Comparison of hemodynamic responses to endotracheal intubation with oliceridine and sufentanil during induction: a randomized controlled trial.

BACKGROUND: Oliceridine, a G-protein-biased μ-opioid receptor agonist, offers a potential alternative to conventional opioids by reducing adverse effects. However, its efficacy in attenuating the hemodynamic response to endotracheal intubation compared to sufentanil remains unclear. This study aimed to evaluate the hemodynamic stability of oliceridine versus sufentanil during anesthesia induction. METHODS: This single-center, double-blind, randomized controlled trial included 120 female patients undergoing elective laparoscopic gynecological surgery. Patients were randomized (1:1) to receive either oliceridine (0.06 mg/kg) or sufentanil (0.1 µg/kg) during induction. The primary outcome was hemodynamic variability, quantified using the variability independent of the mean (VIM) for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR). Secondary outcomes included absolute changes in hemodynamic parameters at specific time points post-intubation. RESULTS: Baseline characteristics were comparable between groups. The oliceridine group demonstrated statistically significant improvements in hemodynamic stability, with lower VIM scores for SBP (P = 0.016), MBP (P = 0.029), and HR (P = 0.042) compared to the sufentanil group. Prior to intubation, the sufentanil group exhibited significantly lower MBP and SBP compared to the oliceridine group. Immediately post-intubation, the sufentanil group experienced significantly greater fluctuations in SBP, MBP, and HR (p < 0.05). Recovery profiles at 1, 3, and 5 min post-intubation were similar between groups. CONCLUSION: Oliceridine demonstrated statistically significant, albeit modest, improvements in hemodynamic stability during anesthesia induction compared to sufentanil. It effectively attenuates the stress response to intubation while minimizing the risk of induction-related hypotension. TRIAL REGISTRATION: NCT07372209 Date: September 3, 2025 Retrospectively registered.