Oliceridine and its potential to revolutionize GI endoscopy sedation

Abstract

Providing sedation to patients undergoing gastrointestinal (GI) endoscopy is a controversial and emotive issue. The mainstay of sedation is propofol, whose administration is within the sole jurisdiction of anesthesia providers, at least in the USA. Attempts have been made to seize the authority by the GI community. One of the first attempts was the use of the prodrug of propofol –fospropofol. However, as the drug has a similar adverse effect profile as propofol in terms of respiratory depression, the FDA did not approve its use by providers other than those trained in airway management. Sedasys ® was the next attempt, which was a computer-assisted personalized sedation system. As a result of insufficient sedation that could be provided with the device, although very successful in research settings, it was not a commercial success. It seems that remimazolam is the next effort in this direction. It is likely to fail in this regard unless its respiratory depressant properties and failure rates could be addressed. G protein-biased μ-receptor agonists are a new class of opioids exhibiting analgesic properties similar to morphine without equivalent respiratory depressant properties. Oliceridine is the prototype. As a result, the drug can be additive to midazolam or remimazolam and allow screening colonoscopy to be comfortably completed without the need for propofol. For an anesthesia provider, the administration of oliceridine can eliminate the need for drugs such as fentanyl that add to the respiratory depressant properties of propofol. As a result, oliceridine has the potential to render the sedation for GI endoscopy procedures both safe and cost-effective.

Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy

“…This may be a drawback in the practicality of drug administration and requires additional equipment. Remifentanil is used in clinical practice as an adjunct in combination with sedatives/anesthetics such as propofol, ketamine, hypnomidate, and midazolam [ 34 , 35 , 36 ].…”

Oliceridine- Opioid of the 21st Century

“…A recent review by the authors of this manuscript discussed in detail the potential of oliceridine to revolutionize gastrointestinal (GI) endoscopy sedation. [ 25 ] One of the biggest concerns of propofol-induced sedation in GI endoscopy is respiratory depression. Airway difficulties and hypoxia are common causes of cardiac arrest in patients undergoing GI endoscopy with deep sedation.…”

“…Regrettably, many of the details in the prescribing information are, at least partly, contrary to the conclusions made in phases 2 and 3 studies and reviews. [ 7 25 31 32 33 ] The label clearly states that “Olinvyk exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death.”[ 34 35 ] It further mandates clinicians to evaluate each patient for the development of behaviors or conditions suggesting addiction, abuse, and misuse. The label also highlights the possibility of serious, life-threatening, or fatal respiratory depression and requires respiratory monitoring, especially during initiation or following a dose increase.…”

Sedation/analgesia techniques for nonoperating room anesthesia: new drugs and devices

“…We suggest that oliceridine has promise for use in NORA as its analgesic properties, fast onset of action and decreased incidence of respiratory adverse events suggest that it might offer some increased safety over other opioids. Further research is required to fully investigate its potential, including studies in which it is compared to shorter acting agents, such as fentanyl and alfentanil [26].…”