Adjunctive Oliceridine During Propofol or Ciprofol Sedation for Same-Session Bidirectional Endoscopy in Older Adults: A Multicenter Randomized 2×2 Factorial Trial.
Yongjiu Ji, Chenxi Xu, Siqi Yang et al.
✦ AI-curated · Sources linked
In 30 seconds
This multicenter, double-blind, placebo-controlled 2×2 factorial randomized trial assessed adjunctive oliceridine with propofol or ciprofol for same-session bidirectional endoscopy in adults aged 65–80 years. Among 357 participants in the primary analysis, oliceridine shortened the prespecified awakening interval by an estimated 1.42 min versus placebo (95% CI -2.43 to -0.40; P = 0.007). It also reduced supplemental sedative use and time to discharge readiness, but increased hypotension. The awakening difference was not evident in a post hoc analysis timed from the final sedative dose; a potentially greater effect with ciprofol was exploratory.
Key findings
- Oliceridine versus placebo shortened the prespecified awakening interval by 1.42 min (95% CI -2.43 to -0.40, P = 0.007).
- Oliceridine reduced supplemental sedative use (risk difference -16.7%, 95% CI -24.8% to -8.5%, adjusted P < 0.001) and shortened discharge readiness by 1.64 min.
- Hypotension increased with oliceridine (risk difference 15.6%, 95% CI 7.6% to 23.6%, P < 0.001).
- The oliceridine-placebo awakening difference was 0.09 min when measured from the final sedative dose (95% CI -0.78 to 0.96, P = 0.833).
Why it matters
The findings show a trade-off relevant to procedural sedation in older adults: adjunctive oliceridine was associated with less supplemental sedative use and faster discharge readiness, alongside more hypotension. The difference in awakening depended on how the interval was measured, so the overall result should not be interpreted as consistent evidence of faster recovery across measures.
What to keep in mind
The trial was not powered to test interaction effects; the suggested greater oliceridine effect with ciprofol is exploratory. The final-dose awakening analysis was post hoc.