REMIFENTANIL

Ranozaline is in Pregnancy Category C.  No data to show the effects on pregnancy and breastfeeding has been reported.

• nausea
• shivering
• diaphoresis
• blurred vision
• chest pain or discomfort
• confusion
• difficult or troubled breathing
• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
• irregular, fast or slow, or shallow breathing
• lightheadedness, dizziness, or fainting
• muscle stiffness or tightness
• pale or blue lips, fingernails, or skin
• shortness of breath
• slow or irregular heartbeat
• sweating
• unusual tiredness or weakness

Less common

• bluish lips or skin
• chills
• decrease in cardiac output
• fast, pounding, or irregular heartbeat or pulse
• feeling of warmth
• fever
• headache
• nausea or vomiting
• nervousness
• not breathing
• pain after surgery
• pain in the shoulders, arms, jaw, or neck
• pounding in the ears
• problems with bleeding or clotting
• redness of the face, neck, arms, and occasionally, upper chest
• shivering

Rare

• abdominal or stomach pain
• black, tarry stools
• bleeding gums
• blood in the urine or stools
• body aches or pain
• burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
• congestion
• cough or hoarseness
• cough producing mucus
• coughing that sometimes produces a pink frothy sputum
• coughing up blood
• decreased frequency or amount of urine
• difficult, fast, or noisy breathing, sometimes with wheezing
• difficulty with swallowing
• disorientation
• dry mouth
• dryness or soreness of the throat
• dysphoria
• eye pain
• flushed, dry skin
• fruit-like breath odor
• general feeling of illness
• hiccups
• hives
• increased blood pressure
• increased hunger
• increased menstrual flow or vaginal bleeding
• increased sweating
• increased thirst
• increased urination
• itching
• loss of appetite
• lower back or side pain
• muscle cramps or pain
• nervousness
• noisy breathing
• nosebleeds
• numbness or tingling in the hands, feet, or lips
• painful or difficult urination
• pale skin
• paralysis
• pinpoint red spots on the skin
• prolonged bleeding from cuts
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• rapid heartbeat
• red or black, tarry stools
• red or dark brown urine
• runny nose
• seizures
• shakiness in the legs, arms, hands, or feet
• skin rash
• small clicking, bubbling, or rattling sounds in the lungs when listening with a stethoscope
• stuffy nose
• swelling in the legs and ankles
• swelling of the face, fingers, or lower legs
• tender, swollen glands in the neck
• tightness in the chest
• troubled breathing with exertion
• unexplained weight loss
• unusual bleeding or bruising
• voice changes
• vomiting
• weakness and heaviness of the legs
• weight gain

Only qualified medical personnel may administer this drug to the patient.

Dosage

Applies to the following strength(s): 1 mg ; 2 mg ; 5 mg ; 50 mcg/mL-NaCl 0.9%

Usual Adult Dose for Anesthesia

The different uses of this drug and corresponding dosage:

Induction of Anesthesia: Continuous IV infusion: 0.5 to 1 mcg/kg/min. If endotracheal incubation is to occur in less than 8 minutes, an initial dose of 1 mcg/kg may be administered over 30 to 60 seconds.

Maintenance of Anesthesia: With Nitrous Oxide, 0.4 mg/kg/min by continuous IV infusion.

Infusion dose range: 0.1 to 2 mcg/kg/min.

Supplemental IV bolus: 1 mcg/kg every 2 to 5 minutes.

With Isoflurane or Propofol: 0.25 mg/kg/min by continuous IV infusion.

Infusion dose range. 0.05 to 2 mcg/kg/min.

Supplemental IV bolus: 1 mcg/kg dose.

Continuation into Postoperative Period: Continuous IV infusion: 0.1 mcg/kg/min.

Infusion dose range: 0.025 to 0.2 mcg/kg/min.

Monitored Anesthesia Care: Single IV dose: 1 mcg/kg over 30 to 60 seconds, given 90 seconds before local anesthetic or 0.5 mcg/kg with midazolam 2 mg.

Continuous IV infusion: 0.1 mcg/kg/min beginning 5 minutes before local anesthetic. Then, decrease to 0.05 mcg/kg/min (range 0.025 to 0.2 mcg/kg/min) after local anesthetic or 0.05 mcg/kg/min given with midazolam 2 mg, beginning 5 minutes before local anesthetic . Then, decrease to 0.025 mcg/kg/min (range 0.025 to 0.2 mcg/kg/min) after local anesthetic.

Usual Pediatric Dose for Anesthesia

Neonatal:

Maintenance of anesthesia with nitrous oxide (70%):

IV continuous infusion: 0.4 mcg/kg/minute (range: 0.4 to 1 mcg/kg/minute)

Supplemental bolus dose of 1 mcg/kg may be administered; smaller bolus dose may be required with potent inhalation agents, potent neuraxial anesthesia, significant comorbidities, significant fluid shifts, or without atropine pretreatment.

Clearance in neonates is highly variable. Dose should be carefully titrated.

Endotracheal intubation (nonemergent): IV: 1 to 3 mcg/kg/dose; may repeat dose in 2 to 3 minutes if needed.

IV continuous infusion: Dose should be based on ideal body weight (IBW) in obese patients (greater than 30% over IBW).

Infants 1 to 2 months: Maintenance of anesthesia with nitrous oxide (70%): 0.4 mcg/kg/minute (range: 0.4 to 1 mcg/kg/minute).

Supplemental bolus dose of 1 mcg/kg may be administered, smaller bolus dose may be required with potent inhalation agents, potent neuraxial anesthesia, significant comorbidities, significant fluid shifts, or without atropine pretreatment.

Children 1 to 12 years: Maintenance of anesthesia with halothane, sevoflurane, or isoflurane: 0.25 mcg/kg/minute (range: 0.05 to 1.3 mcg/kg/minute).

Supplemental bolus dose of 1 mcg/kg may be administered every 2 to 5 minutes. Consider increasing concomitant anesthetics with infusion rate greater than 1 mcg/kg/minute. Infusion rate can be titrated upward in increments up to 50% or titrated downward in decrements of 25 to 50%. May titrate every 2 to 5 minutes.