{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:23:15Z","timestamp":1786123395597,"version":"build-2736575974"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5]]},"abstract":"\n BACKGROUND:<\/jats:title>\n The aim of this study was to explore a new method for determining optimal dosing regimens for combinations of propofol, midazolam, and an opioid to achieve rapid on- and off-set of deep sedation.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We simulated 16 published dosing regimens using a well-validated pharmacodynamic model. The study was divided into 2 parts. First, the regimen that best provided deep sedation and rapid recovery was selected. A deep sedation-time area-under-the-curve (AUC) method was used to compare published dosing regimens; a higher AUC indicated better sedation and faster recovery. Second, subgroup analysis of the best-performing dosing regimen was undertaken better to understand how each drug affected patient recovery.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n The AUC method identified a combination of midazolam 1 mg, alfentanil 500 \u00b5g, and propofol target infusion effect-site concentration (Ce) 2 \u00b5g mL\n \u2212<\/jats:sup>\n 1<\/jats:sup>\n as the optimal regimen (\n P<\/jats:italic>\n < .01). Propofol correlated with high probability of sedation and increased AUC (R\n 2<\/jats:sup>\n = 0.53), whereas midazolam had a significant impact on time to return of consciousness (R\n 2<\/jats:sup>\n = 0.86). Subgroup analysis indicated that regimens consisting of a fixed dose of alfentanil and either 5 \u00b5g mL\n \u22121<\/jats:sup>\n Ce propofol, or 1 mg midazolam with 3\u20135 \u00b5g mL\n \u22121<\/jats:sup>\n Ce of propofol, or 2 mg midazolam with 2 \u00b5g mL\n \u22121<\/jats:sup>\n Ce propofol provided adequate sedation and rapid recovery. Midazolam >3 mg greatly prolonged recovery.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n This study used a clinically relevant method and model simulation to determine suitable sedation regimens for use in gastrointestinal endoscopy. A balanced propofol, midazolam, and an opioid should be used. The AUC method was capable of providing objective assessments for model selection.<\/jats:p>\n <\/jats:sec>","DOI":"10.1213\/ane.0000000000007263","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T13:00:32Z","timestamp":1738760432000},"page":"1168-1177","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["A New Method for Comprehensive Analysis of Benzodiazepine, Opioid, and Propofol Interactions and Dose Selection Rationales in Gastrointestinal Endoscopy Sedation"],"prefix":"10.1213","volume":"140","author":[{"given":"Jing-Yang","family":"Liou","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Department of Biomedical Engineering, National Yang-Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin-Yi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Ting","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Department of Biomedical Engineering, National Yang-Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Yung","family":"Tsou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Cardinal Tien Hospital, New Taipei City, Taiwan"},{"name":"School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weng-Kuei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Kun","family":"Ting","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Institute of Emergency and Critical Care Medicine, National Yang-Ming Chiao Tung University, Taipei, 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