GasGasGas - The FRCA Primary Exam Podcast GasGasGas - RemiFentanil and the Minto TCI Model
Jun 9, 2025
Dive into the world of remifentanil, a potent synthetic opioid that every anaesthetist dreams of for its rapid effects and easy dosing. Discover how it works on opioid receptors and the crucial sites in the CNS that influence its efficacy. Learn about the advantages of the Minto TCI model for tailoring anesthesia in various surgical procedures. From its quick onset and offset times to the potential adverse effects, this discussion is a must-listen for anyone interested in modern anaesthesia techniques!
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Remifentanil’s Unique Pharmacology
- Remifentanil is an ultra-short, potent synthetic opioid derived from fentanyl with rapid onset and offset.
- Its context-sensitive half-time stays ~3 minutes even after prolonged infusion due to ester hydrolysis clearance.
Prefer Infusion Over Repeated Boluses
- Dose remifentanil as an infusion rather than repeated boluses to avoid peaks and chest rigidity.
- Expect peak effect at 1–3 minutes and offset around 5–10 minutes after stopping.
Watch For Bradycardia And Hypotension
- Monitor blood pressure and heart rate because remifentanil commonly reduces MAP and heart rate by ~20%.
- Anticipate possible drop in cardiac output and manage hemodynamics accordingly.