Remifentanil Morphine

Alfentanil, codein, dihydromorphine, etor-phine, fentanyl, heroin, hydromorphone, levo-methadone, morphine, oxycodone, pethidine, piritramide, remifentanil, sufentanil, tilidine, tramadol Buprenorphine, pentazocine Naloxone, naltrexone... 

Sufentanil, fentanyl, remifentanil, alfentanil, and morphine sulfate should be administered only by those specifically trained in the use of IV and epidural anesthetics Oxygen, resusdtative, and intubation equipment should be readily available. 

Mortazavi, S., Thompson, J., Baghdoyan, H. A. Lydic, R. (1999). Fentanyl and morphine, but not remifentanil, inhibit acetylcholine release in pontine regions modulating arousal. Anesthesiology 90, 1070-7. 

Morphine Diamorphine Codeine Pethidine Fentanyl Alfentanil Remifentanil... 

Diazepam is a prescription-only medicine whereas pethidine, morphine, alfentanil and remifentanil are controlled drugs. 

Esters (eg, heroin, remifentanil) are rapidly hydrolyzed by common tissue esterases. Heroin (diacetylmorphine) is hydrolyzed to monoacetylmorphine and finally to morphine, which is then conjugated with glucuronic acid. 

In addition to the development of tolerance, persistent administration of opioid analgesics has been observed to increase the sensation of pain leading to a state of hyperalgesia. This phenomenon has been observed with several opioid analgesics, including morphine, fentanyl, and remifentanil. Spinal dynorphin and activation of the bradykinin receptor have emerged as important candidates for the mediation of opioid-induced hyperalgesia. 

Several drugs are used intravenously, alone or in combination with other drugs, to achieve an anesthetic state (as components of balanced anesthesia) or to sedate patients in intensive care units who must be mechanically ventilated. These drugs include the following (1) barbiturates (thiopental, methohexital) (2) benzodiazepines (midazolam, diazepam) (3) opioid analgesics (morphine, fentanyl, sufentanil, alfentanil, remifentanil) (4) propofol (5) ketamine and (6) miscellaneous drugs (droperidol, etomidate, dexmedetomidine). Figure 25-2 shows the structures of... 

Perioperative administration of morphine is another way of enhancing its analgesic properties during the transition from total remifentanil-based anesthesia to the postoperative period, when adequate analgesia is sometimes difficult. 

Fletcher D, Pinaud M, Scherpereel P, Clyti N, Chauvin M. The efficacy of intravenous 0.15 versus 0.25 mg/kg intraoperative morphine for immediate postoperative analgesia after remifentanil-based anesthesia for major surgery. Anesth Analg 2000 90(3) 666-71. 

The opioid agonists include morphine, meperidine, methadone, fentanyl, alfentanil, remifentanil and carfentanil. 

Fentanyl (Sublimaze), sufentanil (Sufenta), alfentanil (Alfenta), remifentanil (Ultiva), meperidine (Demerol), and morphine are the major parenteral opioids used in the perioperative period. The primary analgesic activity of each of these drugs is produced by agonist activity at p-opioid receptors. Their order of potency (relative to morphine) is sufentanil (lOOOx) > remifentanil (300x) > fentanyl (lOOx) > alfentanil (15x) > morphine (lx) > meperidine (O.lx). 

Guignard B, Bossard AE, Coste C, Sessler DI, Lehrault C, Alfonsi P, Fletcher D, Chauvin M. Acute opioid tolerance intraoperative remifentanil increases postoperative pain and morphine requirement Anesthesiology (2000) 93, 409-17. 

Drug withdrawal A withdrawal syndrome has been described after the use of remifenta-nil by infusion in intensive care units [166 ]. Within 10 minutes of withdrawal, patients experienced tachycardia, hypertension, sweating, mydriasis, and myoclonus. These symptoms persisted despite the use of morphine and clonidine and only resolved on readministration of remifentanil. Gradual tapering of remifentanil reduces the incidence of withdrawal symptoms. 

McDonnell C, Zaarour C, Hull R, Thalayasingam P, Pehora C, Ahier J, Crawford MW. Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia. Can J Anaesth 2008 55(12) 813-8. 

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