Delving into the Latest Updates on Remifentanil Hydrochloride with Synapse

Overview

Basic Info

Drug Type

Small molecule drug

Synonyms

Afentanil, Aruchiba, Remifentanil

+ [16]

Target

μ opioid receptor

Action

agonists

Mechanism

μ opioid receptor agonists(Mu opioid receptor agonists)

Therapeutic Areas

Nervous System DiseasesOther Diseases

Active Indication

PainAnesthesia

Inactive Indication

AnalgesiaHyperalgesiaSedation

Originator Organization

Abbott Laboratories

Active Organization

GSK PlcAbbott Laboratories (Philippines), Inc.Janssen Pharmaceutical KK

+ [2]

Inactive Organization

Air Liquide Santé (International) SA

License Organization-

Drug Highest PhaseApproved

First Approval Date

United States (12 Jul 1996),

Anesthesia

Regulation-

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Structure/Sequence

Molecular FormulaC20H29ClN2O5

InChIKeyWFBMIPUMYUHANP-UHFFFAOYSA-N

CAS Registry132539-07-2

JOURNAL/mgres/04.03/01612956-202606000-00005/figure1/v/2025-08-20T112310Z/r/image-tiff Low-flow anesthesia aims to minimize anesthetic gas consumption while maintaining adequate anesthesia. To examine the effects of minimal-flow anesthesia on perioperative lung dynamics and postoperative pulmonary function tests, a prospective, randomized controlled study was conducted between October 2023 and March 2024 at Atatürk University. A total of 66 patients (15 males, 45 females) with confirmed American Society of Anesthesiologists (ASA) grade I–II, aged 18–65 years, and scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomized into two groups: MeFA (medium flow anesthesia, 2 L/min fresh gas flow) and MiFA (minimal flow anesthesia, 0.5 L/min fresh gas flow). In both groups, dynamic compliance values, peak inspiratory pressure (PIP) values, total inhalation anesthetic drug consumption, total remifentanil drug consumption, duration of anesthesia, duration of surgery, and spirometry test results were recorded. Respiratory measurements were recorded at the 5th minute after intubation (T1), 5th (T2), 10th (T3), 30th (T4), and 60th (T5) minutes after surgical incision and immediately after the surgical suturing (T6) pulse. There was no significant difference in compliance or PIP values between the groups from T1 to T5 (P > 0.05). However, at T6, the MeFA group exhibited a significant decrease in compliance and an increase in PIP compared with the MiFA group (P < 0.05). Additionally, significant differences in compliance and PIP values were found across all time intervals compared with those at T1, except for the T5–6 compliance values in the MiFA group (P < 0.001). No significant difference in respiratory function test values was noted between the groups (P > 0.05). The MiFA group exhibited a relatively milder reduction in compliance values and a lesser elevation in PIP values. Compared with medium-flow anesthesia, minimal-flow anesthesia may help mitigate perioperative lung function deterioration. These findings suggest potential benefits in preserving lung mechanics, warranting further research. This trial was registered at clinicaltrials.gov (identifier No. NCT06055335, registered March 25, 2023).

01 May 2026·NEUROCHEMISTRY INTERNATIONAL

Representation and control of remifentanil-induced hyperalgesia and pain-like hypersensitivity by distinct neural ensembles in the anterior cingulate cortex

Article

Author: Zhang, Liang ; Zhang, Huan ; Gao, Tingting ; Zhao, Shu ; Wang, Xinyao ; Sun, Xude ; Liu, Jing ; Li, Guangyao

Remifentanil-induced hyperalgesia (RIH) is a common but severe clinical problem that occurs following intraoperative analgesia with remifentanil. However, it still remains unknown how RIH signals are encoded in the brain. Here, we uncover the critical role of the anterior cingulate cortex (ACC) in mediating RIH using chemogenetic approach. Chemogenetic manipulation of the excitatory neurons in the ACC was found to affect RIH bidirectionally. Furthermore, we reported that RIH and formalin-induced pain-like hypersensitivity (PLH) were represented and processed by separate neural ensembles in the ACC. Using a virus-mediated target-recombination-in-active population (TRAP) system, RIH- and PLH-activated neural ensembles in the ACC were labeled and manipulated respectively. Chemogenetic manipulation of RIH-activated neural ensembles in the ACC selectively affected RIH but not PLH. Conversely, chemogenetic manipulation of PLH-activated neurons in the ACC significantly affected PLH, whereas the intervention did not alter RIH. Moreover, RIH- and PLH-activated neural ensembles in the ACC were found to differ dramatically in histological locations and electrophysiological properties. These findings reveal the contribution of the ACC to the development of RIH and separate encoding of RIH and PLH by distinct neural ensembles in the ACC. Our study provides a novel perspective for the understanding of RIH information processing in the brain.

01 Apr 2026·JOURNAL OF CLINICAL ANESTHESIA

Association of target-controlled versus manually controlled infusion with postoperative recovery outcomes in elderly cardiac surgery patients: an international multi-cohort study

Article

Author: Chen, Shi-Qiang ; Xu, Zhen-Zhen ; Zhou, Fang-Ling ; Li, Xia ; Wang, Yan-Ting ; Bai, Yun-Xiao ; Wu, Qing-Ping

BACKGROUND:

Target-controlled infusion (TCI) optimizes drug delivery and hemodynamic stability using individualized pharmacokinetic models. We compared the effects of TCI versus manually controlled infusion (MCI) of propofol and remifentanil on postoperative recovery in elderly cardiac surgery patients.

METHODS:

An international retrospective cohort study was conducted using data from Union Hospital and the INSPIRE dataset. Elderly patients (≥65 years) receiving TCI were matched 1:1 with those receiving MCI using propensity scores to adjust for confounding variables. The primary outcome was the length of stay in the ICU. Secondary outcomes included postoperative complications and intraoperative hemodynamic stability.

RESULTS:

Of 1398 enrolled patients, propensity score matching yielded 468 in the Union cohort and 270 in the INSPIRE cohort. In the Union cohort, TCI was associated with a significantly shorter ICU stay (Mean Difference [MD] -0.92 days; 95% CI: -1.68 to -0.17; P = 0.017), lower odds of reintubation (OR 0.94; 95% CI: 0.90-0.99), reduced AKI incidence (OR 0.84; 95% CI: 0.78-0.91), and lower in-hospital mortality (OR 0.95; 95% CI: 0.92-0.99) compared with MCI. Validation in the INSPIRE cohort confirmed shorter ICU stays (MD -1.20 days; 95% CI: -2.32 to -0.80; P = 0.036) and lower reintubation rates (OR 0.96; 95% CI: 0.92-0.99). In both cohorts, TCI was associated with superior intraoperative hemodynamic stability, characterized by lower blood pressure variability and a reduced burden of hypotension.

CONCLUSION:

TCI is associated with superior intraoperative hemodynamic stability, significantly shorter ICU length of stay, and improved postoperative recovery profiles compared with MCI in elderly cardiac surgery patients.

20

News (Medical) associated with Remifentanil Hydrochloride

11 Sep 2025

·www.drugs.com

No Adverse Neurodevelopmental Effects Seen From Inhaled Anesthesia in Children Under 2

THURSDAY, Sept. 11, 2025 -- For children younger than 2 years undergoing surgery , no adverse neurodevelopmental effects are seen with the addition of dexmedetomidine and remifentanil to sevoflurane anesthesia versus sevoflurane alone, according to a study published online Sept. 9 in Anesthesiology . Sang-Hwan Ji, M.D., Ph.D., from Seoul National University Hospital in the Republic of Korea, and colleagues conducted a prospective, double-blind, randomized clinical trial including children younger than 2 years undergoing nonstaged, nonrepetitive surgeries to examine whether the combination of dexmedetomidine and remifentanil had any differential effect on neurodevelopmental outcomes compared to sevoflurane alone. Participants received dexmedetomidine and remifentanil as adjuncts to sevoflurane (DEX-R group; 176 children) or sevoflurane alone (control group; 169 children). Using the Korean Leiter International Performance Scale and the Child Behavior Checklist, neurodevelopmental status was examined at 28 to 30 months. The researchers found that the groups had no difference in the mean anesthesia duration. Compared with the control group, the DEX-R group had a significantly lower mean end-tidal sevoflurane concentration (1.8 versus 2.6 percent; P < 0.001). The mean full-scale IQ score was 102.5 ± 11.5 and 103.6 ± 11.5 in the DEX-R and control groups, respectively (P = 0.442). The Child Behavior Checklist total score did not differ significantly between the groups. "These findings support existing evidence suggesting that brief anesthetic exposure is unlikely to result in clinically significant neurodevelopmental impairment," the authors write. Abstract/Full Text

Clinical ResultClinical Study

09 Apr 2025

·www.echemi.com

Viatris to Pay Up to $335 Million Over Nine Years to Settle Opioid Claims

Viatris has agreed to pay up to $335 million over a nine-year period as part of a nationwide settlement addressing claims from U.S. state and local governments regarding the company’s alleged role in the opioid crisis. The Pennsylvania-based pharmaceutical firm, established through the 2020 merger of Mylan and Pfizer’s Upjohn division, has not admitted to any wrongdoing in connection with this agreement. Under the terms of the settlement, Viatris will contribute between $27.5 million and $40 million annually to support state and local opioid initiatives. New York Attorney General Letitia James, a key figure in the negotiation process, emphasized the importance of this settlement, stating, “While no settlement can fully repair the damage caused by dangerous opioids, these funds will help New York and other states fight the opioid crisis.” Viatris markets opioid products, including the painkiller Ultiva and the Fentanyl Transdermal System, a generic version of Johnson & Johnson’s Duragesic patch. The company is among several pharmaceutical manufacturers accused by state and local governments of downplaying the risks associated with opioid medications. This settlement contributes to the more than $50 billion already secured from various drugmakers, distributors, and pharmacies implicated in the opioid epidemic. Notably, in January, Purdue Pharma and its owners, the Sackler family, reached a $7.4 billion settlement to resolve numerous lawsuits related to their pain medication OxyContin, which has been widely blamed for initiating the crisis. According to the Centers for Disease Control and Prevention, opioid-related overdoses claimed over 80,000 lives in 2023, contributing to a total of 700,000 deaths over the past two decades. This settlement underscores the ongoing efforts to address the devastating impact of the opioid epidemic and hold pharmaceutical companies accountable for their roles in the crisis.

Patent Infringement

14 Mar 2025

·www.echemi.com

5 Key Updates on China's Fentanyl Control Amid US Tariffs

On February 1st, the United States announced a 10% tariff on products imported from China, citing concerns over the fentanyl crisis. In response, a spokesperson from the Ministry of Public Security emphasized that China maintains one of the strictest drug control policies in the world. As a signatory to the three UN drug control conventions, China has consistently upheld its international obligations and actively collaborates with countries, including the US, on drug enforcement efforts. In 2019, China took a humanitarian step by becoming the first country to classify all fentanyl-related substances under stringent controls, responding to US requests. Since this classification, China has not received reports of these substances being seized in the US. On March 12th, the National Medical Products Administration (NMPA) shared insights regarding China's management of fentanyl substances through a recently released white paper. The spokesperson addressed concerns about the production and export of fentanyl-related pharmaceuticals. Currently, four fentanyl-related drugs are approved for clinical use in China: fentanyl, sufentanil, remifentanil, and alfentanil. Three companies have been authorized to produce raw materials, while five are permitted to manufacture formulations. In 2024, China produced 100 kilograms of fentanyl raw materials, primarily for domestic medical use and export, with only 12.3 kilograms exported to countries like South Korea, Vietnam, and the Philippines. Notably, China has never exported fentanyl products to North America. All fentanyl-related drugs in China are classified as controlled narcotics, subjected to stringent regulations. The production and distribution of these drugs are closely monitored, with specific companies designated for manufacturing and fixed sales channels established. Export controls require permits, and international verification ensures the legality of trade before issuing export licenses. The NMPA will continue to enhance the supervision of fentanyl-related drug production and strictly regulate exports to prevent illegal channels and misuse, ensuring that medical needs are met responsibly.

Drug Approval

100 Deals associated with Remifentanil Hydrochloride

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External Link

KEGG	Wiki	ATC	Drug Bank
D01177	Remifentanil Hydrochloride	N01AH06	DB00899

R&D Status

Approved

10 top approved records.

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Indication	Country/Location	Organization	Date
Pain	Switzerland	GSK Plc	28 Jan 1997
Anesthesia	United States	Mylan Institutional LLC	12 Jul 1996

Developing

10 top R&D records.

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Indication	Highest Phase	Country/Location	Organization	Date
Analgesia	Phase 3	Germany	GSK Plc	01 Nov 2006
Sedation	Phase 3	Germany	GSK Plc	01 Nov 2006
Hyperalgesia	Phase 1	Germany	Air Liquide Santé (International) SA	01 Jan 2012

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Clinical Result

Indication

Phase

Evaluation

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT02527083 (CTgov)	Phase 4	Anesthesia \| Hernia \| Acute Pain ... View more	10	Propofol+Ketamine (TIVA-K)	zlhpxolltg(wkcledqols) = lwiafnkujf gwtokcirng (ecvdeqzgoz, 2.1) View more	-	31 Dec 2025
				Propofol+Remifentanil (TIVA-R)	zlhpxolltg(wkcledqols) = eqbkvhxdin gwtokcirng (ecvdeqzgoz, 0) View more
NCT02703090 (CTgov)	Not Applicable	Pain \| Anesthesia	44	Normal saline (Placebo)	nvfidalepw(tyvrbmuijr) = pkhifkeert fuoflbzeou (babfeynlye, 0.032) View more	-	15 Dec 2025
				Remifentanil (Drug lower dose)	nvfidalepw(tyvrbmuijr) = ddgttpeqsc fuoflbzeou (babfeynlye, 0.021) View more
NCT05279898 (PATHFINDERII, CTgov)	Not Applicable	Cognitive Dysfunction \| Pain \| Emergence Delirium	70	dexmedetomidine+EEG Monitoring+Ropivacaine+Propofol+Rocuronium+Ketamine+Remifentanil (Multimodal General Anesthesia (MMGA Bundle) - EEG Guided)	tchqzpyarh(oonazryyqr) = apoxuqymyw adufsrjiwh (xocpmharas, 28.5) View more	-	26 Nov 2025
				Dexmedetomidine+fentanyl+Hydromorphone+Acetaminophen+Oxycodone+Propofol+Sevoflurane+Lidocaine (Standard of Care/Control)	tchqzpyarh(oonazryyqr) = xlpadnznzk adufsrjiwh (xocpmharas, 79.9) View more
NCT06096181 (CTgov)	Phase 2	Analgesia \| Idiopathic scoliosis \| Spinal fusion ... View more	13	Propofol TIVA+Remifentanil TIVA (Propofol + Remifentanil)	fzxnhopzxn(cmgcgbcmkq) = fwkvghadcg fogytknwsm (znayeiafaw, pkywkakpik - wnkalebndt) View more	-	10 Nov 2025
				Dexmedetomidine TIVA+Propofol TIVA (Propofol + Dexmedetomidine)	fzxnhopzxn(cmgcgbcmkq) = gduegeeobp fogytknwsm (znayeiafaw, zbtwdvqqqk - mmrcnntghi) View more
NCT05026125 (OBEREM, Pubmed \| Anaesth Crit Care Pain Med)	Phase 4	Obesity	50	Remifentanil 3 μg kg-1 + Remifentanil 3 μg kg-1	vzalihnexg(gnmlunxfvj) = kpumytznyu fllvyphern (heetudoztk )	Positive	01 Nov 2025
NCT04364945 (Pubmed \| Anesthesiology)	Not Applicable	-	343	Dexmedetomidine and Remifentanil as adjuncts to Sevoflurane	ilxitkmbvi(fbtmznwivg) = No significant difference was observed between groups judkoevxmg (khcypibhmy )	Positive	01 Oct 2025
				Sevoflurane alone
NCT05391555 (CTgov)	Phase 2/3	Opioid-Related Disorders \| Miosis \| Respiratory Insufficiency	10	Pupillometry measurement+Remifentanil Hydrochloride	adfqvfghbx = iczdvbhrdc udworhvjks (ughfkmserz, mbyynwqmgu - hvaefkhbgp) View more	-	02 May 2025
NCT02898792 (Pubmed \| Br J Anaesth)	Early Phase 1	Sleep Apnea, Obstructive	-	remifentanil (Adult volunteers without OSA)	njxtoakhxi(crsrdnlxtp) = ujjanjatrp sohkqwseez (pzlpobmfis ) View more	Positive	01 Mar 2025
				remifentanil (Adult volunteers with untreated OSA)	njxtoakhxi(crsrdnlxtp) = ibbhrymkli sohkqwseez (pzlpobmfis ) View more
NCT04734418 (Pubmed \| J Intensive Care) Manual	Not Applicable	-	179	Remifentanil	pdehpumgrj(hlgoumrtie) = oteojzcvcf qhyolohhsd (xehghihbeb ) View more	Negative	18 Sep 2024
				Dexmedetomidine	pdehpumgrj(hlgoumrtie) = fauxakoncu qhyolohhsd (xehghihbeb ) View more
NCT02631135 (CTgov)	Phase 4	-	40	Propofol+Rocuronium+Remifentanil (Group 1 (TIVA))	wspsfdkhqf(nmvpcihjxn) = tzczibshhn tlarqimyry (jpdqwgoufq, 1.31) View more	-	17 May 2024
				Dexmedetomidine+Propofol+Rocuronium+Remifentanil (Group 2 (TIVA+D))	wspsfdkhqf(nmvpcihjxn) = dbxqvdijlz tlarqimyry (jpdqwgoufq, 1.19) View more