Rapid response

  • Quick emergence for neurological assessment1,3*,4*
    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
    Despite the higher risk of treatable postoperative hypertension, propofol-Remi allowed for earlier cognitive recovery1,4

Rapid recovery

  • Supports return of cognitive function1,2*
    Normal recovery score at 30 minutes was 81% in Remi-treated patients versus 59% in fentanyl-treated patients (P=0.06). Recovery rates were similar at 45 minutes1,2

Added characteristics of ULTIVA

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

Studies evaluated patients undergoing craniotomy with general anesthesia.2-4

Remifentanil is commonly referred to as Remi by anesthesia providers.

Awake craniotomy case study

57-year-old male

5'10'', 100 kg (220 lb)

BMI 31.6 kg/m2


  • Obesity
  • Hypertension
  • Diabetes

Supratentorial tumor

Previous history of prolonged emergence

Previous history of postoperative nausea and vomiting 

Medications: antidiabetic agent (oral), 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 craniotomy procedures include:

See also:

  1. ULTIVA [package insert]. Rockford, IL: Mylan Institutional LLC; 2016.
  2. Guy J, Hindman BJ, Baker KZ, et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology. 1997;86(3):514-524.
  3. Gesztesi Z, Mootz BL, White PF. The use of a remifentanil infusion for hemodynamic control during intracranial surgery. Anesth Analg. 1999;89(5):1282-1287.
  4. Bilotta F, Caramia R, Paoloni FP, et al. Early postoperative cognitive recovery after remifentanil-propofol or sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial. Eur J Anaesthesiol. 2007;24(2):122-127.
  5. Samra SK, Dy EA, Welch KB, Lovely LK, Graziano GP. Remifentanil- and fentanyl-based anesthesia for intraoperative monitoring of somatosensory evoked potentials. Anesth Analg. 2001;92(6):1510-1515.