EC₅₀ and EC₉₅ of Remifentanil for Inhibiting Bronchoscopy Responses in Elderly Patients During Fiberoptic Bronchoscopy Under Ciprofol Sedation: An Up-and-Down Sequential Allocation Trial.

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2024-12-31 eCollection Date: 2024-01-01 DOI:10.2147/DDDT.S490907

Hongmeng Lan, Susu Liu, Yeqing Liao, Bing Xu, Yuliu Lin, Xiaoshan Wu, Qiuling Chen, Huihe Chen, Xuehai Guan

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引用次数: 0

Abstract

Background: Opioids are used to suppress cough during fiberoptic bronchoscopy (FOB). However, evidence regarding the optimal dose of remifentanil during FOB under ciprofol sedation is limited. This study aimed to investigate the effective concentration (EC) of remifentanil required to suppress bronchoscopy responses during FOB under ciprofol sedation in elderly patients.

Materials and methods: Elderly patients aged 60 to 90 years with American Society of Anesthesiologists (ASA) physical status I-III, scheduled for FOB, were enrolled. Patients were assigned to either the male or the female group. Remifentanil was administered intravenously prior to ciprofol administration. The endpoints included responses to FOB, such as vocal cords movement, coughing, and body movement. The EC₅₀ and EC₉₅ values of remifentanil required to alleviate the responses to FOB were calculated using Dixon's up-and-down method for both male and female groups. Probit analysis was used to generate a dose-response curve.

Results: Thirty-nine patients (19 males and 20 females) were enrolled. The EC₅₀ values (plasma concentration) of remifentanil for blunting FOB responses under ciprofol sedation were 3.25 (2.75 to 3.26) ng/mL and 2.25 (1.75 to 2.25) ng/mL in males and females, respectively (p = 0.0023). Probit analysis indicated that the EC₅₀ of remifentanil required to suppress responses to FOB under ciprofol sedation was 3.102 [95% confidence interval (CI):2.694 to 3.749] ng/mL and 2.052 [95% CI: 1.345 to 2.750] ng/mL in males and females, respectively. The EC₉₅ of remifentanil required to suppress responses to FOB under ciprofol sedation was 3.741 [95% CI: 3.366 to 7.699] ng/mL and 2.943 [95% CI: 2.456 to 9.533] ng/mL in males and females, respectively.

Conclusion: The results indicate differences between males and females in the EC₅₀ and EC₉₅ of remifentanil needed to suppress responses to FOB under ciprofol sedation while preserving spontaneous breathing in elderly patients.

Trial registration: The study was registered with chictr.org.cn (ChiCTR2300077720; 17 ^th November 2023).

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瑞芬太尼在环丙酚镇静下抑制老年患者纤维支气管镜检查反应的EC50和EC95：一项上下序贯分配试验

背景：阿片类药物用于纤维支气管镜检查（FOB）时的止咳。然而，关于环丙酚镇静下FOB期间瑞芬太尼的最佳剂量的证据有限。本研究旨在探讨瑞芬太尼在环丙酚镇静下抑制老年患者FOB期间支气管镜反应所需的有效浓度（EC）。材料和方法：入选年龄在60 ~ 90岁、美国麻醉医师协会（ASA）身体状况I-III级、计划进行FOB的老年患者。患者被分为男性组和女性组。在给予环丙酚之前静脉给予瑞芬太尼。终点包括对FOB的反应，如声带运动、咳嗽和身体运动。采用Dixon上下法计算男女两组瑞芬太尼缓解FOB反应所需的EC50和EC95值。概率分析生成剂量-反应曲线。结果：39例患者入组，其中男19例，女20例。瑞芬太尼在环丙酚镇静作用下，男性和女性的EC50值分别为3.25 (2.75 ~ 3.26)ng/mL和2.25 (1.75 ~ 2.25)ng/mL （p = 0.0023）。Probit分析显示，瑞芬太尼抑制环丙酚镇静下对FOB反应所需的EC50在男性和女性中分别为3.102[95%可信区间（CI）：2.694 ~ 3.749] ng/mL和2.052 [95% CI: 1.345 ~ 2.750] ng/mL。男性和女性瑞芬太尼抑制环丙酚镇静下对FOB反应所需的EC95分别为3.741 [95% CI: 3.366 ~ 7.699] ng/mL和2.943 [95% CI: 2.456 ~ 9.533] ng/mL。结论：老年患者在环丙酚镇静下，瑞芬太尼抑制FOB反应所需的EC50和EC95在维持自主呼吸方面存在男女差异。试验注册：本研究在chictr.org.cn注册(ChiCTR2300077720；2023年11月17日)。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.