Remifentanil for gynaecological and obstetric procedures.

Recently, with the introduction of the novel mu-opioid receptor agonist remifentanil, anaesthesiologists have acquired a unique tool to provide adequate, titratable and predictable analgesia throughout surgery, without the risk of opioid-related delay in postoperative recovery. This new compound will therefore mandate a change in anaesthesia practice from opioid-restricted to opioid-dominated anaesthesia. It is the first in the class of esterase-metabolized opioids within the 4-anilidopiperidine series of drugs, and it possesses an analgesic potency similar to that of fentanyl. The advantages of remifentanil are mainly related to its unique pharmacokinetics, whereas its pharmacodynamics are the same as those of fentanyl. Because of these characteristics, remifentanil-based anaesthesia allows profound opioid analgesia intraoperatively, with rapid and predictable awakening thereafter. Review of the recent literature reveals the potential of remifentanil for improving analgesia in gynaecological procedures and its theoretical advantage in obstetric procedures.