Post-Intubation Hypotension After Titrated Induction with Ciprofol versus Propofol in Older Adults Undergoing Non-Cardiac Surgery: A Randomized Controlled Trial.
Bai H, Guo J, et al. • Clinical interventions in aging • 2026
In older adults undergoing non-cardiac surgery, ciprofol-based titrated induction was associated with less post-intubation hypotension, lower rescue vasopressor requirement, and less cumulative hypotensive exposure than propofol, without an apparent increase in early adverse recovery outcomes.
Key Findings
Results
Post-intubation hypotension occurred significantly less frequently in the ciprofol group than in the propofol group.
Post-intubation hypotension was defined as any mean arterial pressure (MAP) ≤ 65 mmHg during the 15-minute period after successful tracheal intubation and before surgical incision.
Incidence was 28/77 (36.3%) in the ciprofol group versus 53/79 (67.0%) in the propofol group.
Adjusted odds ratio was 0.28 (95% CI 0.15–0.54; P < 0.001).
Results were consistent across BIS-adjusted sensitivity analyses.
160 patients were randomized in a 1:1 ratio in this prospective, double-blind trial of adults aged 65–89 years.
Results
Ciprofol was associated with a lower hypotension burden as measured by the area under the curve (AUC) for MAP ≤ 65 mmHg.
AUC for MAP ≤ 65 mmHg was 0.0 (IQR 0.0–3.2) mmHg·min in the ciprofol group versus 2.5 (IQR 0.0–14.8) mmHg·min in the propofol group.
This difference was statistically significant (P = 0.047).
AUC was used as a secondary outcome to quantify cumulative hypotensive exposure (hypotension burden).
Results
Ciprofol-based induction required less rescue norepinephrine than propofol-based induction.
Median norepinephrine requirement was 0.0 (IQR 0.0–10.0) µg in the ciprofol group versus 10.0 (IQR 0.0–20.0) µg in the propofol group.
This difference was statistically significant (P < 0.001).
Norepinephrine requirement was a prespecified secondary outcome.
Results
Ciprofol was associated with a milder early decline in cardiac output compared to propofol.
The group-by-time interaction coefficient was β = −0.008 (95% CI −0.010 to −0.005; P < 0.001), indicating a less steep cardiac output decline in the ciprofol group.
Cardiac output trajectories were assessed as a secondary outcome.
Both drugs were administered using an identical titration-to-effect induction protocol.
Results
No significant between-group differences were observed in early postoperative adverse outcomes.
Early postoperative recovery outcomes were evaluated as secondary endpoints.
No statistically significant differences were found in adverse recovery outcomes between the ciprofol and propofol groups.
The trial was conducted at a single center, which the authors note as a limitation requiring confirmation in larger multicenter studies.
Methods
The study enrolled adults aged 65–89 years undergoing elective non-cardiac surgery using a prospective, randomized, double-blind design.
160 patients were randomized in a 1:1 ratio to ciprofol or propofol.
Both groups followed an identical titration-to-effect induction protocol.
The primary outcome was post-intubation hypotension (MAP ≤ 65 mmHg) during the 15-minute window after intubation and before surgical incision.
Secondary outcomes included hypotension AUC, norepinephrine requirement, cardiac output trajectories, time to loss of consciousness, and early postoperative recovery outcomes.
What This Means
This research suggests that when older adults (ages 65–89) are put under general anesthesia for non-cardiac surgery, using a newer sedative drug called ciprofol instead of the commonly used propofol leads to meaningfully better blood pressure stability immediately after a breathing tube is inserted. Dangerous drops in blood pressure (below 65 mmHg average arterial pressure) occurred in about 36% of patients given ciprofol compared to 67% of patients given propofol — and when blood pressure did drop, the total amount of time spent with dangerously low pressure was also lower with ciprofol. Patients given ciprofol also needed less of the emergency blood-pressure-raising medication norepinephrine, and their heart output declined less steeply during induction.
This matters because low blood pressure during anesthesia induction is a well-recognized risk in older patients and has been linked to organ damage, prolonged hospital stays, and other complications. A drug that reduces this risk without causing other problems could be clinically useful for this vulnerable population. Importantly, the study found no significant difference in early recovery complications between the two drugs, suggesting ciprofol did not introduce new risks in this setting.
This research suggests ciprofol has a more favorable blood pressure profile than propofol for anesthesia induction in older adults, but the authors caution that the study was conducted at a single center with a relatively small number of patients (160 total). Larger, multi-site trials would be needed to confirm these findings and to determine whether this hemodynamic benefit translates into meaningful improvements in longer-term patient outcomes.
Bai H, Guo J, Li Y, Zhang S, Chen S, Wang Z, et al.. (2026). Post-Intubation Hypotension After Titrated Induction with Ciprofol versus Propofol in Older Adults Undergoing Non-Cardiac Surgery: A Randomized Controlled Trial.. Clinical interventions in aging. https://doi.org/10.2147/CIA.S609412