Dose-Finding of Alfentanil for Hysteroscopy Under Remimazolam Sedation in Obese and Normal-Weight Patients: An Up-and-Down Trial.
Jindi Cao, Jinghui Ma, Jingyan Chen et al.
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From the abstract
Hysteroscopy is a minimally invasive procedure with rapid recovery. However, obesity may alter opioid pharmacokinetics and pharmacodynamics, and optimal alfentanil dosing remains uncertain. This study estimated the median effective dose (ED 50 ) and explored the 95% effective dose (ED 95 ) of alfentanil for suppressing predefined procedural responses during hysteroscopy under…
Reported results
Sixty patients (31 normal-weight, 29 obese) were enrolled. Probit regression estimated an ED 50 of 9.71 μg/kg (95% confidence interval [CI], 7.81-12.26) in obese patients and 13.67 μg/kg (95% CI, 12.77-15.07) in normal-weight patients (P = 0.001). The corresponding ED 95 estimates were 12.57 μg/kg (95% CI, 10.92-28.28) and 16.24 μg/kg (95% CI, 14.92-21.48), respectively.
Authors' conclusions
The total-body-weight (TBW)-normalized ED 50 of alfentanil was significantly lower in obese than in normal-weight patients (P = 0.001). The ED 95 estimates are model-based and carry substantial uncertainty; no formal hypothesis test was performed for ED 95 comparisons. Close respiratory monitoring and individualized titration remain necessary.