[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Opioids and antagonists](https://durgical.com/en/pharmacology/classes/opioids-and-antagonists/) › Remifentanil [Pharmacology](https://durgical.com/en/pharmacology/) · [Opioids and antagonists](https://durgical.com/en/pharmacology/classes/opioids-and-antagonists/) # Remifentanil An ultra-short μ opioid for anaesthesia, broken down by blood esterases. Its effect is gone minutes after stopping, independent of liver or kidney. Updated 2026-11-01 - Class: [Opioids and antagonists](https://durgical.com/en/pharmacology/classes/opioids-and-antagonists/) - Receptor: μ-opioid receptor - ATC code: N01AH06 ## ⚠ High-alert medication An error with this medicine can cause serious harm: double checks and protocols are used. ◎**μ-opioid receptor**Remifentanil ⓘ The figure shows fentanyl, from the same 4-anilidopiperidine family, in the μ receptor bound to its Gi protein; remifentanil occupies the same site. **Target in 3D:** μ-opioid receptor. PDB structure 8EF5 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8EF5) · Drag to rotate · pinch to zoom ## Mechanism of action Remifentanil is a potent μ agonist of the fentanyl family with an ester bond that non-specific esterases in blood and tissues hydrolyse very quickly to an almost inactive metabolite. So its effect does not accumulate even after hours of infusion, and pain relief and respiratory depression disappear a few minutes after stopping, regardless of liver or kidney function. - Potently activates the μ receptor - Strong pain relief during anaesthesia - Blood esterases hydrolyse it within minutes - When the infusion stops, the effect is gone in 5 to 10 minutes ## Pharmacokinetics **Metabolism** Hydrolysis by non-specific esterases in blood and tissues. **Elimination** Independent of liver and kidney. **Half-life** Very short, about 8 to 20 minutes. **Onset and duration** Rapid onset; no residual pain relief 5 to 10 minutes after stopping. ## Indications - Analgesia during induction and maintenance of general anaesthesia - Continued analgesia in the immediate postoperative period under direct anaesthesia supervision ## Adverse effects ### Common - Nausea and vomiting - Itching - Hypotension - Bradycardia - Shivering ### Serious (rare, important) - Apnoea and respiratory depression - Muscle rigidity - Bradycardia and hypotension - Severe pain on waking if follow-on analgesia is not planned ## Contraindications - Epidural or intrathecal administration (it contains glycine) - Hypersensitivity to remifentanil ## Key interactions **Benzodiazepines, alcohol and other central nervous system depressants** Add up to profound sedation, respiratory depression, coma and death. **Inhaled anaesthetics, propofol and other anaesthetics** Synergistic: they add respiratory depression, hypotension and bradycardia. ## What is monitored - Continuous monitoring of breathing, oxygen saturation, blood pressure and heart rate - Pain when the infusion stops ## Administration and safety - Given only by staff trained in anaesthesia and airway management, with continuous monitoring and resuscitation equipment. - It can cause muscle rigidity, above all of the breathing muscles, managed with a neuromuscular blocker. - Not given through the same line as blood: esterases in blood products inactivate it. - When the infusion stops, the line is flushed so no drug left in the tubing is later given as a bolus. - Before stopping it, other analgesia is given if postoperative pain is expected. ## Nursing care - Watch breathing, saturation, blood pressure and heart rate continuously. - Check that bridging analgesia was given before the infusion stops. - Flush and label the line at the end. - Watch for chest-wall rigidity or difficulty ventilating. ## Pregnancy and breastfeeding It crosses the placenta; when used near delivery, the newborn is watched for respiratory depression. ## Memory aid REMIfentanil = «REMoved In minutes»: esterases wipe it out. Without bridging analgesia, the patient wakes in pain. ## Test yourself Think of the answer, then tap the question to see it. ## Why does remifentanil's effect disappear so fast? Because non-specific esterases in blood and tissues hydrolyse it within minutes; it does not accumulate even after a long infusion. ## Why is it contraindicated epidurally or intrathecally? Because of the glycine in the formulation. ## What must be done before stopping remifentanil if postoperative pain is expected? Give other analgesia, because within 5 to 10 minutes no pain relief is left. ## Why is it not infused through the same line as blood? Because esterases in blood products can inactivate it. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/remifentanil/) ## Related drugs - [Fentanyl](https://durgical.com/en/pharmacology/fentanyl/) - [Sufentanil](https://durgical.com/en/pharmacology/sufentanil/) [← Back to the class: Opioids and antagonists](https://durgical.com/en/pharmacology/classes/opioids-and-antagonists/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [REMIFENTANIL HYDROCHLORIDE injection, powder, lyophilized, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5b8025d2-3424-477b-9cff-3990a98c2a65) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 23 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N01AH06) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/remifentanil/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/remifentanil/