Remifentanil, a different opioid: potential clinical applications and safety aspects.

IMPORTANCE OF THE FIELD: Opioids play an important role in every aspect of modern anesthetic practice. Remifentanil is an ultra-short-acting opioid featuring a unique pharmacokinetic profile allowing clinical versatility and improved control of its action. In this review, we assess the pharmacology of remifentanil, its clinical uses as well as safety issues on its action on the major organ systems and in particular clinical settings. AREAS COVERED IN THIS REVIEW: A synthesis of evidence from a MEDLINE search for articles from 1993 to 2009 for available up-to-date information on remifentanil and its current applications and safety profile. WHAT THE READER WILL GAIN: A synopsis of the unique pharmacokinetic properties of remifentanil and its action on major organ systems will provide insight on the safe and effective use of the drug in a variety of clinical settings. TAKE HOME MESSAGE: Remifentanil is a valuable opioid in the armamentarium of the clinician, providing great clinical flexibility and safety but vigilance is required to avoid pitfalls.