Hemodynamic Impact of Cipepofol vs Propofol During Anesthesia Induction in Patients With Severe Aortic Stenosis: A Randomized Clinical Trial.
Summary
In a single-center RCT of TAVR patients with severe aortic stenosis (n=122), cipepofol achieved significantly smaller MAP deficit AUC in the first 15 minutes postinduction versus propofol, lower hypotension incidence, and reduced norepinephrine requirements at matched anesthetic depth.
Key Findings
- Primary endpoint: Smaller MAP AUC deficit with cipepofol vs propofol in first 15 minutes postinduction (P<.001).
- Lower postinduction hypotension with cipepofol (70.5% vs 88.5%; P=.01).
- Reduced norepinephrine requirements in the first 15 minutes (median 6.0 μg vs 10.0 μg; P=.006) at comparable BIS.
Clinical Implications
For severe aortic stenosis patients undergoing TAVR, cipepofol can be considered as an induction agent to mitigate postinduction hypotension, pending local availability and clinician familiarity.
Why It Matters
Addresses a high-risk induction scenario where hypotension is common and harmful; provides randomized evidence supporting an alternative induction agent with improved hemodynamic stability.
Limitations
- Single-center trial with short (15-minute) primary observation window.
- Clinical outcomes (e.g., myocardial injury, AKI) were not primary endpoints.
Future Directions
Multicenter trials powered for clinical outcomes and safety endpoints; dose-finding in broader cardiac risk populations; cost-effectiveness and implementation studies.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized clinical trial with intention-to-treat analysis
- Study Design
- OTHER