1
|
Efficacy and safety of Ciprofol for procedural sedation and anesthesia in non-operating room settings. J Clin Anesth 2023; 85:111047. [PMID: 36599219 DOI: 10.1016/j.jclinane.2022.111047] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/11/2022] [Accepted: 12/25/2022] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVE Ciprofol, a novel intravenous anesthetic, provides rapid recovery in patients undergoing colonoscopy. We aimed to examine the efficacy and safety of ciprofol in comparison with propofol for sedation or anesthesia in non-operating room settings including endoscopic submucosal dissection, endoscopic retrograde cholangiopancreatography, and flexible bronchoscopy (FB). DESIGN Prospective, randomized, double-blind, parallel-group clinical trial. SETTING University-affiliated teaching hospital. PATIENTS We recruited 207 patients scheduled for an endoscopic procedure from October 2021 to December 2021. INTERVENTIONS Patients were randomized into three groups according to the dose during induction (n = 69 each): 1) ciprofol 6 mg/kg/h, 2) ciprofol 8 mg/kg/h, or 3) propofol 40 mg/kg/h. Ciprofol or propofol was administered throughout the procedure. MEASUREMENTS The primary outcome was the success rate of sedation or anesthesia for the procedures. Secondary outcomes included induction time, endoscope insertion time, recovery time, discharge time, incidence of drug-related adverse events (AEs), neurological and inflammatory outcomes. MAIN RESULTS The procedure success rates in the three groups were 100%. The induction time in the 6 (3.3 ± 1.0 min) and 8 mg/kg/h (2.9 ± 0.6 min) ciprofol groups was longer than that in the propofol group (2.5 ± 0.6 min) only in patients undergoing FB (p = 0.004). The time for patients to be fully alert and discharged from the post-anesthesia care unit was comparable across the three groups (p > 0.05). The incidence of drug-related AEs in the propofol and 6 and 8 mg/kg/h ciprofol groups was 84.1%, 76.8%, and 79.7%. No pain on injection was reported by ciprofol groups. Neurological outcomes and inflammatory responses were comparable among the three groups. CONCLUSIONS Ciprofol induced a level of sedation or anesthesia equivalent to that induced by propofol in non-operating room settings except for a prolonged induction time in patients undergoing FB. Ciprofol had a safety profile similar to that of propofol. No pain on injection was reported by ciprofol.
Collapse
|
2
|
Loftsson T. Cyclodextrins in Parenteral Formulations. J Pharm Sci 2020; 110:654-664. [PMID: 33069709 DOI: 10.1016/j.xphs.2020.10.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022]
Abstract
Most drugs have very limited solubility in water and some can be extremely difficult to formulate as parenteral solutions where the dose should preferably be dissolved in couple of ml of aqueous media without use of organic solvents and surface active agents, or application of somewhat extreme techniques such as prodrug formation. Thus, pharmaceutical formulators are constantly looking for new, biologically acceptable, and low-cost armamentarium for parenteral formulation development. Cyclodextrins (CDs) are enabling pharmaceutical excipients that can temporarily camouflage undesirable physiochemical drug properties such as low aqueous solubility through formation of drug/CD inclusion complexes. CDs are cyclic oligosaccharides that have similar physiological and biological properties like linear saccharides of comparable molecular weight. Due to their very favorable toxicological and pharmacokinetic profiles their usage in parenteral drug formulations is frequently preferred over other solubilizing techniques. Here the physiochemical and biological properties of CDs are reviewed as well as their pharmacokinetics after intravenous administration. Their regulatory status is briefly reviewed and their tendency to self-assemble to form clusters or aggregates discussed. Finally, some examples are given of how CDs are applied in aqueous parenteral formulations, how their solubilizing effect has been enhanced and how their target concentration is determined.
Collapse
Affiliation(s)
- Thorsteinn Loftsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, IS-107 Reykjavik, Iceland.
| |
Collapse
|
3
|
Antkowiak B, Rammes G. GABA(A) receptor-targeted drug development -New perspectives in perioperative anesthesia. Expert Opin Drug Discov 2019; 14:683-699. [DOI: 10.1080/17460441.2019.1599356] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Bernd Antkowiak
- Department of Anesthesiology and Intensive Care, Experimental Anesthesiology Section, Eberhard-Karls-University,
Tübingen, Germany
- Department of Anaesthesiology and Intensive Care, Experimental Anaesthesiology Section, Werner Reichardt Center for Integrative Neuroscience, Tübingen,
Germany
| | - Gerhard Rammes
- University Hospital rechts der Isar, Department of Anesthesiology, München,
Germany
| |
Collapse
|
4
|
Hulsman N, Hollmann M, Preckel B. Newer propofol, ketamine, and etomidate derivatives and delivery systems relevant to anesthesia practice. Best Pract Res Clin Anaesthesiol 2018; 32:213-221. [DOI: 10.1016/j.bpa.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
|
5
|
Shityakov S, Roewer N, Förster C, Broscheit JA. In silico investigation of propofol binding sites in human serum albumin using explicit and implicit solvation models. Comput Biol Chem 2017; 70:191-197. [PMID: 28917201 DOI: 10.1016/j.compbiolchem.2017.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/24/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
All-atom molecular dynamics (MD) simulations are presented on general anesthetic propofol bound to human serum albumin (HSA) due to the drug pharmacokinetics and pharmacodynamics in the circulatory system. We implemented the explicit and implicit solvation models to compare the binding affinity of propofol at the different binding sites (PR1 and PR2) in the HSA protein. Only the implicit solvation models provided the evidence in accordance with the experimental data indicating that the HSA-ligand interactions are dominanted by hydrophobic forces due to the higher drug affinity at the PR1 position with a ΔGMM-PB/SA value of -23.44kcalmol-1. Overall, this study provides important information on the accuracy of explicit and implicit solvation models to characterize the propofol interaction with different HSA binding sites.
Collapse
Affiliation(s)
- Sergey Shityakov
- Department of Anesthesia and Critical Care, University of Würzburg, 97080 Würzburg, Germany.
| | - Norbert Roewer
- Department of Anesthesia and Critical Care, University of Würzburg, 97080 Würzburg, Germany; Sapiotec Ltd., 97078 Würzburg, Germany
| | - Carola Förster
- Department of Anesthesia and Critical Care, University of Würzburg, 97080 Würzburg, Germany
| | - Jens-Albert Broscheit
- Department of Anesthesia and Critical Care, University of Würzburg, 97080 Würzburg, Germany; Sapiotec Ltd., 97078 Würzburg, Germany
| |
Collapse
|
6
|
Abstract
Pain on propofol injection (POPI) is a minor problem that all anesthetists face every day. Introduction of several new formulations and hundreds of clinical trials have failed to find its remedy with just one intervention in all patients. This article highlights the causes of POPI and interventions that are used to eliminate this pain in current practice. Relevant articles from Medline and Embase databases were searched and included in this descriptive review with the following conclusions: (1) POPI is due to irritation of venous adventitia leading to release of mediators such as kininogen from kinin cascade. (2) When two or more drugs or measures are used, the incidence of POPI decreases considerably. Hence, the approach to eliminating POPI should be multimodal. (3) Any regimen that includes a drug having local anesthetic effect combined with central sedative/analgesic and rapid injection into a large vein should definitely reduce the risk of POPI to negligible levels.
Collapse
|
7
|
Wang W, Wu L, Zhang C, Sun L. Is propofol injection pain really important to patients? BMC Anesthesiol 2017; 17:24. [PMID: 28212628 PMCID: PMC5316212 DOI: 10.1186/s12871-017-0321-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/13/2017] [Indexed: 12/12/2022] Open
Abstract
Background Propofol injection pain (PIP) has been adequately studied during the past decades. However, patients’ opinion on this problem and the incidence of patients’ recall of this brief discomfort are still unknown. Thus, we conducted this study to know the patients’ perspectives on PIP and provide useful information about the incidence of recall of PIP under our routine general anesthesia. Methods Five hundred preoperative questionnaires were distributed to patients who were scheduled for elective open thyroidectomy under general anesthesia from May 2016 to July 2016. They were asked to rank ten possible adverse effects associated with general anesthesia from their most undesirable to their least undesirable effect. Patients who completed the preoperative questionnaires were asked whether they could recall PIP and to grade the severity of PIP on the first postoperative day. Results A total of 448 preoperative questionnaires were returned and analyzed with an efficient rate of 89.6%. Incisional pain was ranked as most undesirable, followed (in order) by vomiting, gagging on the tracheal tube, nausea, sore throat, propofol injection pain, shivering, intravenous puncture pain, and anxiety. The majority (91.5%) of surveyed patients could not recall any discomfort or pain during anesthetics injection. Of those who could recall PIP, 89.5% grade it as mild pain, 7.9% moderate pain, and 2.6% severe pain. Conclusions Most of patients undergoing elective open thyroidectomy in our hospital viewed PIP as a relatively minor problem. The incidence of recall of PIP was low and the majority of those who recalled regarded it as mild, temporary and acceptable pain. However, further investigations into propofol injection pain may be warranted as patients’ perspectives on propofol injection pain and its severity may differ between patient populations.
Collapse
Affiliation(s)
- Wen Wang
- Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Linxin Wu
- Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Chaobin Zhang
- Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Li Sun
- Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| |
Collapse
|
8
|
Feng AY, Kaye AD, Kaye RJ, Belani K, Urman RD. Novel propofol derivatives and implications for anesthesia practice. J Anaesthesiol Clin Pharmacol 2017; 33:9-15. [PMID: 28413268 PMCID: PMC5374837 DOI: 10.4103/0970-9185.202205] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Propofol (2,6-diisopropylphenol) is the most commonly used intravenous agent for induction of anesthesia. It is also used for maintenance of anesthesia and sedation in both Intensive Care Units and outpatient procedural settings. Its success in the clinical setting has been a result of its rapid onset, short duration of action, and minimal side effects despite disadvantages associated with its oil emulsion formulation. Early attempts to alter the standard emulsion or to develop new formulations with cyclodextrins and micelles to resolve issues with pain upon injection, the need for antimicrobial agents, and possible hyperlipidemia have mostly failed. With these challenges in the foreground, attention has now shifted to the use of more prodrugs and exogenous alternatives, the success of which is yet to be determined. These new agents must offer significant clinical advantages over the well-entrenched, generic propofol oil emulsion to justify higher costs and to be well received in the increasingly cost-conscious healthcare marketplace.
Collapse
Affiliation(s)
- Aiden Y Feng
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Rachel J Kaye
- Department of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Department of Biochemistry, Bowdoin College, Brunswick, ME, USA
| | - Kumar Belani
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
9
|
Shityakov S, Salmas RE, Durdagi S, Salvador E, Pápai K, Yáñez-Gascón MJ, Pérez-Sánchez H, Puskás I, Roewer N, Förster C, Broscheit JA. Characterization, in Vivo Evaluation, and Molecular Modeling of Different Propofol-Cyclodextrin Complexes To Assess Their Drug Delivery Potential at the Blood-Brain Barrier Level. J Chem Inf Model 2016; 56:1914-1922. [PMID: 27589557 DOI: 10.1021/acs.jcim.6b00215] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this study, we investigated the ability of the general anesthetic propofol (PR) to form inclusion complexes with modified β-cyclodextrins, including sulfobutylether-β-cyclodextrin (SBEβCD) and hydroxypropyl-β-cyclodextrin (HPβCD). The PR/SBEβCD and PR/HPβCD complexes were prepared and characterized, and the blood-brain barrier (BBB) permeation potential of the formulated PR was examined in vivo for the purpose of controlled drug delivery. The PR/SBEβCD complex was found to be more stable in solution with a minimal degradation constant of 0.25 h-1, a t1/2 of 2.82 h, and a Kc of 5.19 × 103 M-1 and revealed higher BBB permeability rates compared with the reference substance (PR-LIPURO) considering the calculated brain-to-blood concentration ratio (logBB) values. Additionally, the diminished PR binding affinity to SBEβCD was confirmed in molecular dynamics simulations by a maximal Gibbs free energy of binding (ΔGbind = -18.44 kcal·mol-1), indicating the more rapid PR/SBEβCD dissociation. Overall, the results demonstrated that SBEβCD has the potential to be used as a prospective candidate for drug delivery vector development to improve the pharmacokinetic and pharmacodynamic properties of general anesthetic agents at the BBB level.
Collapse
Affiliation(s)
- Sergey Shityakov
- Department of Anesthesia and Critical Care, University of Würzburg , 97080 Würzburg, Germany
| | - Ramin Ekhteiari Salmas
- Department of Biophysics, School of Medicine, Bahcesehir University , 34349 Istanbul, Turkey
| | - Serdar Durdagi
- Department of Biophysics, School of Medicine, Bahcesehir University , 34349 Istanbul, Turkey
| | - Ellaine Salvador
- Department of Anesthesia and Critical Care, University of Würzburg , 97080 Würzburg, Germany
| | | | | | | | - István Puskás
- CycloLab Cyclodextrin Research & Development Laboratory Ltd. , H-1097 Budapest, Hungary
| | - Norbert Roewer
- Department of Anesthesia and Critical Care, University of Würzburg , 97080 Würzburg, Germany.,Sapiotec Ltd. , 97078 Würzburg, Germany
| | - Carola Förster
- Department of Anesthesia and Critical Care, University of Würzburg , 97080 Würzburg, Germany
| | - Jens-Albert Broscheit
- Department of Anesthesia and Critical Care, University of Würzburg , 97080 Würzburg, Germany.,Sapiotec Ltd. , 97078 Würzburg, Germany
| |
Collapse
|
10
|
Use of remifentanil to reduce propofol injection pain and the required propofol dose in upper digestive tract endoscopy diagnostic tests. Braz J Anesthesiol 2015; 65:437-44. [DOI: 10.1016/j.bjane.2014.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/23/2014] [Indexed: 12/27/2022] Open
|
11
|
Uso do remifentanil para redução da dor à injeção de propofol e a dose necessária de propofol em exames de endoscopia digestória alta diagnóstica. Braz J Anesthesiol 2015; 65:437-44. [DOI: 10.1016/j.bjan.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/23/2014] [Indexed: 12/27/2022] Open
|
12
|
Silva A, Sousa E, Palmeira A, Amorim P, Guedes de Pinho P, Ferreira DA. Interaction between hydroxyethyl starch and propofol: computational and laboratorial study. J Biomol Struct Dyn 2013; 32:1864-75. [PMID: 24138119 DOI: 10.1080/07391102.2013.840248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hydroxyethyl starch (HES) is one of the most used colloids for intravascular volume replacement during anesthesia. AIM To investigate the existence of a chemical interaction between HES and the anesthetic propofol by in vitro propofol dosing, computational docking, and examination of a complex between propofol and HES by infrared (IR), ultraviolet (UV), and (1)H and (13)C nuclear magnetic resonance (NMR) spectroscopy. METHODS Ten samples with human plasma mixed with HES or lactated Ringers (n = 5 for each fluid) were prepared, and the propofol free fraction was quantified until 50 min, using gas chromatography-mass spectrometry. The docking study was performed between HES and propofol and compared with controls. The binding affinities between HES and the small molecules were evaluated by binding free energy approximation (ΔGb, kJ mol(-1)). The IR, UV, and NMR spectra were measured for propofol, HES, and a mixture of both obtained by the kneading method. RESULTS Propofol concentrations were significantly lower in the HES samples than in the LR samples (p = .021). The spectroscopic characterization of propofol combined with HES revealed differences in spectra and docking studies reinforced a potential interaction between propofol and HES. CONCLUSIONS Propofol and HES form a complex with different physical-bio-chemical behavior than the single drugs, which may be an important drug interaction. Further studies should evaluate its clinical effects.
Collapse
Affiliation(s)
- Aura Silva
- a REQUIMTE, Toxicology, Faculdade de Farmácia da , Universidade do Porto , Rua de Jorge Viterbo Ferreira, 228, Porto , 4050-313 , Portugal
| | | | | | | | | | | |
Collapse
|
13
|
Mcintosh MP, Rajewski RA. Comparative canine Pharmacokinetics–Pharmacodynamics of Fospropofol Disodium Injection, Propofol Eemulsion, and Cyclodextrin-Enabled Propofol Solution Following Bolus Parenteral Administration. J Pharm Sci 2012; 101:3547-52. [DOI: 10.1002/jps.23195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 04/22/2012] [Accepted: 04/26/2012] [Indexed: 11/09/2022]
|
14
|
|