opioids

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...

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...

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...

Methadone (Dolophine) is a narcotic best known for providing a safe albeit slow recovery from opioid addiction (even in pregnancy) by replacing more traditional opioids like oxycodone, fentanyl, hydromorphone, and even heroin as part...

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...

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. Similar to other narcotics,...

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,...