Figure 4.

Times to offset of opioid effect after down-titration of remifentanil. Shown are times to offset of opioid effect after scheduled down-titrations (SDT) of remifentanil at 8, 24, 48, and 72 hours of infusion in (a) 10 adult intensive care unit patients with normal or mildly impaired renal function and (b) 30 patients with moderate or severe renal impairment with a mean creatinine clearance of 14.7 ml/minute. Offset times were more variable and statistically significantly longer in the renal impairment group (b). However, the time differences between the groups were only in the order of minutes and without clinical importance (about 17 minutes longer [mean] in the renal impairment group after 72 hours of remifentanil infusion). Adapted with permission from Breen and coworkers [30].