{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T16:21:44Z","timestamp":1769703704348,"version":"3.49.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the effect of a single low dose of sufentanil on the effective dose of ciprofol required to achieve a bispectral index (BIS) &amp;lt;60 during anesthesia induction in elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 48 elderly patients were randomly assigned to either the sufentanil plus ciprofol group (S + C group) or the ciprofol alone group (C group). A sufentanil dose of 0.1 \u03bcg\/kg was administered to the S + C group (diluted to 5 ml), while the C group was administered 5 ml of normal saline. Five minutes later, the initial administration for both groups was 0.3 mg\/kg ciprofol. Subsequent doses were adjusted in increments or decrements of 0.05 mg\/kg according to the response of the preceding patient within the same treatment group, following two independent, arm-specific up-and-down sequences conducted in parallel. Successful sedation was defined as achieving a BIS score of &amp;lt; 60 within 5 min following ciprofol administration. ciprofol's effective doses (ED50\/ED95) were derived through probit regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 23 patients were enrolled in the S + C group and 25 in the C group. The estimated ED50 of ciprofol was 0.075 mg\/kg (95% CI: 0.024\u20130.123 mg\/kg) in the S + C group and 0.267 mg\/kg (95% CI: 0.159\u20130.361 mg\/kg) in the C group. The estimated ED95 values were 0.246 mg\/kg (95% CI: 0.141\u201314.566 mg\/kg) and 0.439 mg\/kg (95% CI: 0.340\u201367.768 mg\/kg), respectively. The Pearson goodness-of-fit test of group S + C and group C were\n                      <jats:italic>P<\/jats:italic>\n                      = 0.965 and\n                      <jats:italic>P<\/jats:italic>\n                      = 0.615, respectively. The incidence of adverse events, including hypotension (39% vs. 64%) and respiratory depression (17% vs. 16%), did not differ significantly between S + C group and C group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Under BIS monitoring, the estimated ED50 and ED95 of ciprofol for induction in elderly patients were 0.267 and 0.439 mg\/kg, respectively, without sufentanil, and 0.075 and 0.246 mg\/kg with 0.1 \u03bcg\/kg sufentanil. The addition of a low dose of sufentanil reduced the ciprofol requirement for BIS-targeted induction by about 44%\u221272% without increasing the incidence of hypotension or respiratory depression. This regimen provides an effective and well-tolerated strategy for anesthesia in elderly patients, particularly in day surgery and outpatient settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>http:\/\/www.chictr.org.cn<\/jats:ext-link>\n                      , identifier: ChiCTR2400090926.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1715148","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T06:41:32Z","timestamp":1769668892000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of low-dose sufentanil on the effective sedative dose of ciprofol for BIS-guided induction in elderly patients: an up-and-down sequential allocation trial"],"prefix":"10.3389","volume":"12","author":[{"given":"Qing","family":"Han","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The First People's Hospital of Linping District","place":["Hangzhou, Zhejiang, China"]},{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-ming","family":"Hu","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]},{"name":"Department of Anesthesiology, Hangzhou Children's Hospital","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun-li","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First People's Hospital of Linping District","place":["Hangzhou, Zhejiang, China"]},{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao-dong","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University)","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University)","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-long","family":"Wang","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Zhou","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhen-feng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University)","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/EJA.0000000000001799","article-title":"Efficacy and safety of ciprofol vs. propofol for the induction and maintenance of general anaesthesia: a multicentre, single-blind, randomised, parallel-group, phase 3 clinical trial","volume":"40","author":"Liang","year":"2023","journal-title":"Eur J Anaesthesiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"5063","DOI":"10.26355\/eurrev_202207_29292","article-title":"Effect of ciprofol on induction and maintenance of general anesthesia in patients undergoing kidney transplantation","volume":"26","author":"Qin","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"111976","DOI":"10.1016\/j.jclinane.2025.111976","article-title":"Respiratory-related safety profiles of ciprofol for anesthesia\/sedation in Chinese elderly patients undergoing gastroscopy: a multicenter, parallel controlled clinical trial (REST trial)","volume":"106","author":"Zhang","year":"2025","journal-title":"J Clin Anesth."},{"key":"B4","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1001\/jamasurg.2025.1299","article-title":"Hemodynamic impact of ciprofol vs propofol during anesthesia induction in patients with severe aortic stenosis: a randomized clinical trial","volume":"160","author":"Ni","year":"2025","journal-title":"JAMA Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e105818","DOI":"10.1136\/bmjopen-2025-105818","article-title":"Effects of ciprofol on postoperative delirium and outcomes in older patients undergoing major thoracic surgery: protocol for a multicentre, prospective, single-blinded, randomised controlled study","volume":"15","author":"Hong","year":"2025","journal-title":"BMJ Open."},{"key":"B6","doi-asserted-by":"publisher","first-page":"3095","DOI":"10.1073\/pnas.1121461109","article-title":"A neurophysiological\u2013metabolic model for burst suppression","volume":"109","author":"Ching","year":"2012","journal-title":"Proc Natl Acad Sci USA."},{"key":"B7","doi-asserted-by":"publisher","first-page":"6195","DOI":"10.3390\/ijms22126195","article-title":"Improper remodeling of organelles deputed to Ca2+ handling and aerobic ATP production underlies muscle dysfunction in ageing","volume":"22","author":"Protasi","year":"2021","journal-title":"Int J Mol Sci."},{"key":"B8","doi-asserted-by":"publisher","first-page":"S48","DOI":"10.1038\/sj.ejcn.1601025","article-title":"Fat and protein redistribution with aging: metabolic considerations","volume":"54","author":"Beaufr\u00e8re","year":"2000","journal-title":"Eur J Clin Nutr."},{"key":"B9","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1080\/03602530902722679","article-title":"Pharmacokinetics and drug metabolism in the elderly","volume":"41","author":"Klotz","year":"2009","journal-title":"Drug Metab Rev."},{"key":"B10","doi-asserted-by":"publisher","first-page":"735700","DOI":"10.3389\/fphar.2021.735700","article-title":"Safety, pharmacokinetics, and pharmacodynamics of a single bolus of the \u03b3-aminobutyric acid (GABA) receptor potentiator HSK3486 in healthy Chinese elderly and non-elderly","volume":"12","author":"Li","year":"2021","journal-title":"Front Pharmacol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.2147\/DDDT.S453486","article-title":"Exploring the median effective dose of ciprofol for anesthesia induction in elderly patients: impact of frailty on ED50","volume":"18","author":"Yuan","year":"2024","journal-title":"Drug Des Devel Ther."},{"key":"B12","doi-asserted-by":"publisher","first-page":"3729","DOI":"10.2147\/DDDT.S473662","article-title":"The impact of fentanyl on the effective dose of remimazolam-induced sedation in elderly female patients: an up-and-down sequential allocation trial","volume":"18","author":"Huang","year":"2024","journal-title":"Drug Des Devel Ther"},{"key":"B13","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1213\/00000539-199810000-00038","article-title":"The effect of the interaction of propofol and alfentanil on recall, loss of consciousness, and the bispectral index","volume":"87","author":"Iselin-Chaves","year":"1998","journal-title":"Anesth Analg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.2147\/DDDT.S504189","article-title":"Effect of fentanyl on remimazolam-induced sedation in female patients undergoing hysteroscopic surgery: a randomized controlled trial","volume":"19","author":"Huang","year":"2025","journal-title":"Drug Des Devel Ther."},{"key":"B15","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/S0952-8180(01)00375-0","article-title":"The effect of fentanyl on hemodynamic and bispectral index changes during anesthesia induction with propofol","volume":"14","author":"Nakayama","year":"2002","journal-title":"J Clin Anesth."},{"key":"B16","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1097\/00000539-200001000-00034","article-title":"The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation","volume":"90","author":"Guignard","year":"2000","journal-title":"Anesth Analg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1093\/bja\/aep162","article-title":"Bispectral and spectral entropy indices at propofol-induced loss of consciousness in young and elderly patients","volume":"103","author":"Lysakowski","year":"2009","journal-title":"Br J Anaesth."},{"key":"B18","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1097\/01.anes.0000267514.42592.2a","article-title":"Advances in and limitations of up-and-down methodology: a pr\u00e9cis of clinical use, study design, and dose estimation in anesthesia research","volume":"107","author":"Pace","year":"2007","journal-title":"Anesthesiology."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1411856","DOI":"10.3389\/fphar.2024.1411856","article-title":"The dose of remimazolam combined with sufentanil for the induction of general anesthesia in obese patients undergoing bariatric surgery: an up-and-down sequential allocation trial","volume":"15","author":"Chen","year":"2024","journal-title":"Front Pharmacol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/j.0001-5172.2004.00323.x","article-title":"Time-frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane, propofol, and thiopental anesthesia","volume":"48","author":"Vakkuri","year":"2004","journal-title":"Acta Anaesthesiol Scand."},{"key":"B21","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1034\/j.1399-6576.2003.00041.x","article-title":"Different benefit of bispectal index (BISTM) in desflurane and propofol anesthesia","volume":"47","author":"Luginb\u00fchl","year":"2003","journal-title":"Acta Anaesthesiol Scand."},{"key":"B22","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1097\/00000539-199704000-00035","article-title":"A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect","volume":"84","author":"Sebel","year":"1997","journal-title":"Anesth Analg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1007\/s11096-022-01529-x","article-title":"Efficacy and safety of ciprofol versus propofol for the induction of anesthesia in adult patients: a multicenter phase 2a clinical trial","volume":"45","author":"Zhu","year":"2023","journal-title":"Int J Clin Pharm."},{"key":"B24","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1093\/bja\/66.4.490","article-title":"Brain and spinal cord metabolic activity during propofol anaesthesia","volume":"66","author":"Cavazzuti","year":"1991","journal-title":"Br J Anaesth"},{"key":"B25","doi-asserted-by":"publisher","first-page":"7294358","DOI":"10.1155\/2022\/7294358","article-title":"Clinical value of total intravenous anesthesia with sufentanil and propofol in radical mastectomy","volume":"2022","author":"Qu","year":"2022","journal-title":"Dis Markers."},{"key":"B26","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1097\/00000542-200510000-00026","article-title":"Propofol: the challenges of formulation","volume":"103","author":"Baker","year":"2005","journal-title":"Anesthesiology."},{"key":"B27","doi-asserted-by":"publisher","first-page":"5484","DOI":"10.1007\/s12325-021-01914-4","article-title":"Sedation effects produced by a ciprofol initial infusion or bolus dose followed by continuous maintenance infusion in healthy subjects: a phase 1 trial","volume":"38","author":"Hu","year":"2021","journal-title":"Adv Ther."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1715148\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T06:41:35Z","timestamp":1769668895000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1715148\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":27,"alternative-id":["10.3389\/fmed.2025.1715148"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1715148","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"article-number":"1715148"}}