The median effective doses of propofol combined with two different doses of nalbuphine for adult patients during painless gastroscopy

Abstract

Objective: Propofol is the most widely administered intravenous anesthetic to induce deep sedation for gastroscopy procedures. Coadministration of nalbuphine can provide analgesia and sedation to patients experiencing visceral pain, thereby decreasing the amount of propofol needed and reducing the risk of propofol-induced adverse events. We carried out this study to determine the median effective dose (ED50) of propofol in combination with different dosages of nalbuphine and the optimal dosage of nalbuphine during painless gastroscopy.Methods: We recruited sixty-five patients aged 18–60 years who underwent elective painless gastroscopy. A total of sixty-one patients were allocated randomly to the N1 group (nalbuphine 0.1 mg/kg) or N2 group (nalbuphine 0.15 mg/kg). Three minutes after administration of nalbuphine, patients received a preset dose of propofol at 2.0 mg/kg with a dose gradient of 0.2 mg/kg according to Dixon’s “up-and-down” method. The primary outcome was the ED50 of propofol in combination with nalbuphine. Hemodynamic parameters, recovery time, pain score, and adverse events were recorded as secondary outcomes.Results: The ED50 of propofol in the N2 group was significantly lower than that observed in the N1 group (p < 0.01). Using probit analysis, the ED50 and ED95 of propofol were 1.632 mg/kg and 2.759 mg/kg in the N1 group and 1.111 mg/kg and 2.243 mg/kg in the N2 group, respectively. The incidence of hypotension in the N2 group was lower than that in the N1 group (p < 0.05), and the recovery time was shorter than that of the N1 group (p < 0.05).Conclusion: In adult patients, 0.15 mg/kg nalbuphine led to a significant reduction in the ED50 and ED95 of propofol during gastroscopy. This dose of nalbuphine also reduced the incidence of hypotension and shortened the recovery time. Therefore, nalbuphine (0.15 mg/kg) combined with propofol is a safe option for enhancing recovery after painless gastroscopy in adult patients.Clinical Trial Registration: [https://www.chictr.org.cn/edit.aspx?pid=126699&htm=4], identifier [ChiCTR2100053204].

Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy: A Prospective, Double-Blind, Randomized Controlled Trial

“…Hemodynamic fluctuations is the most frequent intraoperative adverse event in painless gastroscopy. 14 Zhan et al reported that there was no significant difference with or without esketamine administration (0.05, 0.1 and 0.2 mg/kg) in terms of hemodynamic characteristics in painless gastroscopy. 15 However, the hemodynamics were more stable as the doses of esketamine were 0.25 and 0.5 mg/kg.…”

Efficacy and safety comparison of esketamine-propofol with nalbuphine-propofol for upper gastrointestinal endoscopy in children: a multi-center randomized controlled trial

“…Chen et al investigated that the ED95 of nalbuphine in painless induced abortion is 0.128 mg/kg ( 20 ). While in 2022, Tang et al demonstrated that the nalbuphine dosage of 0.15 mg/kg was better than 0.1 mg/kg, as the nalbuphine dose increased from 0.1 mg/kg to 0.15 mg/kg, the ED95 of propofol in adults decreased significantly from 2.759 mg/kg to 2.243 mg/kg, with the lower incidence of hypotension and the shorter recovery time ( 21 ). Li et al concluded that the ED95 of nalbuphine combined with propofol in adults was 0.162 mg/kg ( 11 ).…”

Up-to-date literature review and issues of sedation during digestive endoscopy.

“…The increased satisfaction scores reflect this among patients based on their perceived quality and readiness to undergo another procedure whenever needed. It has been furtherly demonstrated that such effectiveness is usually associated with increased surgical, scientific, and clinical quality based on gastroenterologists' perspective because they can better perform upper and lower exploration procedures, which have been associated with improved adenoma resection rates and enhanced main quality indices [129][130][131][132][133]. However, besides the issues mentioned above, the effectiveness of sedation during digestive endoscopies might also be burdened by financial costs.…”