{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T11:45:19Z","timestamp":1782647119194,"version":"3.54.5"},"reference-count":28,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"High-level Innovative Talent Project of Guizhou Province","award":["gzwjrs -2024-009"],"award-info":[{"award-number":["gzwjrs -2024-009"]}]},{"name":"Talent Project of Science and Technology Bureau of Guiyang Municipality","award":["zhukehe [2024]-2-27"],"award-info":[{"award-number":["zhukehe [2024]-2-27"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Flexible bronchoscopy frequently provokes airway reflexes that impair patient comfort and procedural quality. Remimazolam provides effective sedation but often requires adjunctive opioids to suppress coughing and movement. Oliceridine is a G-protein-biased \u03bc-opioid receptor agonist that may provide effective pain relief while minimising respiratory and haemodynamic side effects. However, the optimal dose of oliceridine combined with remimazolam for bronchoscopy remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a prospective, single-centre, sex-stratified, up-and-down sequential allocation trial. Adult patients (18\u201365 years, American Society of Anesthesiologists I\u2013III) undergoing painless flexible bronchoscopy will receive intravenous oliceridine followed by remimazolam (0.3\u2009mg\/kg). The initial oliceridine dose is 40\u2009\u00b5g\/kg and is adjusted in 10\u2009\u00b5g\/kg steps according to the Dixon method based on bronchoscopic response. The primary outcome is the ED50 and ED95 of oliceridine for suppressing bronchoscopic responses during remimazolam sedation in male and female patients. ED50 and ED95 values with 95% CIs will be estimated using probit regression. Secondary outcomes include respiratory and haemodynamic events, rescue medication use, recovery characteristics and satisfaction scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Approval for the study has been granted by the Ethics Committee of Guiyang First People\u2019s Hospital. Written informed consent will be obtained from each participant. The findings will be shared through peer-reviewed journals and academic conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ChiCTR2500114090.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117378","type":"journal-article","created":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T11:25:35Z","timestamp":1782645935000},"page":"e117378","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Estimation of ED50 and ED95 of oliceridine required to suppress bronchoscopic responses during remimazolam sedation: study protocol for an up-and-down sequential allocation trial"],"prefix":"10.1136","volume":"16","author":[{"given":"Anhong","family":"Li","sequence":"first","affiliation":[{"name":"College of Anesthesiology, Guizhou Medical University, Guiyang, China"},{"name":"Department of Anesthesiology, The First People\u2019s Hospital of Guiyang, Guiyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuancheng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First People\u2019s Hospital of Guiyang, Guiyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueying","family":"Zhou","sequence":"additional","affiliation":[{"name":"College of Anesthesiology, Guizhou Medical University, Guiyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1126-5381","authenticated-orcid":false,"given":"Bailong","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"key":"2026062804251204000_16.6.e117378.1","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.3855\/jidc.17866","article-title":"Fiberoptic bronchoscopy for the prevention of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials","volume":"18","author":"Tang","year":"2024","journal-title":"J Infect Dev Ctries"},{"key":"2026062804251204000_16.6.e117378.2","doi-asserted-by":"crossref","first-page":"107196","DOI":"10.1016\/j.lungcan.2023.107196","article-title":"Diagnostic yield and safety of navigation bronchoscopy: A systematic review and meta-analysis","volume":"180","author":"Kops","year":"2023","journal-title":"Lung Cancer"},{"key":"2026062804251204000_16.6.e117378.3","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/thoraxjnl-2013-203618","article-title":"British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE","volume":"68 Suppl 1","author":"Du Rand","year":"2013","journal-title":"Thorax"},{"key":"2026062804251204000_16.6.e117378.4","doi-asserted-by":"crossref","DOI":"10.12659\/MSM.943784","article-title":"Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study","volume":"30","author":"Liu","year":"2024","journal-title":"Med Sci 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A Randomized Controlled Trial","volume":"45","author":"Huang","year":"2025","journal-title":"CURR MED SCI"},{"key":"2026062804251204000_16.6.e117378.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-025-05984-9","article-title":"Comparison of the efficacy and safety of remimazolam and propofol for fiberoptic bronchoscopy in older patients: a prospective, randomized controlled study","volume":"25","author":"Chai","year":"2025","journal-title":"BMC Geriatr"},{"key":"2026062804251204000_16.6.e117378.9","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.20552","article-title":"Comparison of the safety and efficacy of remimazolam for sedation during bronchoscopy: a meta-analysis of randomized controlled trials","volume":"14","author":"Yuan","year":"2026","journal-title":"PeerJ"},{"key":"2026062804251204000_16.6.e117378.10","doi-asserted-by":"crossref","first-page":"3000605251372495","DOI":"10.1177\/03000605251372495","article-title":"Safety and efficacy of remimazolam combined with 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