{"paper_id":"08f2f1e2-6a19-4b3f-a60c-fe4bbea5b289","body_text":"Using transthoracic echocardiography (TTE) to compare the hemodynamic effects of Ciprofol and Propofol during the induction phase of general anesthesia: A prospective, double-blind, randomized, controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Using transthoracic echocardiography (TTE) to compare the hemodynamic effects of Ciprofol and Propofol during the induction phase of general anesthesia: A prospective, double-blind, randomized, controlled trial Yaling Li, Jing Cai, Chuhan Bian, Ruining Huang, Wei Feng, Zhe Li, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7286060/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cipropfol,a new intravenous anesthetic,is structurally and pharmacologically similar to propofol. However, its impact on cardiac function and hemodynamics during anesthesia induction compared to propofol is unclear. This study uses echocardiography to compare cardiac systolic and diastolic performance and hemodynamic measures between Ciprofol and Propofol during anesthesia induction. Methods A total of 204 patients aged 18–65 years, regardless of gender, with ASA physical status I-Ⅱ, BMI 18–30 kg/m 2 , and modified Mallampati classification I-II, were selected for pain-free gastroscopy. They were randomly divided into two groups: Group C (n = 99) received 0.2–0.4 mg/kg of Ciprofol, and Group P (n = 105) received 2–4 mg/kg of Propofol. Each patient was intravenously given 5-7ug/kg of Alfentanil. Pain - free endoscopy started when the MOAA/S score reached ≤ 1. At two time points (T 0 :before anesthesia induction;T 1 :MOAA/S ≤ 1), TTE indices (Sa, Ea, TAPSE values) and monitor data (HR, SBP, DBP, MAP) were recorded for both groups. The study also recorded the incidence of successful sedation, the utilization rate of vasoactive medications (Ephedrine and Atropine), the incidence of injection-related pain, respiratory depression, coughing, intraoperative movements, bradycardia, agitation during recovery, and other adverse reactions like nausea and vomiting within 48 hours post - surgery for both groups. Results The success rate of sedation in both groups was 100%. Upon induction of general anesthesia, the Sa level in the Ciprofol group was observed to be higher than that in the Propofol group (8.73 ± 1.37 vs 8.21 ± 1.10, p = 0.004), SBP in the Ciprofol group was significantly higher than that in the Propofol group (105.44 ± 16.45 vs 100.26 ± 14.10, p = 0.016). Conclusion Ciprofol exhibits superior hemodynamic stability during the induction of general anesthesia compared to Propofol, the benefit might due to its ability to preserve cardiac contractile function, particularly that of the left ventricle. Clinical Trials Registration : https://www.chictr.org.cn/indexEN.html , identifier ChiCTR2500095938. Ciprofol Hemodynamic induction phase of general anesthesia Post-induction hypotension (PIH) Propofol Transthoracic Echocardiography (TTE) Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Background Hemodynamic management during the induction phase of general anesthesia is a vital aspect of perioperative anesthesia management.Post-induction hypotension (PIH), commonly characterized by a reduction in SBP of at least 20% from baseline or a drop to below 80 mmHg, or a decrease in MAP to less than or equal to ≤ 60 mmHg, typically occurs within the initial 20 minutes following the anesthesia induction [ 1 ] . Post-induction hypotension (PIH) has the potential to provoke serious adversereactions associated with anesthesia, including ischemic stroke, myocardial ischemia, and arrhythmias.Consequently, it is crucial to preserve hemodynamic stability during anesthesia induction.The incidence of PIH varies between 45–55% [ 2 – 4 ] , with approximately one-third of hypotensive episodes occur during anesthesia induction phase and prior to surgical incision [ 5 ] .The incidence of PIH is contingent upon the patient's condition and the management of anesthesia [ 6 ] . To minimize the occurrence of PIH, an array of anesthesia management strategies can be employed. These include appropriate fluid resuscitation and the concurrent administration of vasopressors. However, a crucial aspect of these approaches is the optimization of induction agents selection. Propofol, the most frequently utilized short-acting intravenous anesthetic in clinical anesthesia [ 7 ] , achieves its sedative and general anesthetic properties by diminishing central nervous system excitability and enhancing the activity of the inhibitory neurotransmitter GABA [ 8 ] . Its rapid onset, potent suppression of pharyngeal reflexes and stress responses, lack of accumulation with short-term use, absence of respiratory stimulation, and swift recovery have earned it widespread recognition in clinical practice [ 9 ] . It is extensively employed in surgical anesthesia as well as in outpatient painless endoscopic procedures [ 10 ] . However, Propofol is associated with various adverse drug reactions, including injection-related pain, dose-dependent circulatory and respiratory depression [ 11 ] , post-awakening headaches, nausea, andvomiting, and even can lead to severe cardiovascular and cerebrovascular events [ 12 ] . Consequently, There is a clinical need for a new anesthetic sedative with reduced adverse effects. Ciprofol,chemically known as 2-[(1R)‐[1‐cyclopropylethyl]]‐6‐isopropylphenol, is a novel 2,6-disubstituted phenol derivative inspired by Propofol. It falls within the category of innovative γ-aminobutyric acid (GABA) receptor enhancers. This is a new type of sedative anesthetics independently developed in China, distinguished by its excellent safety profile and tolerance, featuring pharmacodynamic activity approximately five times that of Propofol. Current clinical trials suggest that Ciprofol possesses advantages, including rapid and smooth onset, quick and complete recovery, high potency, and a wide safety margin [ 13 ] . Compared to Propofol, Ciprofol associated with fewer instances of respiratory depressions and cardiovascular adverse events, along with an extremely low incidence of injection-related pain and lower lipid input volume [ 14 , 15 ] . Ciprofol offers a safer and more efficacious anesthesia experience, markedly decreasing the incidence of adverse events, particularly among elderly patients and those suffering from respiratory and circulatory comorbidities [ 16 , 17 ] . Ciprofol is currently extensively utilized for sedation and anesthesia in non-intubated surgical procedures, for the induction and maintenance of general anesthesia, and for sedation in intensive care settings [ 15 ] . However, Ciprofol as a new class of intravenous general anesthetic, there is subject of limited clinical research concerning its effects on special populations, including the elderly, children, and pregnant women. Furthermore, with a shorter clinical history compared to traditional intravenous anesthetics such as Propofol, the influence of Ciprofol on cardiac contractility, diastolic function, and hemodynamics has been clinically assessed over a shorter period, and its full effects remain unclear. Ongoing research and clinical assessment are necessary to ensure the safe application of Ciprofol within medical practice.TTE is a vital tool for evaluating cardiac function and hemodynamic status. Doppler echocardiography utilizes the detection of frequency shifts in reflected ultrasound signals from moving objects. Conventional Doppler techniques measure blood flow velocity by detecting high-frequency, low-amplitude signals from small, fast-moving blood cells. In tissue Doppler imaging (TDI), the same Doppler principles are applied to quantify lower-amplitude, lower-velocity signals from myocardial tissue motion [ 18 ] . A decrease in Sa velocity can be detected within 15 seconds of the onset of ischemia [ 19 ] , and regional reductions in Sa are correlated with regional wall motion abnormalities. The incorporation of TDI measures of systolic function in exercise testing to assess for ischemia, viability, and contractile reserve has been suggested due to the normal increase in peak Sa velocity with dobutamine infusion and exercise, and the decrease with ischemia [ 20 ] . TDI assessment of diastolic function is less load dependent than that provided by standard Doppler techniques. Ea maintains its resistance to changes in filling pressure, although there is a more noticeable preload dependence in structurally normal hearts. Anesthesiologists using TTE during surgery can rapidly identify new cardiovascular complications and aid in the analysis of factors contributing to hemodynamic instability [ 21 , 22 ] . This study aims to compare the alterations in hemodynamics and cardiac function between Ciprofol and Propofol during anesthesia induction, providing a reference for future selection of general anesthesia agents and the clinical application of Ciprofol. 2. Methods 2.1 Study design This single-center, prospective, double-blind, randomized, controlled clinical study was performed at the endoscopic center of The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China. Ethical approval for this study (EC-2024-KS-134) was approved by the Institutional Ethics Committee of The Fourth Affiliated Hospital of China Medical University(Chairperson Prof Zhao) on 1st July 2024 and registered at The Chinese Clinical Trial Registry (number MR-21-24-043752), first submitted 11 July 2024, in accordance with the Declaration of Helsinki. In China, Ciprofol for induction and maintenance of general anesthesia (approval no. H20200013) has been approved by the National Medical Products Administration. Written informed consent was obtained from all patients before they were enrolled. Based on the results of the pre-test, the calculations showed that the sample size was at least 199 cases, taking into account a category I error ( α ) of 0.05 and a test efficacy (1-β) of 0.9. In order to ensure the stability of the study and to take into account the possibility of lost visits or incomplete data, we decided to include 240 patients. 2.2 Participants This study included adult patients between the ages of 18 and 65 with an American Society of Anesthesiologists physical classification status of Ⅱ-Ⅲ who were scheduled to undergo elective gastroscopy at the endoscopic center of The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China. Detailed inclusion and exclusion criteria are presented in Table S1 . The research center consecutively recruited 240 eligible patients using computer-generated random sequences and randomly assigned them to the Ciprofol 0.2–0.4 mg/kg group or the Propofol 2.0–4.0 mg/kg group in a 1:1 ratio. The grouping information was concealed and kept in sealed envelopes. Researcher A opened the envelope and prepared the intravenous anesthetic drugs, Researcher B administered the anesthesia, and Researcher C performed TTE on the patient, and Researcher D was involved in data collection. The physical appearance of Ciprofol and Propofol( milky solutions) are semblable, so the researchers could not visually distinguish between them. Both the anesthesiologist, endoscopist, patients, and data collection personnel were blinded to the randomization. 2.3 Interventions Preparation for elective gastroscopy procedures was conducted in accordance with the local protocol or national guidelines of China [ 23 ] . All the patients were infused with 0.9% sodium chloride solution at 8 mL · kg-1, which was completed before sedation was initiated. The infusion rate was 2ml·min-1 after that. A multi-parameter monitor (WATO EX-55, Mindray, Shenzhen, China) was used to continuously monitor pulse oxygen saturation (SpO2), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), standard 12-lead electrocardiogram (ECG), and bispectral index (BIS). Oxygen at a flow rate of 5 L·min-1 was administered continuously through a nasal catheter. All the patients received 5–7 µg · kg-1 alfentanil (33S070212) injection intravenously in 10s before administration of the study drugs. Then, 0.2–0.4 mg·kg-1 Ciprofol (20240131) or 2–4 mg· kg-1 Propofol (16SK8910) was given intravenous injection over 1min. A gastroscope was inserted when the MOAA/S (Table S2 ) score was 1 or lower. The MOAA/S score was repeatedly assessed by the anesthesiologist every 30 seconds during sedation induction. If the MOAA/S score remained > 1 after 2 min of initial administration of the study drug, a top-up dose of 1/2 initial dose was injected over 10s. During maintenance sedation, if the patient showed agitation or inadequate sedation, a top‐up doses were given and repeated every 2 minutes as needed. Sedation was considered unsuccessful if more than five refill doses were required within 15 minutes, and Propofol was the only alternative sedative in this study. 2.4 Outcomes TTE was performed on both groups of patients at two-time points: before anesthesia induction (T0) and when the MOAA/S score was ≤ 1 (T1) (Fig. 1). The probe was adjusted or rotated as necessary to obtain a clear and complete apical four-chamber view. In tissue-Doppler echocardiography, a sample volume of 5–10 mm was used, with the sampling point cursor placed at the mitral valve annulus on the interventricular septum to obtain the peak systolic velocity (Sa) and early diastolic peak velocity (Ea) (Fig. 2a). M-mode was then applied with the sampling point cursor positioned on the lateral tricuspid valve annulus, parallel to the direction of annulus motion, to measure the tricuspid annular plane systolic excursion (TAPSE) (Fig. 2b) [ 24 , 25 ] . All echocardiograms were analyzed by taking the mean value of 2–3 artifact-free sinus beats. Two independent researchers conducted each analysis in a blinded manner. Additionally, the patient's heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded at the corresponding times, as indicated by the electrocardiogram monitor. Primary Outcomes The primary outcome includes the Sa value, Ea value, and TAPSE value from the TTE; HR,SBP,DBP and MAP from the monitor, which examinations at two-time points: before anesthesia induction (T0) and when the MOAA/S score was ≤ 1 (T1). Secondary Outcomes The secondary outcomes included the usage rates of vasoactive medications (such as ephedrine and atropine), the incidence of injection-related pain, coughing episodes, intraoperative movements, bradycardia, agitation during the recovery phase, and other adverse events such as nausea and vomiting within 48 hours post-surgery. 2.5 Statistical analysis Data with a normal distribution are presented as the mean ± standard deviation (SD) and analysed using the two-sampled independent t- test, while data with a non-normal distribution are reported as the median with range and analysed using the Mann–Whitney U test. A P value < 0.05 (one-sided for the primary outcome, and two-sided for all others) indicated a statistically significant difference. Data analysis was performed using Statistical Package for the Social Sciences version 26.0 software (IBM SPSS, Chicago, IL, United States). 3. Results 3.1 Patients’ Disposition and Baseline Characteristics Between 6 August 2024 and 1st November 2024, 240 patients undergoing general anesthesia for elective gastroscopy procedures were enrolled. Of these, 99 patients were assigned to the Ciprofol group and 105 to the Propofol group, based on inclusion and exclusion criteria between 6 August 2024 and 1st November 2024 (Fig. 3). Overall, the two groups had similar demographic and baseline characteristics. (Table 1) 3.2 Primary Outcome Comparison of TTE Parameters Between Two Groups At Two Time Point At the pre-induction (T 0 ) stage, there were no statistically significant differences in TAPSE, Ea, and Sa values between the Propofol group and the Ciprofol group. After induction of general anesthesia when the MOAA/S score was ≤ 1 (T 1 ), the Sa value in the Propofol group was lower than that in the Ciprofol group, with a statistically significant difference ( p = 0.004). Additionally, at T 1 , the TAPSE, Ea, and Sa values in the Propofol group were all lower than those at T 0 , with statistically significant differences. Although the TAPSE and Ea values in the Ciprofol group also decreased from T 0 to T 1 with statistically significant differences, the Sa value in the Ciprofol group did not show a statistically significant difference from T 0 ( p = 0.607).(Fig. 4) (Table 2) Comparison of Heart Rate and Blood Pressure Parameters Between Two Groups at Two Time Points At the pre-induction (T0) stage, there were no statistically significant differences in SBP、DBP、MAP and HR between the Propofol group and the Ciprofol group. After induction of general anesthesia when the MOAA/S score was ≤ 1 (T1), both groups showed a decrease in SBP, DBP, MBP, and HR compared to T0, with statistically significant differences ( p < 0.001). Additionally, at T1, the SBP level in the Propofol group was lower than in the Ciprofol group, with a statistically significant difference ( p = 0.016), while there was no statistically significant difference in HR between the two groups at T1 ( p = 0.666). (Table 3) 3.3 Secondary Outcome Comparison of Vasoactive Drug Use and Perioperative Adverse Events Between the Two Groups There was no statistically significant difference in the use of vasoactive drugs such as ephedrine, phenylephrine, and atropine between the two groups during surgery. The incidence of injection-related pain was significantly lower in the Ciprofol group compared to the Propofol group ( p < 0.001). Other perioperative adverse events, including coughing episodes, intraoperative movements, bradycardia, agitation during the recovery phase, and nausea and vomiting within 48 hours post-surgery, showed no statistically significant differences ( p > 0.05). (Table 4) 4. Discussion Induction of general anesthesia is the initial step in the administration of general anesthesia. Post-induction hypotension (PIH), a distinct phenomenon typically occurring following the administration of general anesthetic induction anesthetics, is frequently observed. This phenomenon is associated with various factors including the patient's pre-induction blood volume, lack of appropriate surgical stimulation corresponding to depth of anesthesia post-induction, autonomic nervous system function, vasodilation caused by anesthetics, and reduced myocardial contractility [ 26 ] . As reported, PIH can compromise the perfusion of vital organs, leading to severe perioperative anesthesia-related complications such as Myocardial Infarction (MI), Acute Kidney Injury (AKI), Stroke, and Postoperative Cognitive Dysfunction (POCD). PIH even can prolong the duration of mechanical ventilation in the intensive care unit postoperatively, increase the incidence of perioperative complications, and anesthesia elevate mortality rates [ 27 , 28 ] . Propofol is currently the most commonly used intravenous anesthetic in clinical practice, exhibiting a strong dose-dependent inhibitory effect on the cardiovascular and respiratory systems [ 9 , 11 ] . Ciprofol is a novel intravenous anesthetic, similar to propofol, which enhances the ion channel-mediated by the γ -aminobutyric acid subtype A receptor (GABAA) to increase chloride ion influx, causing hyperpolarization of the neuronal cell membrane and thereby achieving central nervous system inhibition [ 29 ] . Multiple studies have shown that Ciprofol offers several advantages, including rapid onset, potency efficacy, less respiratory depression, and diminished injection-related pain, leading to increased patient comfort and satisfaction. In this study, the sedation success rate was 100% when using both Propofol and Ciprofol. Consistent with previous research findings, the success rate of sedation with Ciorofol and Propofol during fiberoptic bronchoscopy and colonoscopy was also 100%. [ 14 , 29 ] . Sa (Systolic myocardial velocity) at the lateral mitral annulus is a measure of longitudinal systolic function and is correlated with measurements of LV ejection fraction and peak dP/dt, which can evaluate the systolic function of the ventricular base. Ea(Early diastolic motion) at the mitral annulus reflects the velocity of early myocardial relaxation ascends during early rapid LV filling, which can evaluate ventricular diastolic function. TAPSE at the lateral tricuspid annulus reflects the tricuspid annular systolic displacement, which can evaluate the longitudinal systolic function of the right ventricle [ 18 , 30 ] . This study's results indicate that following induction of general anesthesia, Ea and TAPSE values decreased significantly in the Ciprofol group compared to pre-induction levels, while the Sa value also decreased but was not statistically significant ( p = 0.607). In the Propofol group, general anesthesia induction caused Sa, Ea, and TAPSE values to decrease compared to pre-induction levels. Moreover, the Sa value was higher in the Ciprofol group after induction of general anesthesia than in the Propofol group ( p = 0.004). These findings suggest that Ciprofol has a lesser inhibitory effect on left ventricular systolic function than Propofol, although both groups' diastolic effects were similar. Furthermore, the subjects of this study were patients without severe organic diseases, and the differences between the two drugs may be more pronounced in elderly patients and those with cardiovascular comorbidities. In summary, Ciprofol has a smaller impact on left ventricular systolic function, and there is no significant difference between the two drugs in their diastolic effects. This study's results indicate both Ciprofol and Propofol groups experienced a decrease in heart rate (HR) following general anesthesia induction ( p < 0.001), and there was no significant difference between the two groups ( p = 0.666). Following general anesthesia induction, the systolic blood pressure (SBP) in the Ciprofol group was higher than that in the Propofol group ( p = 0.016). The diastolic blood pressure (DBP) in the Ciprofol group was slightly higher than that in the Propofol group, but there was no significant difference between the two groups ( p = 0. 125). The mean arterial pressure (MAP) in the Ciprofol group was also higher than that in the Propofol group after general anesthesia induction, but there was no significant difference between the two groups ( p = 0. 144). Thus, Ciprofol had a smaller effect on SBP compared to Propofol, while there was no significant difference in the effects on DBP and MAP between the two anesthetics.These findings are consistent with the conclusions of Hung et al's study [ 31 ] . SBP changes are predominantly influenced by stroke volume, primarily affected by myocardial contractility; whereas changes in diastolic blood pressure are mainly influenced by heart rate and peripheral vascular resistance. The effects of Propofol on hemodynamics are primarily associated with reductions in sympathetic neuron tone, direct peripheral vascular vasodilation, and inhibition of physiological baroreflex mechanisms [ 32 , 33 ] . Han et al ’ suggested that Propofol [ 34 ] , at clinically relevant concentrations, promotes catecholamine release as long as calcium influx is supported, the effect of Propofol on myocardial contractility may be related to its inhibition of Ca2 + influx, and thus the reduction of catecholamine release. This may also be a contributing factor to the hypotension caused by Ciprofol, but further research is necessary to elucidate the specific mechanisms. Furthermore, the subjects of this study were patients without severe organic diseases, and the differences between the two drugs may be more pronounced in elderly patients and those with cardiovascular comorbidities. Moreover, the incidence of injection-related pain in patients administered Ciprofol was significantly decreased ( P < 0.001), which may be associated with the higher concentration of Propofol in the aqueous phase [ 35 ] . Therefore, due to its higher lipophilicity, Ciprofol has a significantly lower concentration of free molecules in the emulsion compared to Propofol, thereby reducing stimulation to the venous endothelium and resulting in a lower incidence of injection-pain. The research data shows that Ciprofol and Propofol have comparable effects on inhibiting diastolic cardiac function, dilating peripheral vasculature, and reducing peripheral resistance. Specifically, at equivalent sedative doses, Ciprofol and Propofol show similar impacts on ventricular diastolic function and peripheral vasodilation. While Propofol may have a more pronounced effect on blood pressure compared to Ciprofol, this could be more due to its influence on myocardial contractility. It is important to note that during the perioperative period, transient hypotension (lasting 1 to 5 minutes) is associated with elevated risks of postoperative myocardial injury, acute kidney injury, and a higher 30-day mortality rate [ 36 , 37 ] . Jor et al. suggest several primary causes of PIH following general anesthesia [ 38 ] , including prolonged fasting and fluid restriction, vasodilation and decreased peripheral resistance post-induction, and inadequate effective circulating blood volume. Suppression of the body's stress response by anesthesia induction and varying degrees of circulatory suppression caused by intravenous induction drugs can also contribute to PIH. Reduced vascular elasticity and compromised cardiac function in elderly patients can further exacerbate PIH, leading to insufficient cardiac pumping and decreased effective circulating blood volume. Savarese [ 39 ] et al. found over 20% of patients monitored with non-invasive blood pressure and over 33% of those monitored with invasive blood pressure experienced PIH during Propofol anesthesia induction in elderly patients. Patients with a history of hypertension, diabetes, ischemic heart disease, stroke, chronic kidney disease, or chronic medication use, including beta-blockers, CCB, ACEI, angiotensin I, diuretics, and insulin, are also at risk. Current clinical strategies for the prevention and treatment of PIH primarily include 1) volume monitoring and fluid therapy. Anesthesiologists can assess a patient's blood volume and predict the likelihood of PIH by monitoring indicators such as heart rate, blood pressure, cardiac output, cardiac index, stroke volume, stroke volume variation, IVCCI, and carotid FTc. Research indicated that administering a specific volume of colloid solution to patients before induction can effectively reduce the incidence of hypotension during induction and the use of vasoactive drugs, while preventing full activation of the antidiuretic hormone and the renin-angiotensin-aldosterone system (RAAS), thereby lowering the risk of acute renal failure [ 40 ] .2) rational use of vasoactive drugs such as phenylephrine, norepinephrine, and ephedrine. 3) rational combination and dosage administration of general anesthesia induction drugs in different patient populations is essential. In high-risk groups for PIH, drugs with weaker inhibitory effects on the cardiovascular system are preferred. Studies suggest that etomidate, compared to propofol, has a smaller impact on patients' hemodynamics and offers better controllability [ 41 ] . However, some research has found that the incidence of hypotension following etomidate-fentanyl intravenous induction remains high (47%) [ 42 ] . Regarding opioid selection, alfentanil, a new type of opioid, that primarily acts on µ-opioid receptors, is a short-acting analgesic with high safety and 15 times the analgesic strength of morphine. Remifentanil is a novel ultra-short-acting analgesic, characterized by rapid onset and short duration of action, with weak cardiovascular inhibition after induction. Optimizing the combination of anesthesia induction drugs for sedation and analgesia, as well as administering them in divided doses, can reduce the incidence of PIH. Therefore, appropriate blood volume supplementation, judicious selection of vasoactive drugs, and optimization of the combination of anesthetics during the induction phase of general anesthesia can help reduce PIH and perioperative anesthesia-related complications and improve prognosis, ensuring patient safety. 5. Limitations This study has several limitations: the study population predominantly consisted of preoperatively deprived of water, fasting, and using laxatives before surgery, so the study did not account for the potential influence of relative hypovolemia on compensatory cardiac contractility enhancement. 6. Conclusion Ciprofol demonstrates superior hemodynamic stability during general anesthesia induction compared to Propofol, which may be attributed to its advantage in maintaining cardiac (particularly left ventricular) contractile function levels. A dosage of 0.2–0.4 mg/kg of Ciprofol provides similar sedation effects as 2.0–4.0 mg/kg of Propofol during painless gastrointestinal endoscopy, with Ciprofol exhibiting lower incidences of adverse effects such as hypotension, respiratory depression, and injection pain compared to Propofol. Abbreviations Abbreviations Full title in English TTE Transthoracic echocardiography ASA American Society of Anesthesiologists BMI Body mass index MOAA/S Modified Observers alert/sedation PIH Post-induction hypotension SBP Systolic blood pressure DBP Diastolic blood pressure MAP Mean arterial pressure HR Heart rate CVP Central venous pressure PAWP Pulmonary artery wedge pressure PICCO Pulse indicate continuous cardiac output TEE Transesophageal Echocardiography TDI Tissue Doppler Imaging CO Cardiac output SVR Systemic Vascular Resistance PONV Postoperative nausea and vomiting BIS Bispect ral index CI Confidence interval PRIS Propofol Infusion Syndrome MI Myocardial injury AKI Acute Kidney Injury IOH Intraoperative hypotension POCD Post Operative Cognitive Dysfunction Declarations Ethics approval and consent to participate Ethical approval for this study (EC-2024-KS-134) was approved by the Instit utional Ethics Committee of The Fourth Affiliated Hospital of China Medical University (Chairperson Prof Zhao) on 1st July 2024 and registered at The Chi nese Clinical Trial Registry (number ChiCTR2500095938), in accordance with t he Declaration of Helsinki. Written informed consent was obtained from all pat ients before they were enrolled. Consent for publication Not applicable. Availability of data and materials The data and materials in this study are available from the corresponding author( [email protected] ) on reasonable request. Competing Interests The authors declare no competing interests. Funding Not applicable. Authors' contributions LYL and JC contributed to the data collection, analysis, and writing throughout the entire study process. CHB,RNH,WF, ZL and DML contributed to analysis, and interpretation. YYW contributed to the conception, design, analysis, interpretation, and manuscript revision. Acknowledgements The authors thank all anaesthesiologists, digestive endoscopist and nurses who contributed to the study. References Südfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. 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Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography. J Am Coll Cardiol. 2001 Mar 1;37(3):726-30.PMID: 11693743 Marwick TH, Case C, Leano R, Short L, Baglin T, Cain P, et al. Use of tissue Doppler imaging to facilitate the prediction of events in patients with abnormal left ventricular function by dobutamine echocardiography. Am J Cardiol. 2004 Jan 15;93(2):142-6.PMID: 14715337 Sheth A, Dabo-Trubelja A. Perioperative focused cardiac ultrasound: a brief report. J Anesth Crit Care. 2021;13(1):55–60.PMID: 33816785 Kratz T, Steinfeldt T, Exner M, Dell Orto MC, Timmesfeld N, Kratz C, et al. Impact of Focused Intraoperative Transthoracic Echocardiography by Anesthesiologists on Management in Hemodynamically Unstable High-Risk Noncardiac Surgery Patients. J Cardiothorac Vasc Anesth. 2017 Apr;31(2):602-609.PMID: 28089598 Chinese guideline for bowel preparation for colonoscopy (2019, Shanghai). Zhonghua Nei Ke Za Zhi. 2019 Jul 1;58(7):485-495.PMID: 31269564 Roberto ML,Luigi PB,Victor MA, Jonathan A, Anderson A, Laura E, et al.Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14.PMID: 25559473 Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. N Engl J Med. 2021 Oct 21;385(17):1593-1602.PMID: 34670045 Wesselink EM, Kappen TH, Torn HM, Slooter AJC, Van Klei WA.Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth.2018 Oct;121(4):706-721.PMID: 30236233 Green RS, Butler MB. Postintubation Hypotension in General Anesthesia: A Retrospective Analysis. J Intensive Care Med. 2016 Dec;31(10):667-675.PMID: 26721639 Bian Y, Zhang H, Ma S, Jiao Y, Yan P, Liu X, et al. Mass balance, pharmacokinetics and pharmacodynamics of intravenous HSK3486, a novel anaesthetic, administered to healthy subjects. Br J Clin Pharmacol. 2021 Jan;87(1):93-105.PMID: 32415708 Luo Z, Tu H, Zhang X, Wang X, Ouyang W, Wei X, et al. Efficacy and Safety of HSK3486 for Anesthesia/Sedation in Patients Undergoing Fiberoptic Bronchoscopy: A Multicenter, Double-Blind, Propofol-Controlled, Randomized, Phase 3 Study. CNS Drugs. 2022 Mar;36(3):301-313.PMID: 35157236 Omerovic S, Jain A. Echocardiogram. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32644366 Kuo-Chuan H,Jen-Yin C,Shao-Chun W,Po-Yu H,Jheng-Yan W,Ting-Hui L,et al.A systematic review and meta-analysis comparing the efficacy and safety of ciprofol (HSK3486) versus propofol for anesthetic induction and non-ICU sedation. Front Pharmacol.2023 Sep 25:14:1225288.PMID: 37818194 Kanaya N, Gable B, Wickley PJ, Murray PA, Damron DS. Experimental conditions are important determinants of cardiac inotropic effects of propofol. Anesthesiology. 2005 Nov;103(5):1026-34.PMID: 16249677 Nagakawa T, Yamazaki M, Hatakeyama N, Stekiel TA. The mechanisms of propofol-mediated hyperpolarization of in situ rat mesenteric vascular smooth muscle. Anesth Analg. 2003 Dec;97(6):1639-1645.PMID: 14633534 Han L, Fuqua S, Li Q, Zhu L, Hao X, Li A, et al. Propofol-induced Inhibition of Catecholamine Release Is Reversed by Maintaining Calcium Influx. Anesthesiology. 2016 Apr;124(4):878-84.PMID: 26808630 Bakhtiari E, Mousavi SH, Gharavi Fard M. Pharmacological control of pain during propofol injection: a systematic review and meta-analysis. Expert Rev Clin Pharmacol. 2021 Jul;14(7):889-899.PMID: 33896305 Nakanishi T, Tsuji T, Sento Y, Hashimoto H, Fujiwara K, Sobue K. Association between postinduction hypotension and postoperative mortality: a single-centre retrospective cohort study. Can J Anaesth. 2024 Mar;71(3):343-352.PMID: 37989941 Wesselink EM, Wagemakers SH, van Waes JAR, Wanderer JP, van Klei WA, Kappen TH. Associations between intraoperative hypotension, duration of surgery and postoperative myocardial injury after noncardiac surgery: a retrospective single-centre cohort study. Br J Anaesth. 2022 Oct;129(4):487-496.PMID: 36064492 Jor O, Maca J, Koutna J, Gemrotova M, Vymazal T, Litschmannova M, et al. Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study. J Anesth.2018 Oct;32(5):673-680.PMID: 30027443 Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology.Review.Cardiovasc Res. 2023 Jan 18;118(17):3272-3287.PMID: 35150240 Myrberg T, Lindelöf L, Hultin M. Effect of preoperative fluid therapy on hemodynamic stability during anesthesia induction, a randomized study. Acta Anaesthesiol Scand. 2019 Oct;63(9):1129-1136.PMID: 31240711 Masoudifar M, Beheshtian E. Comparison of cardiovascular response to laryngoscopy and tracheal intubation after induction of anesthesia by Propofol and Etomidate. J Res Med Sci. 2013;18:870–4.2013 Oct;18(10):870-4.PMID: 24497858 Zhang J, Critchley LAH. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction. Anesthesiology. 2016 Mar;124(3):580-9.PMID: 26771910 Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files TablesforTTE.pdf Researchethicsreviewdocumentsp1.pdf Researchethicsreviewdocumentsp2.pdf TableS1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7286060\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":502671585,\"identity\":\"7cc3fa4e-27ef-4c4e-a4e7-91149d329373\",\"order_by\":0,\"name\":\"Yaling Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Fourth Affiliated Hospital of China Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yaling\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":502671586,\"identity\":\"ecaeddc9-dc7d-43d3-9729-56f5a5d2bffb\",\"order_by\":1,\"name\":\"Jing 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Propofol during the induction phase of general anesthesia: A prospective, double-blind, randomized, controlled trial\",\"fulltext\":[{\"header\":\"1. Background\",\"content\":\"\\u003cp\\u003eHemodynamic management during the induction phase of general anesthesia is a vital aspect of perioperative anesthesia management.Post-induction hypotension (PIH), commonly characterized by a reduction in SBP of at least 20% from baseline or a drop to below 80 mmHg, or a decrease in MAP to less than or equal to \\u0026le;\\u0026thinsp;60 mmHg, typically occurs within the initial 20 minutes following the anesthesia induction\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003ePost-induction hypotension (PIH) has the potential to provoke serious adversereactions associated with anesthesia, including ischemic stroke, myocardial ischemia, and arrhythmias.Consequently, it is crucial to preserve hemodynamic stability during anesthesia induction.The incidence of PIH varies between 45\\u0026ndash;55%\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR3\\\" citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e, with approximately one-third of hypotensive episodes occur during anesthesia induction phase and prior to surgical incision\\u003csup\\u003e[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e.The incidence of PIH is contingent upon the patient's condition and the management of anesthesia\\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eTo minimize the occurrence of PIH, an array of anesthesia management strategies can be employed. These include appropriate fluid resuscitation and the concurrent administration of vasopressors. However, a crucial aspect of these approaches is the optimization of induction agents selection.\\u003c/p\\u003e\\u003cp\\u003ePropofol, the most frequently utilized short-acting intravenous anesthetic in clinical anesthesia\\u003csup\\u003e[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e, achieves its sedative and general anesthetic properties by diminishing central nervous system excitability and enhancing the activity of the inhibitory neurotransmitter GABA\\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e. Its rapid onset, potent suppression of pharyngeal reflexes and stress responses, lack of accumulation with short-term use, absence of respiratory stimulation, and swift recovery have earned it widespread recognition in clinical practice\\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e. It is extensively employed in surgical anesthesia as well as in outpatient painless endoscopic procedures\\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. However, Propofol is associated with various adverse drug reactions, including injection-related pain, dose-dependent circulatory and respiratory depression\\u003csup\\u003e[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e, post-awakening headaches, nausea, andvomiting, and even can lead to severe cardiovascular and cerebrovascular events\\u003csup\\u003e[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/sup\\u003e. Consequently, There is a clinical need for a new anesthetic sedative with reduced adverse effects. Ciprofol,chemically known as 2-[(1R)‐[1‐cyclopropylethyl]]‐6‐isopropylphenol, is a novel 2,6-disubstituted phenol derivative inspired by Propofol. It falls within the category of innovative γ-aminobutyric acid (GABA) receptor enhancers. This is a new type of sedative anesthetics independently developed in China, distinguished by its excellent safety profile and tolerance, featuring pharmacodynamic activity approximately five times that of Propofol. Current clinical trials suggest that Ciprofol possesses advantages, including rapid and smooth onset, quick and complete recovery, high potency, and a wide safety margin \\u003csup\\u003e[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e. Compared to Propofol, Ciprofol associated with fewer instances of respiratory depressions and cardiovascular adverse events, along with an extremely low incidence of injection-related pain and lower lipid input volume\\u003csup\\u003e[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e. Ciprofol offers a safer and more efficacious anesthesia experience, markedly decreasing the incidence of adverse events, particularly among elderly patients and those suffering from respiratory and circulatory comorbidities\\u003csup\\u003e[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e. Ciprofol is currently extensively utilized for sedation and anesthesia in non-intubated surgical procedures, for the induction and maintenance of general anesthesia, and for sedation in intensive care settings\\u003csup\\u003e[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eHowever, Ciprofol as a new class of intravenous general anesthetic, there is subject of limited clinical research concerning its effects on special populations, including the elderly, children, and pregnant women. Furthermore, with a shorter clinical history compared to traditional intravenous anesthetics such as Propofol, the influence of Ciprofol on cardiac contractility, diastolic function, and hemodynamics has been clinically assessed over a shorter period, and its full effects remain unclear.\\u003c/p\\u003e\\u003cp\\u003eOngoing research and clinical assessment are necessary to ensure the safe application of Ciprofol within medical practice.TTE is a vital tool for evaluating cardiac function and hemodynamic status. Doppler echocardiography utilizes the detection of frequency shifts in reflected ultrasound signals from moving objects. Conventional Doppler techniques measure blood flow velocity by detecting high-frequency, low-amplitude signals from small, fast-moving blood cells. In tissue Doppler imaging (TDI), the same Doppler principles are applied to quantify lower-amplitude, lower-velocity signals from myocardial tissue motion\\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e. A decrease in Sa velocity can be detected within 15 seconds of the onset of ischemia\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e, and regional reductions in Sa are correlated with regional wall motion abnormalities. The incorporation of TDI measures of systolic function in exercise testing to assess for ischemia, viability, and contractile reserve has been suggested due to the normal increase in peak Sa velocity with dobutamine infusion and exercise, and the decrease with ischemia\\u003csup\\u003e[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e. TDI assessment of diastolic function is less load dependent than that provided by standard Doppler techniques. Ea maintains its resistance to changes in filling pressure, although there is a more noticeable preload dependence in structurally normal hearts. Anesthesiologists using TTE during surgery can rapidly identify new cardiovascular complications and aid in the analysis of factors contributing to hemodynamic instability\\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eThis study aims to compare the alterations in hemodynamics and cardiac function between Ciprofol and Propofol during anesthesia induction, providing a reference for future selection of general anesthesia agents and the clinical application of Ciprofol.\\u003c/p\\u003e\"},{\"header\":\"2. Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.1 Study design\\u003c/h2\\u003e\\u003cp\\u003eThis single-center, prospective, double-blind, randomized, controlled clinical study was performed at the endoscopic center of The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China. Ethical approval for this study (EC-2024-KS-134) was approved by the Institutional Ethics Committee of The Fourth Affiliated Hospital of China Medical University(Chairperson Prof Zhao) on 1st July 2024 and registered at The Chinese Clinical Trial Registry (number MR-21-24-043752), first submitted 11 July 2024, in accordance with the Declaration of Helsinki. In China, Ciprofol for induction and maintenance of general anesthesia (approval no. H20200013) has been approved by the National Medical Products Administration. Written informed consent was obtained from all patients before they were enrolled. Based on the results of the pre-test, the calculations showed that the sample size was at least 199 cases, taking into account a category I error ( α ) of 0.05 and a test efficacy (1-β) of 0.9. In order to ensure the stability of the study and to take into account the possibility of lost visits or incomplete data, we decided to include 240 patients.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.2 Participants\\u003c/h2\\u003e\\u003cp\\u003eThis study included adult patients between the ages of 18 and 65 with an American Society of Anesthesiologists physical classification status of Ⅱ-Ⅲ who were scheduled to undergo elective gastroscopy at the endoscopic center of The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China. Detailed inclusion and exclusion criteria are presented in Table \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e. The research center consecutively recruited 240 eligible patients using computer-generated random sequences and randomly assigned them to the Ciprofol 0.2\\u0026ndash;0.4 mg/kg group or the Propofol 2.0\\u0026ndash;4.0 mg/kg group in a 1:1 ratio. The grouping information was concealed and kept in sealed envelopes. Researcher A opened the envelope and prepared the intravenous anesthetic drugs, Researcher B administered the anesthesia, and Researcher C performed TTE on the patient, and Researcher D was involved in data collection. The physical appearance of Ciprofol and Propofol( milky solutions) are semblable, so the researchers could not visually distinguish between them. Both the anesthesiologist, endoscopist, patients, and data collection personnel were blinded to the randomization.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.3 Interventions\\u003c/h2\\u003e\\u003cp\\u003ePreparation for elective gastroscopy procedures was conducted in accordance with the local protocol or national guidelines of China\\u003csup\\u003e[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e. All the patients were infused with 0.9% sodium chloride solution at 8 mL \\u0026middot; kg-1, which was completed before sedation was initiated. The infusion rate was 2ml\\u0026middot;min-1 after that. A multi-parameter monitor (WATO EX-55, Mindray, Shenzhen, China) was used to continuously monitor pulse oxygen saturation (SpO2), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), standard 12-lead electrocardiogram (ECG), and bispectral index (BIS). Oxygen at a flow rate of 5 L\\u0026middot;min-1 was administered continuously through a nasal catheter. All the patients received 5\\u0026ndash;7 \\u0026micro;g \\u0026middot; kg-1 alfentanil (33S070212) injection intravenously in 10s before administration of the study drugs. Then, 0.2\\u0026ndash;0.4 mg\\u0026middot;kg-1 Ciprofol (20240131) or 2\\u0026ndash;4 mg\\u0026middot; kg-1 Propofol (16SK8910) was given intravenous injection over 1min. A gastroscope was inserted when the MOAA/S (Table \\u003cspan refid=\\\"MOESM2\\\" class=\\\"InternalRef\\\"\\u003eS2\\u003c/span\\u003e) score was 1 or lower. The MOAA/S score was repeatedly assessed by the anesthesiologist every 30 seconds during sedation induction. If the MOAA/S score remained\\u0026thinsp;\\u0026gt;\\u0026thinsp;1 after 2 min of initial administration of the study drug, a top-up dose of 1/2 initial dose was injected over 10s. During maintenance sedation, if the patient showed agitation or inadequate sedation, a top‐up doses were given and repeated every 2 minutes as needed. Sedation was considered unsuccessful if more than five refill doses were required within 15 minutes, and Propofol was the only alternative sedative in this study.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.4 Outcomes\\u003c/h2\\u003e\\u003cp\\u003eTTE was performed on both groups of patients at two-time points: before anesthesia induction (T0) and when the MOAA/S score was \\u0026le;\\u0026thinsp;1 (T1) (Fig.\\u0026nbsp;1). The probe was adjusted or rotated as necessary to obtain a clear and complete apical four-chamber view. In tissue-Doppler echocardiography, a sample volume of 5\\u0026ndash;10 mm was used, with the sampling point cursor placed at the mitral valve annulus on the interventricular septum to obtain the peak systolic velocity (Sa) and early diastolic peak velocity (Ea) (Fig.\\u0026nbsp;2a). M-mode was then applied with the sampling point cursor positioned on the lateral tricuspid valve annulus, parallel to the direction of annulus motion, to measure the tricuspid annular plane systolic excursion (TAPSE) (Fig.\\u0026nbsp;2b)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e. All echocardiograms were analyzed by taking the mean value of 2\\u0026ndash;3 artifact-free sinus beats. Two independent researchers conducted each analysis in a blinded manner. Additionally, the patient's heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded at the corresponding times, as indicated by the electrocardiogram monitor.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePrimary Outcomes\\u003c/b\\u003e The primary outcome includes the Sa value, Ea value, and TAPSE value from the TTE; HR,SBP,DBP and MAP from the monitor, which examinations at two-time points: before anesthesia induction (T0) and when the MOAA/S score was \\u0026le;\\u0026thinsp;1 (T1).\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eSecondary Outcomes\\u003c/b\\u003e The secondary outcomes included the usage rates of vasoactive medications (such as ephedrine and atropine), the incidence of injection-related pain, coughing episodes, intraoperative movements, bradycardia, agitation during the recovery phase, and other adverse events such as nausea and vomiting within 48 hours post-surgery.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.5 Statistical analysis\\u003c/h2\\u003e\\u003cp\\u003eData with a normal distribution are presented as the mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (SD) and analysed using the two-sampled independent \\u003cem\\u003et-\\u003c/em\\u003etest, while data with a non-normal distribution are reported as the median with range and analysed using the Mann\\u0026ndash;Whitney U test. A \\u003cem\\u003eP\\u003c/em\\u003e value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 (one-sided for the primary outcome, and two-sided for all others) indicated a statistically significant difference. Data analysis was performed using Statistical Package for the Social Sciences version 26.0 software (IBM SPSS, Chicago, IL, United States).\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.1 Patients\\u0026rsquo; Disposition and Baseline Characteristics\\u003c/h2\\u003e\\u003cp\\u003eBetween 6 August 2024 and 1st November 2024, 240 patients undergoing general anesthesia for elective gastroscopy procedures were enrolled. Of these, 99 patients were assigned to the Ciprofol group and 105 to the Propofol group, based on inclusion and exclusion criteria between 6 August 2024 and 1st November 2024 (Fig.\\u0026nbsp;3). Overall, the two groups had similar demographic and baseline characteristics. (Table\\u0026nbsp;1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.2 Primary Outcome\\u003c/h2\\u003e\\u003cp\\u003e\\u003cb\\u003eComparison of TTE Parameters Between Two Groups At Two Time Point\\u003c/b\\u003e At the pre-induction (T\\u003csub\\u003e0\\u003c/sub\\u003e) stage, there were no statistically significant differences in TAPSE, Ea, and Sa values between the Propofol group and the Ciprofol group. After induction of general anesthesia when the MOAA/S score was \\u0026le;\\u0026thinsp;1 (T\\u003csub\\u003e1\\u003c/sub\\u003e ), the Sa value in the Propofol group was lower than that in the Ciprofol group, with a statistically significant difference (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.004). Additionally, at T\\u003csub\\u003e1\\u003c/sub\\u003e, the TAPSE, Ea, and Sa values in the Propofol group were all lower than those at T\\u003csub\\u003e0\\u003c/sub\\u003e, with statistically significant differences. Although the TAPSE and Ea values in the Ciprofol group also decreased from T\\u003csub\\u003e0\\u003c/sub\\u003e to T\\u003csub\\u003e1\\u003c/sub\\u003e with statistically significant differences, the Sa value in the Ciprofol group did not show a statistically significant difference from T\\u003csub\\u003e0\\u003c/sub\\u003e (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.607).(Fig.\\u0026nbsp;4) (Table\\u0026nbsp;2)\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eComparison of Heart Rate and Blood Pressure Parameters Between Two Groups at Two Time Points\\u003c/b\\u003e At the pre-induction (T0) stage, there were no statistically significant differences in SBP、DBP、MAP and HR between the Propofol group and the Ciprofol group. After induction of general anesthesia when the MOAA/S score was \\u0026le;\\u0026thinsp;1 (T1), both groups showed a decrease in SBP, DBP, MBP, and HR compared to T0, with statistically significant differences (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Additionally, at T1, the SBP level in the Propofol group was lower than in the Ciprofol group, with a statistically significant difference (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.016), while there was no statistically significant difference in HR between the two groups at T1 (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.666). (Table\\u0026nbsp;3)\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.3 Secondary Outcome\\u003c/h2\\u003e\\u003cp\\u003e\\u003cb\\u003eComparison of Vasoactive Drug Use and Perioperative Adverse Events Between the Two Groups\\u003c/b\\u003e There was no statistically significant difference in the use of vasoactive drugs such as ephedrine, phenylephrine, and atropine between the two groups during surgery. The incidence of injection-related pain was significantly lower in the Ciprofol group compared to the Propofol group (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Other perioperative adverse events, including coughing episodes, intraoperative movements, bradycardia, agitation during the recovery phase, and nausea and vomiting within 48 hours post-surgery, showed no statistically significant differences (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). (Table\\u0026nbsp;4)\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eInduction of general anesthesia is the initial step in the administration of general anesthesia. Post-induction hypotension (PIH), a distinct phenomenon typically occurring following the administration of general anesthetic induction anesthetics, is frequently observed. This phenomenon is associated with various factors including the patient's pre-induction blood volume, lack of appropriate surgical stimulation corresponding to depth of anesthesia post-induction, autonomic nervous system function, vasodilation caused by anesthetics, and reduced myocardial contractility\\u003csup\\u003e[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e. As reported, PIH can compromise the perfusion of vital organs, leading to severe perioperative anesthesia-related complications such as Myocardial Infarction (MI), Acute Kidney Injury (AKI), Stroke, and Postoperative Cognitive Dysfunction (POCD). PIH even can prolong the duration of mechanical ventilation in the intensive care unit postoperatively, increase the incidence of perioperative complications, and anesthesia elevate mortality rates\\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003ePropofol is currently the most commonly used intravenous anesthetic in clinical practice, exhibiting a strong dose-dependent inhibitory effect on the cardiovascular and respiratory systems\\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e. Ciprofol is a novel intravenous anesthetic, similar to propofol, which enhances the ion channel-mediated by the γ -aminobutyric acid subtype A receptor (GABAA) to increase chloride ion influx, causing hyperpolarization of the neuronal cell membrane and thereby achieving central nervous system inhibition\\u003csup\\u003e[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e. Multiple studies have shown that Ciprofol offers several advantages, including rapid onset, potency efficacy, less respiratory depression, and diminished injection-related pain, leading to increased patient comfort and satisfaction.\\u003c/p\\u003e\\u003cp\\u003eIn this study, the sedation success rate was 100% when using both Propofol and Ciprofol. Consistent with previous research findings, the success rate of sedation with Ciorofol and Propofol during fiberoptic bronchoscopy and colonoscopy was also 100%.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e. Sa (Systolic myocardial velocity) at the lateral mitral annulus is a measure of longitudinal systolic function and is correlated with measurements of LV ejection fraction and peak dP/dt, which can evaluate the systolic function of the ventricular base. Ea(Early diastolic motion) at the mitral annulus reflects the velocity of early myocardial relaxation ascends during early rapid LV filling, which can evaluate ventricular diastolic function. TAPSE at the lateral tricuspid annulus reflects the tricuspid annular systolic displacement, which can evaluate the longitudinal systolic function of the right ventricle\\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]\\u003c/sup\\u003e. This study's results indicate that following induction of general anesthesia, Ea and TAPSE values decreased significantly in the Ciprofol group compared to pre-induction levels, while the Sa value also decreased but was not statistically significant (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.607). In the Propofol group, general anesthesia induction caused Sa, Ea, and TAPSE values to decrease compared to pre-induction levels. Moreover, the Sa value was higher in the Ciprofol group after induction of general anesthesia than in the Propofol group (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.004). These findings suggest that Ciprofol has a lesser inhibitory effect on left ventricular systolic function than Propofol, although both groups' diastolic effects were similar. Furthermore, the subjects of this study were patients without severe organic diseases, and the differences between the two drugs may be more pronounced in elderly patients and those with cardiovascular comorbidities. In summary, Ciprofol has a smaller impact on left ventricular systolic function, and there is no significant difference between the two drugs in their diastolic effects. This study's results indicate both Ciprofol and Propofol groups experienced a decrease in heart rate (HR) following general anesthesia induction (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and there was no significant difference between the two groups (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.666). Following general anesthesia induction, the systolic blood pressure (SBP) in the Ciprofol group was higher than that in the Propofol group (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.016). The diastolic blood pressure (DBP) in the Ciprofol group was slightly higher than that in the Propofol group, but there was no significant difference between the two groups (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0. 125). The mean arterial pressure (MAP) in the Ciprofol group was also higher than that in the Propofol group after general anesthesia induction, but there was no significant difference between the two groups (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0. 144). Thus, Ciprofol had a smaller effect on SBP compared to Propofol, while there was no significant difference in the effects on DBP and MAP between the two anesthetics.These findings are consistent with the conclusions of Hung et al's study\\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e. SBP changes are predominantly influenced by stroke volume, primarily affected by myocardial contractility; whereas changes in diastolic blood pressure are mainly influenced by heart rate and peripheral vascular resistance. The effects of Propofol on hemodynamics are primarily associated with reductions in sympathetic neuron tone, direct peripheral vascular vasodilation, and inhibition of physiological baroreflex mechanisms\\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]\\u003c/sup\\u003e. Han et al \\u0026rsquo; suggested that Propofol\\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]\\u003c/sup\\u003e, at clinically relevant concentrations, promotes catecholamine release as long as calcium influx is supported, the effect of Propofol on myocardial contractility may be related to its inhibition of Ca2\\u0026thinsp;+\\u0026thinsp;influx, and thus the reduction of catecholamine release. This may also be a contributing factor to the hypotension caused by Ciprofol, but further research is necessary to elucidate the specific mechanisms. Furthermore, the subjects of this study were patients without severe organic diseases, and the differences between the two drugs may be more pronounced in elderly patients and those with cardiovascular comorbidities. Moreover, the incidence of injection-related pain in patients administered Ciprofol was significantly decreased (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), which may be associated with the higher concentration of Propofol in the aqueous phase\\u003csup\\u003e[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, due to its higher lipophilicity, Ciprofol has a significantly lower concentration of free molecules in the emulsion compared to Propofol, thereby reducing stimulation to the venous endothelium and resulting in a lower incidence of injection-pain.\\u003c/p\\u003e\\u003cp\\u003eThe research data shows that Ciprofol and Propofol have comparable effects on inhibiting diastolic cardiac function, dilating peripheral vasculature, and reducing peripheral resistance. Specifically, at equivalent sedative doses, Ciprofol and Propofol show similar impacts on ventricular diastolic function and peripheral vasodilation. While Propofol may have a more pronounced effect on blood pressure compared to Ciprofol, this could be more due to its influence on myocardial contractility. It is important to note that during the perioperative period, transient hypotension (lasting 1 to 5 minutes) is associated with elevated risks of postoperative myocardial injury, acute kidney injury, and a higher 30-day mortality rate\\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e. Jor et al. suggest several primary causes of PIH following general anesthesia\\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e, including prolonged fasting and fluid restriction, vasodilation and decreased peripheral resistance post-induction, and inadequate effective circulating blood volume. Suppression of the body's stress response by anesthesia induction and varying degrees of circulatory suppression caused by intravenous induction drugs can also contribute to PIH. Reduced vascular elasticity and compromised cardiac function in elderly patients can further exacerbate PIH, leading to insufficient cardiac pumping and decreased effective circulating blood volume. Savarese\\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e et al. found over 20% of patients monitored with non-invasive blood pressure and over 33% of those monitored with invasive blood pressure experienced PIH during Propofol anesthesia induction in elderly patients. Patients with a history of hypertension, diabetes, ischemic heart disease, stroke, chronic kidney disease, or chronic medication use, including beta-blockers, CCB, ACEI, angiotensin I, diuretics, and insulin, are also at risk.\\u003c/p\\u003e\\u003cp\\u003eCurrent clinical strategies for the prevention and treatment of PIH primarily include 1) volume monitoring and fluid therapy. Anesthesiologists can assess a patient's blood volume and predict the likelihood of PIH by monitoring indicators such as heart rate, blood pressure, cardiac output, cardiac index, stroke volume, stroke volume variation, IVCCI, and carotid FTc. Research indicated that administering a specific volume of colloid solution to patients before induction can effectively reduce the incidence of hypotension during induction and the use of vasoactive drugs, while preventing full activation of the antidiuretic hormone and the renin-angiotensin-aldosterone system (RAAS), thereby lowering the risk of acute renal failure\\u003csup\\u003e[\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e.2) rational use of vasoactive drugs such as phenylephrine, norepinephrine, and ephedrine. 3) rational combination and dosage administration of general anesthesia induction drugs in different patient populations is essential. In high-risk groups for PIH, drugs with weaker inhibitory effects on the cardiovascular system are preferred. Studies suggest that etomidate, compared to propofol, has a smaller impact on patients' hemodynamics and offers better controllability\\u003csup\\u003e[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e. However, some research has found that the incidence of hypotension following etomidate-fentanyl intravenous induction remains high (47%)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e. Regarding opioid selection, alfentanil, a new type of opioid, that primarily acts on \\u0026micro;-opioid receptors, is a short-acting analgesic with high safety and 15 times the analgesic strength of morphine. Remifentanil is a novel ultra-short-acting analgesic, characterized by rapid onset and short duration of action, with weak cardiovascular inhibition after induction. Optimizing the combination of anesthesia induction drugs for sedation and analgesia, as well as administering them in divided doses, can reduce the incidence of PIH. Therefore, appropriate blood volume supplementation, judicious selection of vasoactive drugs, and optimization of the combination of anesthetics during the induction phase of general anesthesia can help reduce PIH and perioperative anesthesia-related complications and improve prognosis, ensuring patient safety.\\u003c/p\\u003e\"},{\"header\":\"5. Limitations\",\"content\":\"\\u003cp\\u003eThis study has several limitations: the study population predominantly consisted of preoperatively deprived of water, fasting, and using laxatives before surgery, so the study did not account for the potential influence of relative hypovolemia on compensatory cardiac contractility enhancement.\\u003c/p\\u003e\"},{\"header\":\"6. Conclusion\",\"content\":\"\\u003cp\\u003eCiprofol demonstrates superior hemodynamic stability during general anesthesia induction compared to Propofol, which may be attributed to its advantage in maintaining cardiac (particularly left ventricular) contractile function levels. A dosage of 0.2\\u0026ndash;0.4 mg/kg of Ciprofol provides similar sedation effects as 2.0\\u0026ndash;4.0 mg/kg of Propofol during painless gastrointestinal endoscopy, with Ciprofol exhibiting lower incidences of adverse effects such as hypotension, respiratory depression, and injection pain compared to Propofol.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"542\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAbbreviations\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFull title in English\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTTE\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTransthoracic echocardiography\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eASA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAmerican\\u0026nbsp;Society\\u0026nbsp;of\\u0026nbsp;Anesthesiologists\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBMI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBody mass index\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMOAA/S\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eModified Observers alert/sedation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePIH\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePost-induction hypotension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSBP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSystolic blood pressure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eDBP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eDiastolic blood pressure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMAP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMean arterial pressure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHeart rate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCVP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCentral venous pressure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePAWP \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePulmonary artery wedge pressure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePICCO \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;Pulse indicate continuous cardiac output\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTEE \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTransesophageal Echocardiography\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTDI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTissue Doppler Imaging\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCO \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;Cardiac\\u0026nbsp;output\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSVR \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSystemic Vascular Resistance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePONV\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;Postoperative nausea\\u0026nbsp;and\\u0026nbsp;vomiting\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBIS\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBispect ral index\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCI\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eConfidence interval\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePRIS \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePropofol Infusion Syndrome\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMI\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;Myocardial injury\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAKI \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAcute\\u0026nbsp;Kidney\\u0026nbsp;Injury\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIOH \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIntraoperative hypotension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePOCD\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePost Operative Cognitive Dysfunction\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eEthics approval and consent to participate\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEthical approval for this study (EC-2024-KS-134) was approved by the Instit utional Ethics Committee of The Fourth Affiliated Hospital of China Medical University (Chairperson Prof Zhao) on 1st July 2024 and registered at The Chi nese Clinical Trial Registry (number ChiCTR2500095938), in accordance with t he Declaration of Helsinki. Written informed consent was obtained from all pat ients before they were enrolled.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eConsent for publication\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eAvailability of data and materials\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data and materials in this study are available from the corresponding author(wangyuanyuan@cmu.edu.cn) on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eCompeting Interests\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eFunding\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eAuthors\\u0026apos; contributions\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eLYL and JC contributed to the data collection, analysis, and writing throughout the entire study process. CHB,RNH,WF, ZL and DML contributed to analysis, and interpretation. YYW contributed to the conception, design, analysis, interpretation, and manuscript revision.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eAcknowledgements\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors thank all anaesthesiologists, digestive endoscopist and nurses who contributed to the study. \\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eS\\u0026uuml;dfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017 Jul 1;119(1):57-64.PMID: \\u003cstrong\\u003e28974066\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eOkamura K, Nomura T, Mizuno Y, Miyashita T, Goto T. Pre-anesthetic ultrasonographic assessment of the internal jugular vein for prediction of hypotension during the induction of general anesthesia. J Anesth. 2019 Oct;33(5):612-619.PMID: \\u003cstrong\\u003e31451896\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eChoi MH, Chae JS, Lee HJ, Woo JH. Pre-anaesthesia ultrasonography of the subclavian/infraclavicular axillary vein for predicting hypotension after inducing general anaesthesia: A prospective observational study. Eur J Anaesthesiol. 2020 Jun;37(6):474-481.PMID: \\u003cstrong\\u003e32205573\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003ePurushothaman SS, Alex A, Kesavan R, Balakrishnan S, Rajan S, Kumar L. Ultrasound Measurement of Inferior Vena Cava Collapsibility as a Tool to Predict Propofol-Induced Hypotension. Anesth Essays Res. 2020 Apr-Jun;14(2):199-202.PMID: \\u003cstrong\\u003e33487815\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eMaheshwari K, Turan A, Mao G, Yang D, Niazi AK, Agarwal D, et al. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia. 2018 Oct;73(10):1223-1228.PMID: \\u003cstrong\\u003e30144029\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eIn-Jung J, Junghwa K, Hyun-Gyu K, Gi-Ho K, Jai-Hyun H, Young-Kug K. Risk factors of postoperative major adverse cardiac events after radical cystectomy: implication of diastolic dysfunction. Scientific reports.2019 Oct 1;9(1):14096. PMID: \\u003cstrong\\u003e31575918\\u003c/strong\\u003e\\u003cstrong\\u003e.\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eCt W. Propofol: Milk of Amnesia. Cell. 2018 Sep 20;175(1):10-13. PMID: 30217361\\u003c/li\\u003e\\n\\u003cli\\u003eMatthias K, Sergejus B, Paul S G, Gerhard S, Cornelius S, Uwe R, et al. Propofol Affects Cortico-Hippocampal Interactions via \\u0026beta;3 Subunit-Containing GABAA Receptors.Int J Mol Sci.2020 Aug 14;21(16):5844. PMID: \\u003cstrong\\u003e3282395\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eSahinovic MM, Struys MMRF,Absalom AR.Clinical Pharmacokinetics and Pharmacodynamics of Propofol. Clin Pharmacokinet. 2018;57:1539\\u0026ndash;58. PMID: \\u003cstrong\\u003e30019172\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eZhou S, Zhu Z, Dai W, Qi S, Tian W, Zhang Y, et al. National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals. British Journal of Anaesthesia. 2021;127:56\\u0026ndash;64. PMID: \\u003cstrong\\u003e33685636\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eHao L, Hu X, Zhu B, Li W, Huang X, Kang F. Clinical observation of the combined use of propofol and etomidate in painless gastroscopy. Medicine (Baltimore). 2020 Nov 6;99(45):e23061. PMID: \\u003cstrong\\u003e33157963\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eMashour GA, Sanders RD, Lee U. Propofol Anesthesia: A Leap into the Void? Anesthesiology. 2022 Mar 1;136(3):405-407.PMID: \\u003cstrong\\u003e35120194\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eX L, D Y, Q L, H W, M W, P Y, et al. Safety, Pharmacokinetics, and Pharmacodynamics of a Single Bolus of the \\u0026gamma;-aminobutyric Acid (GABA) Receptor Potentiator HSK3486 in Healthy Chinese Elderly and Non-elderly. Front Pharmacol. 2021 Aug 27:12:735700.PMID: \\u003cstrong\\u003e34512361\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eTeng Y, Ou M, Wang X, Zhang W, Liu X, Liang Y, et al. Efficacy and safety of ciprofol for the sedation/anesthesia in patients undergoing colonoscopy: Phase IIa and IIb multi-center clinical trials. Eur J Pharm Sci. 2021;164:105904.PMID: \\u003cstrong\\u003e34116176\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eLu M, Liu J, Wu X, Zhang Z. Ciprofol: A Novel Alternative to Propofol in Clinical Intravenous Anesthesia? Biomed Res Int. 2023;2023:7443226.PMID: 36714027\\u003c/li\\u003e\\n\\u003cli\\u003eDing G, Wang L, Zhao W, Diao Y, Song D. Comparison of the efficacy and safety of ciprofol and propofol for ERCP anesthesia in older patients: A single-center randomized controlled clinical study. J Clin Anesth. 2024;99:111609.PMID: 39288685 \\u003c/li\\u003e\\n\\u003cli\\u003eSun X, Zhang M, Zhang H, Fei X, Bai G, Li C. Efficacy and safety of ciprofol for long-term sedation in patients receiving mechanical ventilation in ICUs: a prospective, single-center, double-blind, randomized controlled protocol. Front Pharmacol. 2023 Aug 21:14:1235709.PMID: \\u003cstrong\\u003e37670942\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eHo CY, Solomon SD. A clinician\\u0026rsquo;s guide to tissue Doppler imaging. Circulation. 2006 Mar 14;113(10):e396-8.PMID: 16534017\\u003c/li\\u003e\\n\\u003cli\\u003eEdvardsen T, Skulstad H, Aakhus S, Urheim S, Ihlen H. Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography. J Am Coll Cardiol. 2001 Mar 1;37(3):726-30.PMID: \\u003cstrong\\u003e11693743\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eMarwick TH, Case C, Leano R, Short L, Baglin T, Cain P, et al. Use of tissue Doppler imaging to facilitate the prediction of events in patients with abnormal left ventricular function by dobutamine echocardiography. Am J Cardiol. 2004 Jan 15;93(2):142-6.PMID: \\u003cstrong\\u003e14715337\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eSheth A, Dabo-Trubelja A. Perioperative focused cardiac ultrasound: a brief report. J Anesth Crit Care. 2021;13(1):55\\u0026ndash;60.PMID: \\u003cstrong\\u003e33816785\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eKratz T, Steinfeldt T, Exner M, Dell Orto MC, Timmesfeld N, Kratz C, et al. Impact of Focused Intraoperative Transthoracic Echocardiography by Anesthesiologists on Management in Hemodynamically Unstable High-Risk Noncardiac Surgery Patients. J Cardiothorac Vasc Anesth. 2017 Apr;31(2):602-609.PMID: \\u003cstrong\\u003e28089598\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eChinese guideline for bowel preparation for colonoscopy (2019, Shanghai). Zhonghua Nei Ke Za Zhi. 2019 Jul 1;58(7):485-495.PMID: \\u003cstrong\\u003e31269564\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eRoberto ML,Luigi PB,Victor MA, Jonathan A, Anderson A, Laura E, et al.Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14.PMID: \\u003cstrong\\u003e25559473\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eD\\u0026iacute;az-G\\u0026oacute;mez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. N Engl J Med. 2021 Oct 21;385(17):1593-1602.PMID: \\u003cstrong\\u003e34670045\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eWesselink EM, Kappen TH, Torn HM, Slooter AJC, Van Klei WA.Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth.2018 Oct;121(4):706-721.PMID: \\u003cstrong\\u003e30236233\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eGreen RS, Butler MB. Postintubation Hypotension in General Anesthesia: A Retrospective Analysis. J Intensive Care Med. 2016 Dec;31(10):667-675.PMID: \\u003cstrong\\u003e26721639\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eBian Y, Zhang H, Ma S, Jiao Y, Yan P, Liu X, et al. Mass balance, pharmacokinetics and pharmacodynamics of intravenous HSK3486, a novel anaesthetic, administered to healthy subjects. Br J Clin Pharmacol. 2021 Jan;87(1):93-105.PMID: \\u003cstrong\\u003e32415708\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eLuo Z, Tu H, Zhang X, Wang X, Ouyang W, Wei X, et al. Efficacy and Safety of HSK3486 for Anesthesia/Sedation in Patients Undergoing Fiberoptic Bronchoscopy: A Multicenter, Double-Blind, Propofol-Controlled, Randomized, Phase 3 Study. CNS Drugs. 2022 Mar;36(3):301-313.PMID: \\u003cstrong\\u003e35157236\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eOmerovic S, Jain A. Echocardiogram. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan\\u0026ndash;. PMID: 32644366\\u003c/li\\u003e\\n\\u003cli\\u003eKuo-Chuan H,Jen-Yin C,Shao-Chun W,Po-Yu H,Jheng-Yan W,Ting-Hui L,et al.A systematic review and meta-analysis comparing the efficacy and safety of ciprofol (HSK3486) versus propofol for anesthetic induction and non-ICU sedation. Front Pharmacol.2023 Sep 25:14:1225288.PMID: \\u003cstrong\\u003e37818194\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eKanaya N, Gable B, Wickley PJ, Murray PA, Damron DS. Experimental conditions are important determinants of cardiac inotropic effects of propofol. Anesthesiology. 2005 Nov;103(5):1026-34.PMID: \\u003cstrong\\u003e16249677\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eNagakawa T, Yamazaki M, Hatakeyama N, Stekiel TA. The mechanisms of propofol-mediated hyperpolarization of in situ rat mesenteric vascular smooth muscle. Anesth Analg. 2003 Dec;97(6):1639-1645.PMID: \\u003cstrong\\u003e14633534\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eHan L, Fuqua S, Li Q, Zhu L, Hao X, Li A, et al. Propofol-induced Inhibition of Catecholamine Release Is Reversed by Maintaining Calcium Influx. Anesthesiology. 2016 Apr;124(4):878-84.PMID: \\u003cstrong\\u003e26808630\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eBakhtiari E, Mousavi SH, Gharavi Fard M. Pharmacological control of pain during propofol injection: a systematic review and meta-analysis. Expert Rev Clin Pharmacol. 2021 Jul;14(7):889-899.PMID: \\u003cstrong\\u003e33896305\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eNakanishi T, Tsuji T, Sento Y, Hashimoto H, Fujiwara K, Sobue K. Association between postinduction hypotension and postoperative mortality: a single-centre retrospective cohort study. Can J Anaesth. 2024 Mar;71(3):343-352.PMID: \\u003cstrong\\u003e37989941\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eWesselink EM, Wagemakers SH, van Waes JAR, Wanderer JP, van Klei WA, Kappen TH. Associations between intraoperative hypotension, duration of surgery and postoperative myocardial injury after noncardiac surgery: a retrospective single-centre cohort study. Br J Anaesth. 2022 Oct;129(4):487-496.PMID: \\u003cstrong\\u003e36064492\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eJor O, Maca J, Koutna J, Gemrotova M, Vymazal T, Litschmannova M, et al. Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study. J Anesth.2018 Oct;32(5):673-680.PMID: \\u003cstrong\\u003e30027443\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eSavarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology.Review.Cardiovasc Res. 2023 Jan 18;118(17):3272-3287.PMID: \\u003cstrong\\u003e35150240\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eMyrberg T, Lindel\\u0026ouml;f L, Hultin M. Effect of preoperative fluid therapy on hemodynamic stability during anesthesia induction, a randomized study. Acta Anaesthesiol Scand. 2019 Oct;63(9):1129-1136.PMID: \\u003cstrong\\u003e31240711\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eMasoudifar M, Beheshtian E. Comparison of cardiovascular response to laryngoscopy and tracheal intubation after induction of anesthesia by Propofol and Etomidate. J Res Med Sci. 2013;18:870\\u0026ndash;4.2013 Oct;18(10):870-4.PMID: \\u003cstrong\\u003e24497858\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eZhang J, Critchley LAH. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction. Anesthesiology. 2016 Mar;124(3):580-9.PMID: \\u003cstrong\\u003e26771910\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003eTables 1 to 4 are available in the Supplementary Files section.\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Ciprofol, Hemodynamic, induction phase of general anesthesia, Post-induction hypotension (PIH), Propofol, Transthoracic Echocardiography (TTE)\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7286060/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7286060/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eCipropfol,a new intravenous anesthetic,is structurally and pharmacologically similar to propofol. However, its impact on cardiac function and hemodynamics during anesthesia induction compared to propofol is unclear. This study uses echocardiography to compare cardiac systolic and diastolic performance and hemodynamic measures between Ciprofol and Propofol during anesthesia induction.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eA total of 204 patients aged 18\\u0026ndash;65 years, regardless of gender, with ASA physical status I-Ⅱ, BMI 18\\u0026ndash;30 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e, and modified Mallampati classification I-II, were selected for pain-free gastroscopy. They were randomly divided into two groups: Group C (n\\u0026thinsp;=\\u0026thinsp;99) received 0.2\\u0026ndash;0.4 mg/kg of Ciprofol, and Group P (n\\u0026thinsp;=\\u0026thinsp;105) received 2\\u0026ndash;4 mg/kg of Propofol. Each patient was intravenously given 5-7ug/kg of Alfentanil. Pain - free endoscopy started when the MOAA/S score reached\\u0026thinsp;\\u0026le;\\u0026thinsp;1. At two time points (T\\u003csub\\u003e0\\u003c/sub\\u003e:before anesthesia induction;T\\u003csub\\u003e1\\u003c/sub\\u003e:MOAA/S\\u0026thinsp;\\u0026le;\\u0026thinsp;1), TTE indices (Sa, Ea, TAPSE values) and monitor data (HR, SBP, DBP, MAP) were recorded for both groups. The study also recorded the incidence of successful sedation, the utilization rate of vasoactive medications (Ephedrine and Atropine), the incidence of injection-related pain, respiratory depression, coughing, intraoperative movements, bradycardia, agitation during recovery, and other adverse reactions like nausea and vomiting within 48 hours post - surgery for both groups.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eThe success rate of sedation in both groups was 100%. Upon induction of general anesthesia, the Sa level in the Ciprofol group was observed to be higher than that in the Propofol group (8.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.37 vs 8.21\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.10, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.004), SBP in the Ciprofol group was significantly higher than that in the Propofol group (105.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.45 vs 100.26\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.10, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.016).\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e\\u003cp\\u003eCiprofol exhibits superior hemodynamic stability during the induction of general anesthesia compared to Propofol, the benefit might due to its ability to preserve cardiac contractile function, particularly that of the left ventricle.\\u003c/p\\u003e\\u003ch2\\u003eClinical Trials Registration\\u003c/h2\\u003e\\u003cp\\u003e: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.chictr.org.cn/indexEN.html\\u003c/span\\u003e\\u003cspan address=\\\"https://www.chictr.org.cn/indexEN.html\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e, identifier ChiCTR2500095938.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Using transthoracic echocardiography (TTE) to compare the hemodynamic effects of Ciprofol and Propofol during the induction phase of general anesthesia: A prospective, double-blind, randomized, controlled trial\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-08-21 06:52:29\",\"doi\":\"10.21203/rs.3.rs-7286060/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"34cd44fa-790b-49f2-a6a7-7c8b6858dd5d\",\"owner\":[],\"postedDate\":\"August 21st, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-12-22T08:54:51+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-08-21 06:52:29\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7286060\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7286060\",\"identity\":\"rs-7286060\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}