• intraoperative anesthesia:
• Single dose (1):
• intubation dose: 0.5-1 mcg/kg iv
• loading dose: 1.0 mcg/kg iv
• maintenance infusion: 0.5-20 mcg/kg/min iv
• Infusion (2):
• 0.5 mcg/kg/min for 3 min, followed by an infusion of 0.25 mcg/kg/min. With this regimen steady state blood concentrations result after about 20 minutes (approximately 6 ng/ml in younger patients, and 9 ng/ml in elderly patients).
• "Careful bolus": 1 mcg/kg/min for 1 minute, then reduce the rate to 0.5 mcg/kg/min for a further 2 min before making further reductions in infusion rate. This regimen will result in an almost step-wise increase in blood concentration to ~6 ng/ml.
• postoperative analgesia/sedation: 0.05-0.3 mcg/kg/min iv (1)
• Analgosedation for NPPV (3): results of a preliminary study suggest that the use of remifentanil-based sedation is feasible and safe: start with 0.025 mcg/kg/min, then increase by 0.01 mcg/kg/min until a maximum of 0.12 mcg/kg/min to achieve a Ramsay scale score of 2-3.

Referenzen:

1. Morgan & Mikhail's Clinical Anesthesiology. 5th edition. McGraw Hill Education, Lange(R). 2013.
2. Anthony Absalom et al. An overview of TCI & TIVA. Academia Press. 2007:51-2.
3. Monica Rocco et al. Rescue treatment for noninvasive ventilation failure due to interface intolerance with remifentanil analgosedation: a pilot study. Intensive Care Med. 2010;36:2060-2065: full text | pdf.