# APBA Kısa Özet

A randomized controlled trial comparing ciprofol with propofol for titrated induction of anesthesia in older adults undergoing non-cardiac surgery found that ciprofol significantly reduced the incidence of post-intubation hypotension and associated hemodynamic burden, without increasing early adverse recovery outcomes.

# Çalışma neyi araştırdı?

This prospective, randomized, double-blind trial investigated whether ciprofol-based titrated induction could reduce post-intubation hypotension compared to the standard propofol regimen in older adults (aged 65–89 years) undergoing elective non-cardiac surgery. The primary outcome was post-intubation hypotension, defined as any mean arterial pressure ≤65 mmHg during the 15-minute period after successful tracheal intubation and before surgical incision. Secondary outcomes included hypotension burden expressed as area under the curve (AUC), norepinephrine requirement, cardiac output trajectories, time to loss of consciousness, and early postoperative recovery outcomes.

# Yöntem

A total of 160 patients were randomized in a 1:1 ratio to receive either ciprofol or propofol, following an identical titration-to-effect induction protocol. The study was single-center, double-blinded, and included adults aged 65–89 years undergoing elective non-cardiac surgery. The primary outcome was post-intubation hypotension defined as any mean arterial pressure ≤65 mmHg during the 15-minute period after intubation and before surgical incision. Secondary outcomes included hypotension burden expressed as area under the curve (AUC), norepinephrine requirement, cardiac output trajectories, time to loss of consciousness, and early postoperative recovery outcomes.

# Temel bulgular

Post-intubation hypotension occurred less frequently in the ciprofol group than in the propofol group (28/77 [36.3%] vs 53/79 [67.0%]; adjusted odds ratio 0.28, 95% confidence interval [CI] 0.15–0.54; P = 0.047). The ciprofol group also required significantly less norepinephrine (0.0 [0.0–10.0] µg vs 10.0 [0.0–20.0] µg; P < 0.001). Hypotension burden, expressed as AUC, was lower in the ciprofol group. No significant between-group differences were observed in early postoperative adverse outcomes.

# Bulgular ne anlama geliyor?

These findings suggest that ciprofol-based titrated induction is associated with a favorable hemodynamic profile in older adults undergoing non-cardiac surgery, specifically reducing the incidence and burden of post-intubation hypotension and norepinephrine use. However, the single-center design and older adult population limit generalizability, and the results do not extrapolate to cardiac procedures or broader surgical populations.

# Klinik önem

Clinically, the reduction in post-intubation hypotension and norepinephrine requirement may translate to improved hemodynamic stability immediately after intubation. However, these findings should be interpreted with caution given the single-center nature of the trial, the older adult cohort, and the non-cardiac surgery only population. Further multicenter research is needed before routine clinical adoption.

# Sınırlılıklar

The study has several limitations: it was a single-center trial limiting generalizability; the older adult population (65–89 years) may not represent all surgical patients; the study included non-cardiac surgery only, so results may not extrapolate to cardiac procedures; industry sponsorship or funding source was not specified in the abstract; and the short follow-up period focused on immediate postoperative outcomes, leaving longer-term recovery unexplored.