Use of remifentanil in a patient with renal failure and liver dysfunction undergoing hepatectomy

A 74-year-old woman was scheduled for a hepatectomy. Delayed emergence from anesthesia was anticipated because she had renal failure and liver dysfunction. We induced and maintained anesthesia for 478 minutes with propofol and remifentanil. The intraoperative course was uneventful and emergence from anesthesia was not delayed. Spontaneous respiration returned and her trachea was extubated 15 minutes after the surgery. Postoperative analgesia was established by epidural ropivacaine. This case shows that remifentanil is effective in anesthetic management for a patient with renal failure and liver dysfunction undergoing hepatectomy due to its unique mode of metabolism.