The prevention of intraoperative hypotension could reduce postoperative organ injury and mortality, particularly in elderly patients receiving long-term renin-angiotensin system inhibitors. Previous meta-analyses suggest that ciprofol, a novel intravenous anesthetic agent, may provide improved hemodynamic stability compared to propofol; however, its precise effects on perioperative hemodynamics remain unclear. The study will assess whether ciprofol improves perioperative hemodynamic stability in elderly patients receiving renin-angiotensin system inhibitors.
Patients undergoing elective abdominal surgery under general anesthesia
Duration of surgery exceeding 2 hours
Patients receiving long-term renin-angiotensin system inhibitor therapy (>3 months prior to surgery)
Age ≥ 65 years
History of allergy to opioids, propofol, or ciprofol components.
Anticipated difficult airway (limited mouth opening, restricted neck movement, or modified Mallampati grade III-IV) or difficult mask ventilation.
Severe hepatic dysfunction (total bilirubin ≥3.0 mg/dL or AST/ALT ≥2 times the upper limit of normal).
Severe renal impairment (creatinine clearance ≤30 mL/min).
Parallel
Ciprofol group
DrugGeneral anesthesia induction and maintenance were performed using ciprofol.
Propofol group
DrugGeneral anesthesia induction and maintenance were performed using propofol.
The time-weighted average of hypotension
The time-weighted average is measured by calculating the area under the threshold (AUT) divided by the total duration of surgery
Time-weighted average of hypotension
The time-weighted average is measured by calculating the area under the threshold (AUT) divided by the total duration of induction.
Incidence of intraoperative hypotension
Dosage of vasoactive drugs
Success rate of general anesthesia induction
MOAA/S score of 1 or less after administration of ciprofol or propofol, 1 or fewer top-up doses, and no use of rescue drug
Quality of Recovery-15 (QoR-15) score
emergency delirium
RASS\&CAM-ICU, delirium was judged according to whether there were positive features in the questionnaire
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