Ciprofol versus propofol for hemodynamic stability after anesthetic induction in frail older patients undergoing total knee arthroplasty: a randomized trial

Study objectives To compare the incidence of post-induction hypotension (PIH) between ciprofol and propofol in frail older patients undergoing knee arthroplasty. Design A prospective, randomized controlled trial. Setting A tertiary university-affiliated teaching hospital in China. Participants Frail elderly patients scheduled for elective knee arthroplasty under general anesthesia. Interventions Participants were randomized in a 1:1 ratio to receive ciprofol or propofol for anesthesia induction. Measurements The primary outcome was the incidence of PIH, defined as a mean arterial pressure (MAP) < 65 mmHg or a ≥ 20% decrease from baseline occurring within the first 10 min after induction. Secondary outcomes included the area under the curve (AUC) of MAP deviation from baseline (ΔMAP) during the first 20 min after induction, vasopressor requirements, injection pain, and recovery-related parameters. Main results Ninety patients completed the trial (ciprofol: n = 45; propofol: n = 45). The ciprofol group showed a lower incidence of PIH (46.7% vs 71.7%; P = 0.018). The median (IQR) AUC of ΔMAP was smaller with ciprofol (− 289.0 mm Hg ·min [− 365.5 to − 266.5]) than with propofol (− 347.0 mm Hg ·min [− 378.0 to − 296.5]; P = 0.025). Patients receiving ciprofol required fewer vasopressor boluses per case (0 [0–1] vs 1 [0–1]; P = 0.015) and reported less injection pain (6.7% vs 31.1%; P = 0.003). Conclusions In frail older patients undergoing knee arthroplasty, ciprofol was associated with a lower incidence of PIH and improved peri-induction hemodynamic stability than propofol, suggesting its potential role in perioperative hemodynamic risk management for this high-risk population.