Differential impacts of propofol and etomidate on hemodynamic stability and postoperative cognition in elderly surgical patients: A retrospective observational analysis

As the aging population continues to expand, tailoring anesthetic strategies to improve safety and recovery outcomes in elderly patients has become increasingly important. Propofol and etomidate are 2 widely used agents for intravenous induction in general anesthesia, each with distinct pharmacologic properties. This study explores the comparative safety profiles and perioperative outcomes of these agents in an elderly surgical cohort. A retrospective observational study was conducted on 150 patients aged 65 and above who underwent elective surgery under general anesthesia from January 2023 to January 2025. Participants were grouped according to the induction drug received: propofol (n = 77) or etomidate (n = 73). Primary outcomes included adverse reactions during induction (e.g., hypotension, myoclonus), intraoperative hemodynamic variability, emergence time, incidence of postoperative nausea and vomiting, and cognitive changes assessed via mini-mental state examination on the first postoperative day. Baseline characteristics were comparable between groups. Propofol was linked to a significantly higher rate of hypotension during induction (36.4% vs 15.1%, P = .002), whereas etomidate induced more myoclonus (26.0% vs 3.9%, P < .001). Mean arterial pressure fluctuated less in the etomidate group during maintenance (8.6 ± 2.3 mm Hg vs 12.0 ± 3.5 mm Hg, P < .001). Although propofol yielded quicker emergence (9.7 ± 2.9 minutes vs 12.5 ± 3.8 minutes, P = .001), it was associated with greater postoperative cognitive decline ( P = .011). Postoperative nausea and vomiting incidence was higher with etomidate but did not reach statistical significance ( P = .065). Propofol offers rapid recovery advantages but increases the risk of hypotension and cognitive impairment in elderly patients. Etomidate provides superior hemodynamic stability and better cognitive preservation postoperatively, albeit with a higher risk of myoclonus. Anesthetic choice in geriatric populations should be guided by individual risk profiles and perioperative goals.