There was a discussion I had the other day where intranasal remifentanil came up. It turned out they meant sufentanil. But it got me curious, and a PubMed search did of course turn out a study where remifentanil has been used intranasally.

We often use mask induction with sevoflurane on kids, and in this study they tested how remifentanil might improve intubating conditions in such cases. I don’t know how useful it is to give intra-nasal remifentanil during sevoflurane mask induction, as the remi will take away their respiratory drive, and sevoflurane at high concentrations usually gives very good intubating conditions on its own if you just wait a little longer while the kid breathes itself into a deep gas anaesthesia.

What I did like in this article was their remi plasma concentration measurements. The time to peak plasma concentrations was 3-4 minutes. And after 10 minutes, the plasma level is on a clear decline.

I’m wondering if intranasal remifentanil could have a potential use for ultra-short painful procedures without i.v. access? Or get i.v. access after the remifentanil has taken effect? With remifentanil being so potent, I would worry about losing respiratory drive. So, it’s not something I would start using anytime soon, but worth a little brain storming and a think tank. I’ll keep thinking about it.

Remifentanil is reconstituted from dry powder before injection or intranasal atomising, but of course, some anaesthetists push the envelope and just snort the dry powder.

The effect of intranasal administration of remifentanil on intubating conditions and airway response after sevoflurane induction of anesthesia in children, Anesthesia & Analgesia, 2008.

Intranasal Self-Administration of Remifentanil as the Foray into Opioid Abuse by an Anesthesia Resident, Anesthesia & Analgesia, 2008.

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  1. Thomas D says:

    Minh, I’m soon thinking your entire med. bag consists of ketamine and only ketamine! Good links, though!

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