Rapid response

  • Well-established hemodynamic profile1,4,5
    In premedicated patients undergoing anesthesia, 1-minute infusions of
    <2 mcg/kg of Remi* cause dose-dependent hypotension and bradycardia. When appropriate, bradycardia and hypotension can be reversed by reduction of the rate of infusion of Remi or the dose of concurrent anesthetics, or by the administration of fluids or vasopressors5

Rapid recovery

  • Helps facilitate early extubation in laparoscopic gastric banding2 and gastric bypass surgery3
    Continuous infusions of Remi should be administered only by an infusion device. The injection site should be close to the venous cannula and all IV tubing should be cleared at the time of discontinuation of infusion. Interruption of an infusion of Remi will result in rapid offset of effect5

Added characteristics of ULTIVA

  • No accumulation regardless of infusion duration5
  • Rapid onset, offset, and recovery for predictable control of responsiveness5
  • No difference in pharmacokinetics between nonobese and obese§ patients when normalized to ideal body weight (IBW). Remi should be used with caution in obese patients5,6
*

Remifentanil is commonly referred to as Remi by anesthesia providers.

During first 4 hours of recovery, pain was reported higher in the Remi group. Duration of stay in postanesthesia care unit was comparable between sufentanil and Remi.2

Postoperative pain and PONV were higher in the Remi group.3

§

Patients greater than 30% over ideal body weight.5

Gastric bypass case study

45-year-old male

5'9'', 133 kg (292 lb)

BMI 43 kg/m2

Comorbidities

  • Hypertension
  • Type 2 diabetes

Medications: metformin; amlodipine/HCTZ

This case study is for illustrative and educational purposes only. The dosing regimen is specific to this case study and other regimens may vary depending on patient and procedure. Any use of this product is subject to the judgment of the practitioner in each case. Please consult the full Prescribing Information in the use of this product.

ULTIVA should be used with caution in obese patients. Clearance of remifentanil generally correlates with total body weight and may vary in morbidly obese patients due to variation in physiology and pharmacodynamics.

Gastric bypass TIVA plan 

 

Goal: predictable control

Characteristics of ULTIVA in gastric bypass include:

See also:

  1. De Baerdemaeker LEC, Jacobs S, Pattyn P, Mortier EP, Struys MMRF. Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs sufentanil TCI in morbid obesity. Br J Anaesth. 2007;99(3):404-411.
  2. Bidgoli J, Delesalle S, De Hert SG, Reiles E, Van der Linden PJ. A randomised trial comparing sufentanil versus remifentanil for laparoscopic gastroplasty in the morbidly obese patient. Eur J Anaesthesiol. 2011;28(2):120-124.
  3. Gaszynski TM, Strzelczyk JM, Gaszynski WP. Post-anesthesia recovery after infusion of propofol with remifentanil or alfentanil or fentanyl in morbidly obese patients. Obes Surg. 2004;14(4):498-503; discussion 504.
  4. Twersky RS, Jamerson B, Warner DS, Fleisher LA, Hogue S. Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. J Clin Anesth. 2001;13(6):407-416. Sponsored by Glaxo Wellcome Inc.
  5. ULTIVA [package Insert]. Rockford, IL: Mylan Institutional LLC; 2016.
  6. Egan TD, Huizinga B, Gupta SK, et al. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology. 1998;89(3):562-573.