ArticleFrontiers in medicine2025
Impact of low-dose sufentanil on the effective sedative dose of ciprofol for BIS-guided induction in elderly patients: an up-and-down sequential allocation trial.
Article in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: This study aimed to evaluate the effect of a single low dose of sufentanil on the effective dose of ciprofol required to achieve a bispectral index (BIS) <60 during anesthesia induction in elderly patients. Methods: A total of 48 elderly patients were randomly assigned to either the sufentanil plus ciprofol group (S + C group) or the ciprofol alone group (C group). A sufentanil dose of 0.1 μg/kg was administered to the S + C group (diluted to 5 ml), while the C group was administered 5 ml of normal saline. Five minutes later, the initial administration for both groups was 0.3 mg/kg ciprofol. Subsequent doses were adjusted in increments or decrements of 0.05 mg/kg according to the response of the preceding patient within the same treatment group, following two independent, arm-specific up-and-down sequences conducted in parallel. Successful sedation was defined as achieving a BIS score of < 60 within 5 min following ciprofol administration. ciprofol's effective doses (ED50/ED95) were derived through probit regression. Results: A total of 23 patients were enrolled in the S + C group and 25 in the C group. The estimated ED50 of ciprofol was 0.075 mg/kg (95% CI: 0.024-0.123 mg/kg) in the S + C group and 0.267 mg/kg (95% CI: 0.159-0.361 mg/kg) in the C group. The estimated ED95 values were 0.246 mg/kg (95% CI: 0.141-14.566 mg/kg) and 0.439 mg/kg (95% CI: 0.340-67.768 mg/kg), respectively. The Pearson goodness-of-fit test of group S + C and group C were Conclusion: Under BIS monitoring, the estimated ED50 and ED95 of ciprofol for induction in elderly patients were 0.267 and 0.439 mg/kg, respectively, without sufentanil, and 0.075 and 0.246 mg/kg with 0.1 μg/kg sufentanil. The addition of a low dose of sufentanil reduced the ciprofol requirement for BIS-targeted induction by about 44%-72% without increasing the incidence of hypotension or respiratory depression. This regimen provides an effective and well-tolerated strategy for anesthesia in elderly patients, particularly in day surgery and outpatient settings. Clinical trial registration: http://www.chictr.org.cn, identifier: ChiCTR2400090926.
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