.