Facharzt FMH Anästhesiologie Practice Questions - Facharzt FMH Für Anästhesiologie Spécialiste FMH En Anesthésiologie Specialista FMH In Anestesiologia Exam

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A continuous target-controlled infusion (TCI) of remifentanil is administered during a 6-hour craniotomy. Why does remifentanil maintain a virtually constant context-sensitive half-time of 3 to 5 minutes regardless of the duration of infusion?

Rapid metabolism via non-specific esterases in blood and tissues into a weakly active metabolite Extensive pulmonary first-pass uptake followed by rapid renal excretion unchanged in urine Ultra-fast hepatic clearance mediated exclusively by cytochrome P450 CYP3A4 enzymes Immediate irreversible binding to plasma alpha-1-acid glycoprotein preventing tissue accumulation

Correct Answer:

Rapid metabolism via non-specific esterases in blood and tissues into a weakly active metabolite

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