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      ED50 and ED95 of Propofol Combined with Different Doses of Intravenous Lidocaine for First-Trimester Uterine Aspiration: A Prospective Dose-Finding Study Using Up-and-Down Sequential Allocation Method


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          This study aimed to test the effect of different doses of intravenous lidocaine on the median effective dose (ED50) and 95% effective dose (ED95) of propofol-induction dose and identify the optimal dose.

          Patients and Methods

          Patients undergoing first-trimester uterine aspiration were screened and randomly enrolled into the following groups: saline (L 0), 0.5 mg/kg lidocaine (L 0.5), 1.0 mg/kg lidocaine (L 1.0), and 1.5 mg/kg lidocaine (L 1.5). Anesthesia was induced with 1.0 µg/kg fentanyl. Prepared lidocaine or saline solution was injected later according to allocation, followed by propofol. The dose of propofol for each patient was determined using the up-and-down sequential study design. The primary end point was the ED50 and ED95 of the propofol-induction dose. The total propofol doses, awakening time, and adverse events were recorded.


          The ED50 (95% confidence interval) of propofol was significantly lower in groups L 1.0 and L 1.5 than group L 0 (1.6 [1.5–1.7] mg/kg and 1.8 [1.6–1.9] mg/kg, versus 2.4 [2.3–2.5] mg/kg, respectively; p<0.001). There was no significant difference in ED50 between groups L 1.0 and L 1.5 ( p>0.05). However, surprisingly, the ED50 was significantly higher in group L 0.5 than L 0 (2.8 [2.6–3.0] mg/kg vs 2.4 [2.3–2.5] mg/kg; p<0.05). The total doses of propofol in groups L 1.0 and L 1.5 were lower than those in groups L 0 and L 0.5 ( p<0.05). The systolic blood pressure (SBP) decline after anesthesia induction in group L 0.5 was greater than that in group L 0 ( p<0.01). The incidence of respiratory depression in group L 0.5 was greater than that in groups L 0 and L 1.0 ( p<0.05).


          In patients who underwent first-trimester uterine aspiration, intravenous lidocaine 1.0 mg/kg prior to propofol injection significantly reduced the ED50 of propofol induction dose without severe side effects, equivalent to the effect of 1.5 mg/kg dose. We recommend 1.0 mg/kg as the optimal dose.

          Most cited references34

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          Advances in and limitations of up-and-down methodology: a précis of clinical use, study design, and dose estimation in anesthesia research.

          Sequential design methods for binary response variables exist for determination of the concentration or dose associated with the 50% point along the dose-response curve; the up-and-down method of Dixon and Mood is now commonly used in anesthesia research. There have been important developments in statistical methods that (1) allow the design of experiments for the measurement of the response at any point (quantile) along the dose-response curve, (2) demonstrate the risk of certain statistical methods commonly used in literature reports, (3) allow the estimation of the concentration or dose-the target dose-associated with the chosen quantile without the assumption of the symmetry of the tolerance distribution, and (4) set bounds on the probability of response at this target dose. This article details these developments, briefly surveys current use of the up-and-down method in anesthesia research, reanalyzes published reports using the up-and-down method for the study of the epidural relief of pain during labor, and discusses appropriate inferences from up-and-down method studies.
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            Molecular mechanisms of action of systemic lidocaine in acute and chronic pain: a narrative review

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              The efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy: a multicentered, randomized, positive-controlled, phase III clinical trial

              This study aimed to evaluate the efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy. In this multicentered, blinded, randomized, active-controlled, non-inferior phase III trial, 384 eligible patients who were about to undergo colonoscopy were randomized as a ratio of 1:1 into remimazolam and propofol group. Procedure success was assessed and defined as the completion of colonoscopy without administration of rescue sedative agent or more than 5 top-ups of trial drug in any 15 minute-period after initial administration of trial drug. Sedation quality was evaluated by Modified Observer’s Assessment of Alertness/Sedation score. Treatment-emergent adverse events were recorded. Procedure success rate was 96.91% (188/194) in remimazolam group and 100% (190/190) in propofol group, and the difference in rate was -3.09% with 95% confidence interval (CI) of -5.53%~-0.66%. Since the lower limit of 95% CI was greater than the non-inferiority margin of -8.00%, the efficacy of remimazolam tosylate was non-inferior to propofol. Besides, induction time of sedation was increased ( P 0.05) or time to discharge ( P >0.05) were unchanged. For safety assessment, total treatment-emergent adverse events were decreased in remimazolam group compared to propofol group ( P <0.001); specifically, administration site pain ( P <0.001), increased bilirubin ( P =0.019), decreased respiratory rate ( P <0.001) and decreased SpO 2 ( P <0.001) were less frequent in remimazolam group compared with propofol group. In conclusion, remimazolam tosylate is non-inferior in sedation efficacy while safer than propofol in patients undergoing colonoscopy.

                Author and article information

                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                28 September 2022
                : 16
                : 3343-3352
                [1 ]Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education , Chengdu, Sichuan, People’s Republic of China
                [2 ]Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education , Chengdu, Sichuan, People’s Republic of China
                Author notes
                Correspondence: Juan Ni, Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education , No. 20, Section 3, South of Renmin Road, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86 18180609890, Fax +86 2885503752, Email nijuankiki@163.com
                Author information
                © 2022 Zhang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                : 20 July 2022
                : 15 September 2022
                Page count
                Figures: 3, Tables: 3, References: 34, Pages: 10
                Original Research

                Pharmacology & Pharmaceutical medicine
                lidocaine,propofol,uterine aspiration,median effective dose


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