| BackgroundPostoperative cognitive dysfunction(POCD)specifically refers to cognitive decline in patients after surgery and anesthesia,including a decrease in perceptual ability,attention,memory,logical thinking ability,and language expression ability.POCD is more common in elderly patients.Propofol is a first-line drug for clinical anesthesia among sedatives,but it has a significant impact on POCD,mainly due to respiratory depression,hypoxia,excessive depth of anesthesia,and insufficient cerebral blood perfusion caused by low blood pressure.Ciprofol is a propofol analog,a new injectable general anesthetic developed by Sichuan Haikang Pharmaceutical Co.,Ltd.It obtained a drug clinical trial approval from the China Food and Drug Administration(CFDA)in March 2016 and applied for patents in more than 20 countries such as China,the United States,Europe,and Japan.It has completed phase I,II,and III clinical trials in multiple centers in multiple countries.ciprofol is not inferior to propofol in inducing and maintaining general anesthesia,rarely causing pain during induction,and exhibiting better intraoperative hemodynamic characteristics.Since its application in clinical practice in March 2022,ciprofol is gradually replacing propofol and becoming a first-line drug for inducing and maintaining general anesthesia.There are currently no studies on ciprofol and POCD in elderly patients at home and abroad.This study intends to compare ciprofol and propofol to observe whether ciprofol has advantages in reducing POCD in elderly patients.Objective1.Compare and observe the safety window size between ciprofol and propofol in inhibiting motor response and respiratory depression,and compare the risks of hypoxic POCD caused by both drugs.2.Compare the incidence of adverse events during perioperative anesthesia between ciprofol and propofol and compare the probability of POCD caused by low cerebral perfusion in both groups.3.Compare the changes in anesthesia depth(NI)at different time points within 30 minutes after anesthesia induction between ciprofol and propofol,and evaluate the risk of POCD caused by excessive anesthesia depth in both groups.4.Use the reliable change index(RCI)to quantify the differences in reducing POCD between ciprofol and propofol.Materials and Methods:1.Safety window determination of propofol and ciprofol: The difference between the doses required for respiratory and motor suppression was defined as the safety window.This study used sequential determination to compare the safety windows of propofol and ciprofol.2.The incidence of adverse events(AE)in the propofol and ciprofol groups were recorded.A high incidence of these events can increase the risk of POCD.3.The Narcotrend monitor was used to compare the risk of POCD caused by deep anesthesia with propofol and ciprofol.4.The reliable change index(RCI)was calculated for each neuropsychological test item,and if the scores of two or more tests showed a significant decrease,POCD was diagnosed.This study compared the impact of propofol and ciprofol on POCD using this method.Experimental Results The 95% confidence intervals of the EC50 for inhibiting movement and respiration by propofol overlapped,indicating a smaller safety window.The 95% confidence intervals for inhibiting movement and respiration by propofol did not1.overlap,indicating a larger safety window for ciprofol.2.The incidence of hypotension after propofol induction was 37.5%,significantly higher than the 15% observed for ciprofol(P=0.0222).The incidence of bradycardia after propofol induction was 17.5%,significantly higher than the 5%observed for ciprofol(P=0.0339).3.The Narcotrend index(NI)of propofol was significantly higher than that of ciprofol 2 minutes after induction(P<0.05).However,at all time points between6 and 20 minutes after induction,the NI of propofol was significantly lower than that of ciprofol(P<0.05)and below the safety threshold of 40,indicating that ciprofol was more stable and safer for anesthesia depth during induction.4.Three of the six NPT scores had an RCI>1.7.The RCI for propofol was significantly higher than that for ciprofol(P<0.05).Conclusion1.Ciprofol has a wider safety window for anesthesia,with a lower incidence of adverse events during surgery,which may reduce the incidence of POCD.2.Ciprofol provides a more stable anesthesia depth during induction,reducing the risk of burst suppression and POCD.3.Three of the six NPT scores had an RCI>1.7,with a significantly higher RCI for propofol than for ciprofol,indicating that propofol is more likely to cause POCD than ciprofol. |
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