Post-Intubation Hypotension After Titrated Induction with Ciprofol versus Propofol in Older Adults Undergoing Non-Cardiac Surgery: A Randomized Controlled Trial

Summary

In this single-center randomized, double-blind trial of 160 older adults, titrated ciprofol induction was associated with substantially less post-intubation hypotension than propofol. Ciprofol also reduced cumulative hypotensive exposure and rescue norepinephrine use without an apparent increase in early postoperative adverse recovery outcomes.

Key Findings

• Post-intubation hypotension occurred in 36.3% of patients receiving ciprofol versus 67.0% receiving propofol.
• Ciprofol was associated with a lower adjusted odds of post-intubation hypotension, with an adjusted odds ratio of 0.28.
• Ciprofol reduced hypotension burden and rescue norepinephrine requirements without an apparent worsening of early postoperative recovery.

Clinical Implications

Ciprofol may be considered a potential alternative to propofol for carefully titrated induction in older adults at risk of peri-intubation hemodynamic instability. Routine adoption should await confirmation in larger, multicenter trials and evaluation of cost, availability, and clinically important organ outcomes.

Limitations

• The study was conducted at a single center with 160 randomized patients, limiting generalizability.
• The available findings do not establish effects on major postoperative organ injury, mortality, or longer-term recovery.

Future Directions

Larger multicenter trials should compare ciprofol and propofol using standardized hemodynamic management and should assess acute kidney injury, myocardial injury, cerebral outcomes, mortality, recovery quality, and cost-effectiveness.