Experience of ultiva (remifentanil).

[Comaglove]

Hello!

I'm from Sweden and is working on a general intensive care unit. We have just started using Ultiva to mechanically ventilated patients. The idea is that they will be more awake despite the endotracheal tube. Someone else who also uses Ultiva in intensive care?

Yours sincerely,

Emil

[armyicurn]

Can you clarify on what you mean awake despite the ett... are you referring to a sedation holiday?

[RedCell]

hello!

i'm from sweden and is working on a general intensive care unit. we have just started using ultiva to mechanically ventilated patients. the idea is that they will be more awake despite the endotracheal tube. someone else who also uses ultiva in intensive care?

yours sincerely,

emil

i think you mean that they will wake up faster after the infusion is turned off. remifentanil is a badass drug with a similar potency to fentanyl. however, unlike other opioids, remi is hydrolyzed by plasma and tissue esterases making the context sensitive halftime nondependent on duration of the infusion. basically you could run this drug for an hour or a few days, but when you turn it off, the patient will wake up in about 8-10 minutes. i believe the actual half life is around 4 minutes (might be slightly off).

my practice has been using remi much more frequently due to our complications in obtaining adequate reserves of propofol.

[armyicurn]

Yo Red! How expensive is it when compared to fentanyl and propofol?

[RedCell]

yo red! how expensive is it when compared to fentanyl and propofol?

i really don't know the answer to that. i do know that our pharmacists always give us the evil eye when we check out a few amps in addition to our morning narcotic packs.

here is a study you might be interested in. it was published in 2000, but i do not think much has changed.

http://www.anesthesia-analgesia.org/cgi/content/abstract/91/6/1420

there are some other studies out there that report different conclusions depending on how you modify the variables. i think it ultimately comes down to the contract your pharmacy has with the supplier as well as how practitioners are utilizing the drug.

[XingtheBBB, BSN, RN]

Red, sounds like you're in anesthesia? Interesting about it being able to run like that and turn off quickly. I've never heard of remi being used outside the ORs. For some reason, I thought it was a Fentanyl pro-drug... No? Doesn't sound like it if it has a faster "off" I'll have to read your link.

[pebbles, BSN, RN]

It is extremely potent. It's used in the OR's only at my hospital, and the nurses in labour and delivery sometimes use it in PCA form. The hospital policy/monograph specifically states administration is restricted to physicians only, with the exception of the labour floor.

We used it this past month on a patient in profound liver failure, because of its short half-life (the monograph says it should clear the body within 10 minutes), and not wanting to overload this liver failure patient with longer-lasting drugs that wouldn't clear his system for days or weeks. Our attending physician had to write all the orders for it, and had to specifically write orders in the chart covering us to administer this drug. We had a continuous infusion at really low doses (0.01-0.05 mcg/kg/min) and it worked well for this patient.

After seeing the effect that even tiny titrations had on this patient's LOC, I do agree that the use of this drug should be restricted to OR's with very rare exceptions.

[sethmctenn]

2mg/5ml 10 vials = $620.00 or so from one source I was able to check