Why ULTIVA

Rapid response

  • Helps facilitate early extubation1,2*,4
    Prepare for postoperative pain. Rapid offset of Remi results in rapid dissipation of analgesic effect within 5-10 minutes of discontinuation. Other analgesics should be administered prior to discontinuation where postoperative pain is anticipated1

Intraoperative stability

  • Helps manage the intraoperative stress response1,2,5
    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 vasopressors1

Added characteristics of ULTIVA

  • No difference in PK in obese patients (dose adjusted IBW)1
  • Can be used in patients with renal or hepatic impairment1
  • Well-established hemodynamic profile1
*

Median time between end of surgery and eligibility for extubation: 295 minutes (Remi) vs 375 minutes (sufentanil) (P<0.05).2

The study recognized that both Remi and fentanyl allowed for early extubation.4

Remifentanil is commonly referred to as Remi by anesthesia providers.

Cardiac case study––CABG

Obese 48-year-old male

5'10'', 95.7 kg (211 lb)

BMI 30.3 kg/m2

Comorbidities

  • Obesity
  • Type 1 diabetes
  • Hypertension
  • Renal insufficiency

Previous reaction to sulfa drugs

History of peripheral neuropathy, motion sickness, and claustrophobia 

Medications: insulin, beta-blocker, ACE inhibitor

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.

 

 

Goal: predictable control

Characteristics of ULTIVA in cardiac surgery include:

See also:

  1. ULTIVA [package insert]. Rockford, IL: Mylan Institutional LLC; 2016.
  2. Lison S, Schill M, Conzen P. Fast-track cardiac anesthesia: efficacy and safety of remifentanil versus sufentanil. J Cardiothorac Vasc Anesth. 2007;21(1):35-40. Supported by a grant from GlaxoSmithKline.
  3. Knapik M, Knapik P, Nadziakiewicz P, et al. Comparison of remifentanil or fentanyl administration during isoflurane anesthesia for coronary artery bypass surgery. Med Sci Monit. 2006;12(8):P133-P138.
  4. Howie MB, Cheng D, Newman MF, et al. A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery. Anesth Analg. 2001;92(5):1084-1093.
  5. Winterhalter M, Brandl K, Rahe-Meyer N, et al. Endocrine stress response and inflammatory activation during CABG surgery: a randomized trial comparing remifentanil infusion to intermittent fentanyl. Eur J Anaesthesiol. 2008;25(4):326-335.