Editorial Views  |   June 2017
Remifentanil Dosing at Extremes of Body Weight
Author Notes
  • From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California (S.L.S.) and the “P Less Than” Company, San Francisco, California (D.M.F.).
  • Accepted for publication March 3, 2017.
    Accepted for publication March 3, 2017.×
  • Corresponding articles on pages 1005 and 1019.
    Corresponding articles on pages 1005 and 1019.×
  • Address correspondence to Dr. Shafer: steven.shafer@stanford.edu
Article Information
Editorial Views / Pain Medicine / Pharmacology
Editorial Views   |   June 2017
Remifentanil Dosing at Extremes of Body Weight
Anesthesiology 6 2017, Vol.126, 993-994. doi:10.1097/ALN.0000000000001636
Anesthesiology 6 2017, Vol.126, 993-994. doi:10.1097/ALN.0000000000001636
ANESTHESIOLOGISTS are expected to be equally competent treating a 5-kg child and a 250-kg adult. For infused drugs, such as remifentanil, this means selecting an initial infusion rate appropriate for the patient. A practice we have observed is to set a dose that is “close enough,” e.g., 0.1 µg·kg−1·min−1, and then forget about it. Unfortunately, pharmacokinetics typically do not scale linearly to weight,1  particularly at extremes of weight. The child may be underdosed, resulting in needless suffering, and the morbidly obese adult may be overdosed, resulting in life-threatening apnea. Rapid adjustment of the infusion rate to compensate for underdosed and overdosed patients may result in rapid oscillations in remifentanil concentration and opioid drug effect, producing further complications. “Close enough” is not acceptable when we have access to greater precision in drug delivery. We need to tailor anesthetic drug delivery to the individual patient as precisely as possible based on the best available science and technology.
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