The section ‘MCQs for EDAIC, FRCA, FCAI’ covers a different topic each day with the intent that candidates can prepare one small topic each day, making steady progress in their exam preparation.
Question: Characteristics of remifentanil
a. Exclusively metabolized by plasma esterase b. Short context-sensitive half-life c. More potent than fentanyl d. Dose reduced in hepatic and renal disease e. The unique characteristics are due its amide structure.
Explanation:
- Remifentanil (4-anilidopiperidine) is a novel, short-acting mu-receptor opioid agonist with a unique ester structure.
- Remifentanil undergoes widespread extrahepatic metabolism by blood and tissue nonspecific esterases, resulting in extremely rapid clearance of approximately 40ml/Kg/min. clearance not affected in hepatic or renal failure.
- Like the other members of this class of drugs, remifentanil is lipophilic and is widely distributed in body tissues with a steady-state volume of distribution of approximately 100ml/Kg.
- Unlike the other fentanyl congeners, termination of the therapeutic effect of remifentanil mostly depends on metabolic clearance rather than on redistribution.
- The context-sensitive half-time [defined as the time necessary to achieve a 50% decrease in blood (or plasma) concentration after termination of a variable-length, continuous infusion targeted to maintain a steady-state concentration, where the ‘context’ is the duration of the infusion] is strikingly short for remifentanil, at approximately 3 minutes, and is independent of infusion duration.
- Pharmacodynamically, remifentanil is similar to the other fentanyl congeners. The drug produces physiological changes consistent with potent mu-receptor agonist activity, including analgesia and sedation. Its adverse effect profile (like that of the other drugs of this class) includes ventilatory depression, nausea, vomiting, muscular rigidity, bradycardia and pruritus.
- Because it does not release histamine upon injection, remifentanil has fewer haemodynamic adverse effects than morphine.
- Twice as potent as fentanyl
- The speed of onset of effect is very rapid: approximately 1 to 3 minutes.
- plasma protein binding: 70%
Answers:
- false
- true
- false
- false
- false
Cardiopulmonary bypass Module
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- The basic CPB circuitry.
- Myocardial injury and preservation during CPB.
- Conduct and complications of CPB.
- The perioperative considerations surrounding the management of a patient undergoing CPB.
ANAESTHETIC IMPLICATIONS OF THE CARDIAC IMPLANTABLE ELECTRONIC DEVICES (CIEDs)
Cardiovascular physiology module by targetedaic
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The ‘MCQs for EDAIC FRCA FCAI’ section covers a different topic each day with the intent that candidates can prepare one small topic each day, making steady progress in their exam preparation.
