International journal of surgery (London, England) · 2025
The 95% effective dose of ciprofol-assisted sedation for knee arthroplasty in elderly patients: a prospective cohort study.
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Yue Wei, Li Bo, Tian Yandong, Zhang Linzhong
Аннотация
BACKGROUND: Sedation is an important component of regional anesthesia. The pharmacokinetics and pharmacodynamics of elderly patients undergo changes with increasing age, resulting in heightened sensitivity to a multitude of drugs. There is a paucity of data regarding the 95% effective dose of ciprofol-assisted sedation for knee arthroplasty under intrathecal anesthesia in elderly patients.
MATERIALS AND METHODS: A prospective cohort study was conducted on elderly patients aged 65 years and above who were undergoing knee arthroplasty. The initial maintenance dose of ciprofol for sedation was 0.2 mg·kg -1 ·h -1 . The degree of sedation was evaluated using the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale, while Bispectral Index values were monitored. The maintenance dose of ciprofol for each subsequent patient was adjusted by the biased coin design up-and-down sequential method. The ED 95 for ciprofol-assisted sedation was calculated by isotonic regression, and a 95% confidence interval was obtained by a bootstrapping algorithm on the results of 2000 replicates. At the same time, the changes in vital signs and the occurrence of adverse events during and after operation were recorded.
RESULTS: A total of 66 patients participated in the study. One patient was excluded due to insufficient observation time; four patients who had hypotension were relieved and excluded after giving ephedrine; two patients were relieved and excluded after atropine was given due to bradycardia; and three patients were excluded due to abnormal limb movements. Among the 56 patients who completed the experiment, no sedation-related adverse events occurred. The ED 95 for ciprofol-assisted sedation was calculated to be 0.363 mg · kg -1 ·h -1 [95% CI, 0.352~0.375 mg·kg -1 ·h -1 ].
CONCLUSION: At intrathecal anesthesia block planes of T 10 to T 11 , the ED 95 of ciprofol-assisted sedation for knee replacement in elderly patients is 0.363 mg·kg -1 ·h -1 (95% CI, 0.352~0.375 mg·kg -1 ·h -1 ).
MATERIALS AND METHODS: A prospective cohort study was conducted on elderly patients aged 65 years and above who were undergoing knee arthroplasty. The initial maintenance dose of ciprofol for sedation was 0.2 mg·kg -1 ·h -1 . The degree of sedation was evaluated using the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale, while Bispectral Index values were monitored. The maintenance dose of ciprofol for each subsequent patient was adjusted by the biased coin design up-and-down sequential method. The ED 95 for ciprofol-assisted sedation was calculated by isotonic regression, and a 95% confidence interval was obtained by a bootstrapping algorithm on the results of 2000 replicates. At the same time, the changes in vital signs and the occurrence of adverse events during and after operation were recorded.
RESULTS: A total of 66 patients participated in the study. One patient was excluded due to insufficient observation time; four patients who had hypotension were relieved and excluded after giving ephedrine; two patients were relieved and excluded after atropine was given due to bradycardia; and three patients were excluded due to abnormal limb movements. Among the 56 patients who completed the experiment, no sedation-related adverse events occurred. The ED 95 for ciprofol-assisted sedation was calculated to be 0.363 mg · kg -1 ·h -1 [95% CI, 0.352~0.375 mg·kg -1 ·h -1 ].
CONCLUSION: At intrathecal anesthesia block planes of T 10 to T 11 , the ED 95 of ciprofol-assisted sedation for knee replacement in elderly patients is 0.363 mg·kg -1 ·h -1 (95% CI, 0.352~0.375 mg·kg -1 ·h -1 ).