Remifentanil:

Intravenous opioid

ECMO Dose Adjustment:

YES—an increased dose may be warranted in some patients.

Renal Impairment Dose Adjustment:

NONE

CRRT Dose Adjustment:

NONE

Hepatic Impairment Dose Adjustment:

NONE

Adult Starting Dose^:

Adult Bolus: 0.5-1 mcg/kg IV, then continuous infusion: 0.5-1 mcg/kg/hr

Pediatric Starting Dose^:

Pediatric Bolus: 0.5-1 mcg/kg IV, then continuous infusion: 1-1.5 mcg/kg/hr

Neonatal Starting Dose^:

Neonatal Bolus: 0.5-1 mcg/kg IV, then continuous infusion: 1-1.5 mcg/kg/hr

^Always use the lowest-effect dose to an objective endpoint (e.g., pain).

Intravenous opioid physicochemical and pharmacokinetic characteristics

Drug	Remifentanil


Onset (min)	1-3
Log P	1.4
Protein Binding (%)	70
Metabolism / Elimination	Plasma esterase
Dose Adjustment on ECMO	++
Dose Range*	Adult: 0.5-15 mcg/kg/hr
	Pediatric: 0.5-15 mcg/kg/hr
	Neonatal: 0.5-15 mcg/kg/hr

- Minimal sequestration; no need for dose adjustment

++ Moderate sequestration; may require dose adjustment

+++ Significant sequestration; need for dose adjustment

*Titrate to patient-specific goals, using the lowest effective dose. Dose ranges represent doses typically used in clinical practice; in some situations, patients may require doses above the usual dose range to achieve patient-specific goals.