The 90% effective dose of ciprofol and propofol with S-ketamine for painless abortion: a randomized, double-blind,...

Unlike the propofol-opioids combination, a single dose of S-ketamine with propofol achieves the same anesthetic effects while effectively minimizing adverse reactions in painless abortion. Ciprofol, a novel analog of propofol, has distinct advantages, its application in painless abortion is underexplored.

To investigate a 90% effective dose (ED₉₀) of ciprofol and propofol with S-ketamine for painless abortion.

This prospective biased coin up-and-down (BCUD) sequential dose-finding study aimed to estimate the ED₉₀ of ciprofol when administered with 0.15 mg/kg S-ketamine in painless abortion while comparing adverse effects incidence with the ED₉₀ of propofol when combined with the same dose of S-ketamine.

Eighty patients were recruited and randomly allocated to either ciprofol or propofol groups, with initial doses of 0.375 mg/kg and 1.5 mg/kg, respectively. The dose for the subsequent patient in the study was based on the response of the preceding patient, following the BCUD design. The study estimated the ED₉₀ using isotonic regression. Secondary outcomes, including the incidence of injection pain, vital signs, and adverse events, were recorded and compared between the two groups.

The ED₉₀ of ciprofol with 0.15 mg/kg S-ketamine was 0.498 mg/kg (95% confidence interval: 0.498-0.510), while the ED₉₀ of propofol with 0.15 mg/kg S-ketamine was 1.99 mg/kg (95% confidence interval: 1.98-2.16). Patients in the ciprofol group had a lower incidence of respiratory pause (7.5% vs 52.5%; p < 0.001). Other adverse events and recovery time were comparable between groups.

Compared to propofol and S-ketamine combination, ciprofol and S-ketamine are equally effective with reduced respiratory depression. Thus, clinicians should consider a dose of 0.5 mg/kg ciprofol with 0.15 mg/kg S-ketamine for painless abortion.

http://www.chictr.org.cn; ChiCTR2400086522; July 5, 2024.