Determination of the 90% effective dose of propofol combined with oliceridine or fentanyl for inhibiting the insertion response in upper gastrointestinal endoscopy: a dose-finding trial.

Abstract

Propofol combined with opioids is commonly used for procedural sedation, enhancing patient tolerance and reducing the incidence of adverse events. This study aimed to determine the 90% effective dose (ED₉₀) of propofol combined with fentanyl or oliceridine to inhibit the gastroscopy insertion response. This randomized, double-blind, dose-finding trial enrolled patients undergoing painless upper gastrointestinal endoscopy. Participants were assigned to receive propofol combined with fentanyl or oliceridine. A biased coin up-and-down sequential design was used to estimate the ED₉₀ of propofol for inhibiting the gastroscopy insertion response. The primary outcome was the ED₉₀ and 95% confidence intervals (CIs) for propofol in combination with either fentanyl or oliceridine for inhibiting the gastroscopy insertion response. A total of 115 patients were included in the final analysis (59 in Group F and 56 in Group O). The ED₉₀ of propofol required to suppress the gastroscopy insertion response was 1.942 (1.709-2.494) mg/kg in Group F and 1.871 (1.620-2.519) mg/kg in Group O. There were no significant between-group differences in the ED₉₀ or in the incidence of adverse events (<i>P</i> &gt; 0.05). The ED₉₀ of propofol for suppressing gastroscopy insertion responses was 1.942 mg/kg (95% CI, 1.709-2.494) with fentanyl and 1.871 mg/kg (95% CI, 1.620-2.519) with oliceridine. The substantial overlap of the confidence intervals suggests comparable propofol requirements for the two opioid adjuncts under the study conditions. These findings provide quantitative reference data to guide individualized initial propofol dosing during upper gastrointestinal endoscopy. https://www.chictr.org.cn/, identifier ChiCTR2500096971.