Sedation, analgesia and paralysis
Remifentanil (Ultiva) drip
Ultiva
Dosing
| Start | ICU analgesia-sedation (EU label): 0.1–0.15 mcg/kg/min, no bolus. After surgery, under anesthesia supervision (US label): 0.1 mcg/kg/min. Obesity: dose by ideal body weight |
|---|---|
| Titrate | 0.025 mcg/kg/min no more often than every 5 minutes; if sedation is still short at 0.2, add a sedative (EU label) |
| Maximum | US label after surgery: 0.025–0.2 mcg/kg/min (higher rates depress breathing; up to 1 while ventilated after CABG). EU ICU range up to 0.74, studied for up to 3 days |
| Common bags | 5 mg in 100 mL (50 mcg/mL); 2 mg in 100 mL (20 mcg/mL) |
| Dose units | mcg/kg/min, mcg/kg/h |
Line and administration
- Not in the same tubing as blood (blood esterases); run it close to the patient
- When it stops, clear or remove the line: a later flush can give a hidden bolus (apnea, rigidity)
Watch for
- Analgesia gone 5–10 minutes after stopping (esterase metabolism; context-sensitive half-time about 3 minutes): start longer-acting analgesia first; after extubation wean in 25% steps every 10 minutes (EU label)
- Chest wall rigidity with boluses over 1 mcg/kg or rates over 0.1 mcg/kg/min without a hypnotic
- Bradycardia, hypotension, apnea; tolerance and hyperalgesia after high-dose infusions
Remifentanil: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
Other sedation, analgesia and paralysis
- Propofol
- Dexmedetomidine
- Midazolam
- Fentanyl
- Cisatracurium
- Ketamine
- Hydromorphone
- Rocuronium
- Vecuronium
- Pentobarbital
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.