Abstract: Objective To investigate the dose‑effect relationship of ciprofol in inhibiting the response to laryngeal mask airway insertion when used in combination with sufentanil. Methods A total of 23 patients, men or women, aged 18−60 years, with body mass index (BMI) of 18−30 kg/m2, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ, who underwent elective laryngeal mask airway insertion under general anesthesia were selected. Anesthesia induction was conducted through intravenous injection of sufentanil at 0.3 μg/kg, followed by intravenously injection ciprofol 5 min later. After the patients became unconscious, they were intravenously injected with 0.6 mg/kg of rocuronium, before laryngeal mask airway insertion 3 min later. The dose of ciprofol was determined by the up‑and‑down method, with an initial dose of 0.30 mg/kg and a dose gradient of 0.05 mg/kg. The next patient's ciprofol dose was determined according to the response to laryngeal mask airway insertion. The response was positive, when body movement, mouth movement, choking cough, frowning, tears, laryngeal spasm and other reactions occurred during laryngeal mask airway insertion, or the heart rate or blood pressure increased by 20% of pre‑anesthesia baseline within 3 min after laryngeal mask airway insertion. If the response to laryngeal mask airway insertion was positive, or the modified Observer's Assessment of Alertness/Sedation (mOAA/S) score was more than 1 point within 2 min, the dose of ciprofol would increase by one gradient in the next patient, or decrease by one gradient. Their heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded after the patients entered the operation room (T1), after anesthesia induction (T2), and after laryngeal mask airway insertion (T3). The time to loss of consciousness within 2 min after injection of 0.20−0.30 mg/kg ciprofol at T2 was recorded and the success rate of loss of consciousness was calculated. The incidences of adverse reactions after anesthesia induction (bradycardia, hypotension, and injection pain) were recorded. The median effective dose (ED50) [95% confidence interval (CI)] and 95% effective dose (ED95) (95%CI) of ciprofol to inhibit the response to laryngeal mask airway insertion were calculated by the Probit method. Results Compared with those at T1, HR, SBP, DBP, and MAP decreased (all P<0.05), but SpO2 increased (all P<0.05) at T2 and T3. At T2, the time to loss of consciousness within 2 min after injection of 0.20−0.30 mg/kg ciprofol was (71.0±17.8) s. The success rate of loss of consciousness within 2 min after injection of 0.15, 0.20, 0.25 mg/kg and 0.30 mg/kg ciprofol was 0, 40.0%, 85.7%, and 100%, respectively. After anesthesia induction, bradycardia occurred in five patients (21.7%), hypotension in seven patients (30.4%), and injection pain in one patient (4.35%). When used in combined with sufentanil, the ED50 and 95%CI of ciprofol to inhibit the response to laryngeal mask airway insertion were 0.212 (0.182−0.242) mg/kg, and the ED95 and 95%CI were 0.265 (0.237−0.414) mg/kg. Conclusions The ED50 and ED95 of ciprofol when used in combination with sufentanil to inhibit the response to laryngeal mask airway insertion are 0.212 mg/kg and 0.265 mg/kg, respectively.
|