This study will compare three anesthesia medicines used to put people into a deep sleep during surgery: ciprofol, propofol, and sevoflurane. All three are commonly used for general anesthesia, but they work in different ways. Ciprofol and propofol are given through a vein. Sevoflurane is breathed in as a gas. After brain tumor surgery, some older adults may develop sudden confusion and memory problems called delirium. Researchers want to learn which of these three medicines is best at preventing delirium and protecting brain function in older adults undergoing brain tumor surgery.
About 381 participants aged 65 to 90 will take part. Participants will be randomly assigned to one of three groups. One group will receive ciprofol. Another group will receive propofol. The third group will receive sevoflurane. All participants will receive standard care during and after brain tumor removal.
The main goal is to compare how many participants develop delirium within 7 days after surgery. Researchers will also look at how long delirium lasts, how severe it is, thinking and memory skills at 7, 30, 90, and 180 days after surgery, quality of recovery, blood pressure and heart rate during surgery, and treatment safety.
Blood tests will be used to measure markers of body stress, inflammation, and nerve cell injury before surgery, 3 hours after surgery, and 1 day after surgery. Researchers will also test thinking and memory with simple questions twice a day for 7 days after surgery. Later follow-up will be done by phone at 30, 90, and 180 days after surgery.
This study is designed to explore which anesthesia medicine is safest and best at protecting the brain after surgery in older adults with brain tumors. The results may help doctors choose the best anesthesia for this group of patients in the future.
Aged 65 to 90 years, either sex.
Scheduled to undergo elective brain tumor resection under general anesthesia.
American Society of Anesthesiologists (ASA) physical status I-III.
Expected operative time ≥ 2 hours and anticipated postoperative hospital stay > 48 hours.
Preoperative use of medications that may affect postoperative cognition (e.g., long-term benzodiazepines, antidepressants, antipsychotics, or chronic sedative-hypnotic use that cannot be paused).
Preoperative delirium, dementia, diagnosed severe psychiatric disorder, or existing central nervous system disease.
History of alcohol addiction or drug abuse; suspected or confirmed long-term use of narcotic analgesics or sedatives.
Severe visual, auditory, or speech impairment that precludes communication and cognitive testing.
Parallel
Ciprofol
DrugCiprofol injectable emulsion (20 mL: 50 mg) administered intravenously for general anesthesia induction and maintenance during elective brain tumor resection. Induction: 0.3-0.4 mg/kg by slow intravenous injection over ≥30 seconds. Maintenance: continuous intravenous infusion at 0.4-2.4 mg/kg/h via infusion pump, beginning after induction and continuing until the end of surgery. Dose adjustments are made based on patient response and hemodynamic monitoring. Total duration depends on operative time.
Propofol
DrugPropofol injectable emulsion administered intravenously for general anesthesia induction and maintenance during elective brain tumor resection. Induction: 1.5-2.0 mg/kg by slow intravenous injection over ≥30 seconds. Maintenance: continuous intravenous infusion at 4-12 mg/kg/h via infusion pump, beginning after induction and continuing until the end of surgery. Dose adjustments are made based on patient response and hemodynamic monitoring. Total duration depends on operative time.
Sevoflurane
DrugSevoflurane inhalation solution (volatile liquid) administered via inhalation through a calibrated vaporizer for general anesthesia induction and maintenance during elective brain tumor resection. Induction: 7-8% inhaled concentration with oxygen flow 2-4 L/min until loss of consciousness. Maintenance: inhaled concentration adjusted to 1.0-3.0% and titrated to effect; concentration is gradually reduced beginning 30 minutes before the anticipated end of surgery and discontinued at the end of the procedure. Total duration depends on operative time.
Incidence of Postoperative Delirium Within 7 Days After Surgery as Assessed by the Confusion Assessment Method (CAM)
Delirium is diagnosed using the Confusion Assessment Method (CAM). A positive CAM assessment requires the simultaneous presence of Feature 1 (acute onset and fluctuating course) and Feature 2 (inattention), plus either Feature 3 (disorganized thinking) or Feature 4 (altered level of consciousness). The outcome is reported as the proportion of participants with at least one positive CAM assessment during the 7-day postoperative period.
Duration of Postoperative Delirium in Days During the First 7 Days After Surgery
Duration is defined as the time interval from the first positive CAM diagnosis of delirium to the first assessment showing no delirium symptoms (CAM negative) for a continuous period of at least 24 hours. Recorded in days. If delirium persists beyond 7 days, the maximum recorded duration is 7 days.
Mean Daily CAM-Severity (CAM-S) Score During the First 7 Days After Surgery
The CAM-Severity scale quantifies delirium severity based on CAM features. The 4-item version ranges from 0 to 7 points; the 10-item version ranges from 0 to 19 points. Higher scores indicate more severe delirium. The mean daily score is calculated by averaging all CAM-S scores obtained during each calendar day.
Change in Cognitive Function From Baseline as Assessed by T-MoCA at 7 Days After Surgery
The Telephone Montreal Cognitive Assessment (T-MoCA) evaluates cognitive function including attention, memory, language, and orientation. Total scores range from 0 to 22 points, with higher scores indicating better cognitive function. A score of 18 or above indicates normal cognitive function. Change from baseline is calculated as the post-treatment score minus the baseline score; a positive change indicates improvement and a negative change indicates decline.
Change in Cognitive Function From Baseline as Assessed by T-MoCA at 30 Days After Surgery
The Telephone Montreal Cognitive Assessment (T-MoCA) evaluates cognitive function including attention, memory, language, and orientation. Total scores range from 0 to 22 points, with higher scores indicating better cognitive function. Change from baseline is calculated as the post-treatment score minus the baseline score; a positive change indicates improvement and a negative change indicates decline.
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