Common side effects of remifentanil include abnormalities in the blood, digestive, and metabolic systems, most of which can be alleviated through dosage adjustments or symptomatic treatment.

1. Common side effects and treatment

Adverse reactions with an incidence rate of ≥ 20% include bleeding, nausea, musculoskeletal pain, etc. Digestive symptoms such as nausea can be relieved by taking low-fat meals in portions. Diarrhea should maintain electrolyte balance, and constipation should increase dietary fiber intake.

2 serious reactions that require urgent handling

2.1 Cardiotoxicity

QTc prolongation requires immediate interruption of administration, and should be reduced and restarted after recovery to<500msec. During this period, electrocardiogram and blood potassium levels should be monitored.

2.2 Differentiation syndrome

Manifesting as fever, difficulty breathing, etc., immediate use of glucocorticoids and suspension of remifentanil are required. After symptom control, consider reducing dosage and continuing treatment.

3 dose adjustment strategies

Discontinue treatment for toxicity levels ≥ 3, and gradually reduce dosage after recovery: first to 160mg/m ², second to 95mg/m ², twice daily.

4 Preventive measures

Before administration, it is necessary to control white blood cells to<25Gi/L and regularly monitor electrolytes. Avoid driving when experiencing neurological symptoms.

5 Special Population Management

For those who use strong CYP3A4 inhibitors in combination, the dosage should be adjusted to 160mg twice a day, and for patients weighing less than 40kg, the dosage should be calculated based on body surface area.

6 Special precautions

6.1 Prohibition of refrigeration/freezing

Under no circumstances should remifentanil be placed in a refrigerator freezer or in an environment below 2 ° C, as low temperatures can cause the active ingredient to crystallize and alter the physical and chemical properties of the drug.

6.2 Travel carrying suggestions

Insulated medicine carrying boxes should be used to avoid exposure to high temperature environments such as car trunks. It is recommended to equip temperature recorders for cross time zone transportation.

6.3 Exception Handling

If the drug is exposed to extreme temperatures (<15 ° C or>30 ° C) for more than 24 hours, it should be disposed of and replaced with a new packaging, and cannot be continued to be used.