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INTRODUCTION

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HIGH ALERT

remifentanil (rem-i-fen-ta-nil)

Ultiva

Classification

Therapeutic: opioid analgesics

Pharmacologic: opioid agonists

Schedule II

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Indications
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Analgesic supplement to general anesthesia; usually with other agents (ultra–short-acting barbiturates, neuromuscular blockers, and inhalation anesthetics) to produce balanced anesthesia. Induction/maintenance of anesthesia (with oxygen or oxygen/nitrous oxide and a neuromuscular blocker). Analgesic component for monitored anesthesia care (MAC).

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Action
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Binds to opiate receptors in the CNS, altering the response to and perception of pain. Produces CNS depression. Therapeutic Effects: Supplement in anesthesia. Decreased pain.

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Adverse Reactions/Side Effects
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CNS: confusion, paradoxical excitation/delirium, postoperative depression, postoperative drowsiness.

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EENT: blurred/double vision. Resp: APNEA, LARYNGOSPASM, allergic bronchospasm, respiratory depression.

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CV: arrhythmias, bradycardia, circulatory depression, hypotension. GI: biliary spasm, nausea/vomiting (↑ in children). Derm: facial itching. MS: skeletal and thoracic muscle rigidity, shivering (↑ in children).

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PHYSICAL THERAPY IMPLICATIONS*

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*Implications refer primarily to any residual effects that occur typically within 24 hr after anesthesia.

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Examination and Evaluation
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  • Assess respiration, and notify physician immediately if patient exhibits any interruption in respiratory rate (apnea) or signs of respiratory depression, including decreased respiratory rate, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendix I) to quantify suspected changes in ventilation and respiratory function. Apnea or excessive respiratory depression requires emergency care.

  • Monitor signs of laryngeal spasm and allergic bronchospasm, including tightness in the throat and chest, wheezing, cough, and severe shortness of breath. Notify physician or nursing staff immediately if these reactions occur.

  • Be alert for excessive sedation or changes in mood and behavior (confusion, excitation, delirium). Notify physician or nursing staff immediately if patient is unconscious or extremely difficult to arouse.

  • Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

  • Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension) or signs of circulatory depression, including dizziness, fainting, weakness, pallor, and light-headedness.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Be alert for residual muscle rigidity and decreased thoracic and limb movements after rapid IV administration. Report a sustained increase in muscle tone.

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off opioid analgesics as soon as possible.

  • Because of the risk of respiratory depression and hypotension, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart ...

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