Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders>>>>>Drug Dosing in Renal Failure
Question 8#

A patient with chronic renal failure and 60 % (body surface area) burns is undergoing a 20-minute dressing change in the ICU.

Which of the following opioids has the most favorable profile?

A. Morphine
B. Remifentanil
C. Hydromorphone
D. Meperidine

Correct Answer is B

Comment:

Correct Answer: B

All of the opioids listed undergo significant renal elimination except for remifentanil. Remifentanil undergoes rapid metabolism in the blood by plasma esterases. Although its metabolite remifentanil acid requires renal elimination, it has not been shown to be clinically significant.

References:

1. Barash PG. Clinical Anesthesia. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013:1412.
2. Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Manage. 2004;28:497-504.