Methylnaltrexone (Relistor) is a subcutaneous, peripheral μ-opioid receptor antagonist used primarily to offset the detrimental effects of opioids on the gastrointestinal (GI) tract, including constipation and decreased GI motility. Due to its charged, quaternary structure, methylnaltrexone does not cross the blood-brain barrier and does not negate the analgesic benefits of…
The induction of general anesthesia in patients undergoing cardiac surgery is often times different than non-cardiac surgery. At many institutions, these inductions tend to center heavily around high dose opioids due to the hemodynamic stability conferred by narcotics. When talking about fentanyl, this translates to anywhere from 50 – 100…
Fentanyl (Sublimaze) is the most common synthetic narcotic I administer in the OR and the ICU. It is ~100x more potent than morphine and associated with many of the same side effects as other mu-opioid agonists – nausea, vomiting, constipation, respiratory depression, hallucinations, and sedation. Fentanyl can be delivered through…
Sufentanil (Sufenta) is the most powerful narcotic (~1000x more potent than morphine) approved for use in humans. In fact, it’s so potent and has such a strong affinity for mu-opioid receptors that I routinely use sufentanil for patients on buprenorphine (a PARTIAL opioid agonist) to make sure they have adequate…
My opioid of choice in the perioperative and ICU settings is hydromorphone (Dilaudid). This medication is roughly 5-10 times more potent than morphine and comes in intravenous (IV) and oral formulations.
Remifentanil (Ultiva) is a potent (~200-300 times more than morphine), short acting, titratable narcotic infusion I use for moderate/deep sedation and maintaining general anesthetics. Unlike many drugs which rely on hepatic and/or renal metabolism, remifentanil’s metabolism is through nonspecific plasma esterases. This explains why the drug does not “build up”…
