Fospropofol provided more stable intraoperative hemodynamics than propofol in patients undergoing supratentorial tumor resection without increasing the delirium risk, albeit with a slower recovery profile than propofol.
Key Findings
Results
Fospropofol resulted in significantly lower area under the threshold (AUT) for mean arterial pressure below 65 mmHg compared to propofol.
AUT was 65.7 vs. 353.0 mmHg·min for fospropofol versus propofol groups respectively (P < 0.05)
AUT for MAP < 65 mmHg was the primary outcome measure of the trial
217 patients were included in the analysis: 108 in the fospropofol group and 109 in the propofol group
The trial was conducted across multiple centers between August 2023 and December 2024
Results
The incidence of intraoperative hypotension was significantly lower in the fospropofol group than in the propofol group.
Intraoperative hypotension incidence was 49.1% in the fospropofol group versus 70.6% in the propofol group (P < 0.05)
The fospropofol group required less ephedrine to manage hypotension (P < 0.05)
Both fospropofol and propofol were used for anesthesia induction and maintenance
Hypotension incidence was a secondary outcome of the trial
Results
Fospropofol was associated with a longer time to recovery and a higher incidence of delayed recovery compared to propofol.
Time to recovery was 35 min in the fospropofol group versus 25 min in the propofol group (P = 0.002)
Delayed recovery incidence was 60.5% in the fospropofol group versus 38.3% in the propofol group (P = 0.005)
These findings indicate a slower recovery profile for fospropofol relative to propofol
Results
The incidences of emergence delirium and postoperative delirium were comparable between the fospropofol and propofol groups.
No statistically significant difference was found between groups for emergence delirium or postoperative delirium (P > 0.05)
This indicates that fospropofol does not increase delirium risk compared to propofol in this neurosurgical population
Delirium incidence was included among secondary outcomes
Results
The fospropofol and propofol groups differed in baseline characteristics, with the fospropofol group having more males and a higher smoking rate.
The fospropofol group had more males than the propofol group
The fospropofol group had a higher smoking rate than the propofol group
217 total patients were randomized: 108 to fospropofol and 109 to propofol
Patients were scheduled for elective supratentorial tumor resection
Conclusions
Fospropofol was evaluated as a safe and effective option for neurosurgical anesthesia in patients undergoing supratentorial tumor resection.
Fospropofol demonstrated more stable intraoperative hemodynamics than propofol
No increase in delirium risk was observed with fospropofol
The authors note the trade-off of a slower recovery profile compared to propofol
Both induction and maintenance of anesthesia were performed with the assigned agent
What This Means
This research suggests that fospropofol, a newer anesthetic drug related to propofol, keeps blood pressure more stable during brain tumor surgery than the commonly used drug propofol. In a study of 217 patients undergoing surgery to remove tumors in the upper part of the brain, those who received fospropofol experienced fewer episodes of dangerously low blood pressure (about 49% versus 71%) and needed less medication to correct low blood pressure. The measure of how much and how long blood pressure dropped below a safe threshold was also much lower in the fospropofol group.
However, patients who received fospropofol took longer to wake up after surgery — about 35 minutes on average compared to 25 minutes for propofol — and were more likely to experience delayed recovery (about 61% versus 38%). Importantly, both drugs resulted in similar rates of confusion or delirium upon waking and in the days after surgery, meaning fospropofol did not add extra risk of these common post-surgical complications.
This research suggests that fospropofol may be a useful alternative to propofol for brain surgery, particularly for patients where maintaining stable blood pressure during surgery is a priority. The trade-off is a slower wake-up time, which medical teams would need to plan for. These findings are relevant to anesthesiologists and neurosurgeons considering the best anesthetic approach for patients having supratentorial brain tumor operations.
Sun Y, Chen Y, Zhuang W, Deng S, Yang Q, Liao Q, et al.. (2026). Effects of Fospropofol on intraoperative hemodynamics in patients undergoing Supratentorial tumor resection: A randomized controlled trial.. Journal of clinical anesthesia. https://doi.org/10.1016/j.jclinane.2026.112237