Journal Publication

Oliceridine cut the remifentanil dose needed to blunt intubation response

A 50-patient randomized trial found preemptive oliceridine lowered the remifentanil EC50 for suppressing tracheal intubation reflexes by about 29%, with less propofol and less post-extubation pain.

A randomized trial found that a single 1.5 mg dose of oliceridine given before anesthesia induction lowered the remifentanil concentration needed to prevent tracheal intubation responses.

By AppliedXLJuly 16, 2026

Executive Summary

A randomized trial asked whether pretreating patients with oliceridine before anesthesia induction would lower the dose of remifentanil needed to blunt the body's reflex response to tracheal intubation.
Patients who received oliceridine needed markedly less remifentanil to suppress heart rate, blood pressure, and reflex responses during intubation, and also needed less propofol to reach the same anesthetic depth.
Patients given oliceridine also reported less pain immediately after extubation, reinforcing the opioid-sparing signal beyond the primary dose-finding measure.
The result supports a preemptive, opioid-sparing dosing strategy for a routine step in general anesthesia, though it rests on a single dose-finding trial rather than a hard outcomes study.

The question

Tracheal intubation, the placement of a breathing tube during anesthesia induction, triggers a reflex surge in heart rate and blood pressure that anesthesiologists blunt with opioids like remifentanil, a fast-acting synthetic opioid. Because higher remifentanil doses carry their own risks, including hypotension and postoperative hyperalgesia, reducing the dose needed to control this reflex has direct bearing on anesthetic safety. This trial tested whether oliceridine, an opioid with a different receptor-signaling profile, could lower that required dose when given ahead of induction. Oliceridine

How it was done

The trial randomized 50 patients to receive either 1.5 mg of intravenous oliceridine or a saline placebo before induction with a target-controlled infusion of propofol at an effect-site concentration of 3.0 mcg/mL, combined with remifentanil. Each successive patient's remifentanil dose was set using Dixon's up-and-down method, a sequential dose-titration design that adjusts each new dose based on the prior patient's response, to estimate the concentration blunting intubation responses in half of patients (EC50). The primary outcome was that EC50, defined by a 20% or greater rise in heart rate or blood pressure, or the presence of tearing, muscle tremor, or coughing, estimated using probit analysis, a statistical method for dose-response curves. Oliceridine

The result

The remifentanil EC50 needed to prevent an intubation response was 2.52 ng/mL (95% CI 2.19-2.80) in the oliceridine group, compared with 3.52 ng/mL (95% CI 3.27-3.81) in the placebo group, a reduction of about 29% in the target concentration required. Patients who received oliceridine also needed significantly lower induction doses of both remifentanil and propofol (p<0.01). Oliceridine

The secondary signal

Beyond the primary dose-finding endpoint, patients who received oliceridine reported lower pain scores immediately after extubation than those who received placebo (p<0.05). That the opioid-sparing effect carried through to a patient-reported pain measure, not just the hemodynamic dose-response curve, extends the finding beyond a narrow pharmacodynamic result and points to a practical benefit at the moment patients wake from anesthesia. Oliceridine

What it means for practice

The trial supports preemptive oliceridine as a way to reduce total opioid exposure during a routine phase of general anesthesia, by lowering the remifentanil concentration required to control the intubation reflex and, correspondingly, the doses of both remifentanil and propofol used. The design, a single-center, 50-patient dose-finding study using a sequential allocation method rather than a fixed-dose comparison, establishes a pharmacodynamic effect rather than a clinical outcome such as hypotension incidence, respiratory depression, or recovery time. Oliceridine

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