Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 14: Opioids part 2
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Aug 17, 2016 AI Snips
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Opioid Lipid Solubility Effects
- Opioid onset speed correlates with lipid solubility; morphine is slow due to low lipid solubility.
- Remifentanil uniquely hydrolyzes quickly, enabling consistent plasma half-life regardless of infusion duration.
Age and Renal Effects on Opioids
- Fentanyl and remifentanil do not accumulate in renal failure due to hepatic metabolism into inactive metabolites.
- Older patients have reduced opioid clearance and require at least 50% dose reduction; children aged 2-11 need higher doses.
Synergy and Dosing Tips
- Use sufentanil dosing as roughly one-tenth of fentanyl for potency calculations.
- Expect opioid synergy with other anesthetics; reduce inhaled or propofol doses by up to 50% when opioids are used.