Higher Sufentanil Dose Steadies Hysteroscopic Anesthesia but Raises Breathing Risks

A randomized trial of 288 patients undergoing elective hysteroscopic surgery has found that a higher dose of the opioid sufentanil, combined with the sedative ciprofol, kept patients stiller during the procedure and reduced the need for extra sedative doses, but came with a trade-off: more episodes of intraoperative respiratory depression. The study, published in BMC Anesthesiology, compared two induction regimens in which only the sufentanil dose differed.

Patients were randomly assigned, using a random number table, to one of two groups. Group A received intravenous sufentanil at 0.1 micrograms per kilogram of body weight together with ciprofol at 0.4 milligrams per kilogram for anesthesia induction, while Group B received the same ciprofol dose but a higher sufentanil dose of 0.15 micrograms per kilogram. In both groups, sedation was maintained during the procedure with a continuous infusion of ciprofol.

The primary outcome was the incidence of intraoperative body movement, a sign that anesthesia and analgesia are not fully controlling the patient’s response to surgical stimulation. Secondary outcomes included the number of additional ciprofol doses required, the duration of surgery, and recovery time. The researchers also tracked hemodynamic parameters—systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate—at four time points: before induction, after induction, during cervical dilation, and at recovery.

The results favored the higher opioid dose on the effectiveness side. Compared with Group A, Group B showed a significantly lower incidence of intraoperative body movement and required fewer supplemental doses of ciprofol, with both differences reaching statistical significance. This suggests that the 0.15 micrograms per kilogram regimen provided better intraoperative analgesic control, reducing both movement and the need for rescue sedation.

Hemodynamics told a more nuanced story. Repeated-measures analysis of variance demonstrated significant time effects for systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate in both groups, meaning these values changed over the course of the procedure. However, neither the between-group effects nor the interaction effects were statistically significant, indicating that the two sufentanil doses produced comparable hemodynamic profiles.

Safety outcomes diverged in one key respect. Group B had a significantly higher incidence of intraoperative respiratory depression than Group A. The two groups did not differ significantly in the incidence of intraoperative hypotension or bradycardia, nor in postoperative dizziness. There were also no significant differences between the groups in surgical duration or recovery time, and adverse events including postoperative nausea, vomiting, and pain were documented as part of the safety assessment.

The authors concluded that, compared with 0.1 micrograms per kilogram, 0.15 micrograms per kilogram of sufentanil combined with ciprofol improves intraoperative analgesic control during hysteroscopic surgery, as shown by reduced body movement and fewer supplemental sedative requirements, while hemodynamic effects remained comparable between the regimens. Because the higher dose increased respiratory depression, they recommend that sufentanil dosing be individualized to balance analgesic control against safety.

The trial was retrospectively registered at the Chinese Clinical Trial Registry (ChiCTR2400092067) on 8 November 2024, a detail worth noting when weighing the design. The findings also come with clear scope limitations: the studied population consisted of patients aged 18 to 45 years with ASA physical status I or II and a body mass index of 18 to 28 kilograms per square meter, treated at a single center. The results may not generalize to older patients, those with significant comorbidities, or populations outside these weight and health-status ranges.

Subject of Research: Comparing two sufentanil doses combined with ciprofol for anesthesia efficacy and safety in hysteroscopic surgery

Article Title: Efficacy and safety of varying doses of sufentanil combined with ciprofol for anesthesia in hysteroscopic surgery

Article References: LIN, B., HUANG, Z., FAN, X., LIU, F., HU, S., KONG, D., & ZHANG, X. (2026). Efficacy and safety of varying doses of sufentanil combined with ciprofol for anesthesia in hysteroscopic surgery. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04333-6

Image Credits: AI Generated

DOI: 10.1186/s12871-026-04333-6

Keywords: sufentanil, ciprofol, hysteroscopic surgery, anesthesia, respiratory depression, randomized trial, hemodynamics, sedation, analgesia, patient safety, Efficacy, safety