A Comparative Study Protocol Investigating the Association Between Intraoperative Hypotension and the Use of Ring- Versus Propofol-Based Anesthesia in Elderly Patients Undergoing Non-Cardiac Surgery

Overview

we conducted this multicentre retrospective cohort study to evaluate the association between the choice of induction agent (ciprofol versus propofol) and the incidence of IOH in geriatric patients having non-cardiac surgery. We hypothesized that ciprofol use would be associated with a lower risk of clinically significant intraoperative hypotension and a reduced overall hypotension burden compared with propofol in routine clinical practice.

Intraoperative hypotension (IOH) is a frequent and clinically significant complication during non-cardiac surgery, particularly in the geriatric population .On a population basis, the hypotensive harm threshold for AKI is a mean arterial pressure (MAP) of around 65 mm Hg. Maintaining MAP above this level during surgery is therefore recommended. Mounting evidence suggests that even brief periods of low arterial blood pressure are independently associated with an increased risk of postoperative myocardial injury acute kidney injury (AKI), and 30-day mortality . Elderly patients are uniquely vulnerable to these adverse outcomes due to age-related physiological decline, reduced cardiovascular reserve, and multiple comorbidities . Consequently, maintaining hemodynamic stability during the induction and maintenance of anaesthesia is a cornerstone of perioperative care in this fragile cohort . Propofol remains the most widely utilized intravenous anesthetic agent worldwide ; however, its administration is frequently complicated by dose-dependent vasodilation and myocardial depression, leading to a high incidence of IOH . To mitigate these risks, ciprofol, a novel 2,6-disubstituted phenol derivative and GABA(A) receptor agonist, has been developed . While several studies and meta-analyses have demonstrated that ciprofol possesses higher potency and a more favorable safety profile compared with propofol , most evidence to date is derived from randomized controlled trials (RCTs) or specific procedural sedation settings. These studies often employ restrictive inclusion criteria and standardized protocols that may not fully reflect the complexities of real-world clinical practice. The "real-world" impact of ciprofol on the incidence of IOH-especially when administered across diverse surgical settings and multi-institutional practices-remains poorly defined. Specifically, it is unclear whether ciprofol's theoretical pharmacological advantages translate into a lower incidence of IOH in elderly patients undergoing varied non-cardiac procedures in routine clinical care.