Comparative Study of Ciprofol vs. Propofol in Carotid Endarterectomy: Focusing on Blood Pressure, Vasoactive Drug Use, and Postoperative Complications

Comparative Study of Ciprofol vs. Propofol in Carotid Endarterectomy: Focusing on Blood Pressure, Vasoactive Drug Use, and Postoperative Complications | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 4 June 2025 V1 Latest version Share on Comparative Study of Ciprofol vs. Propofol in Carotid Endarterectomy: Focusing on Blood Pressure, Vasoactive Drug Use, and Postoperative Complications Authors : Xinxin Zheng 0009-0009-2970-8196 , Shiyun Deng , Bin Wu , Yin Zhang , Lu Tian , Yanqing Zhang [email protected] , and Lin Bai Authors Info & Affiliations https://doi.org/10.22541/au.174902048.84562192/v1 238 views 146 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Aim: To compare the effects of ciprofol and propofol on mean arterial pressure (MAP) management, vasoactive drug usage, and postoperative complications during carotid endarterectomy. Methods: A total of 103 patients were included in either the ciprofol (n=50) or propofol (n=53) group. The MAP was recorded at nine perioperative timepoints from before anaesthesia (T0) to extubation (T8). We focused on the achievement rate of the target MAP during carotid cross-clamping at T4-T6. We also examined vasopressor use (noradrenaline, urapidil) and postoperative complications. Results: In terms of primary outcomes, the ciprofol group exhibited a higher MAP at T3 (before the skin incision; P=0.006) and achieved the target MAP faster at T4-T5 (during carotid cross-clamping and 5 minutes after cross-clamping; P<0.001) than did the propofol group. There were no statistically significant differences between groups at T6 (10 minutes after cross-clamping; P=0.360). Haemodynamic stability during extubation was superior with ciprofol (P<0.001). Regarding the secondary outcomes, the ciprofol group was administered a lower dosage of noradrenaline (P<0.001) and had fewer cases of early cognitive dysfunction (eCD) (P=0.024). Conclusion: These findings suggest ciprofol offers advantages over propofol during carotid endarterectomy by optimising MAP control, minimising vasopressor use, and mitigating postoperative complications. Ciprofol may be the preferable anaesthetic agent in carotid artery-related procedures. Keywords: Ciprofol, Pharmacodynamics, Anaesthesia, Carotid Endarterectomy Comparative Study of Ciprofol vs. Propofol in Carotid Endarterectomy: Focusing on Blood Pressure, Vasoactive Drug Use, and Postoperative Complications Running title: Ciprofol in Carotid Endarterectomy Xinxin Zheng 1 , Shiyun Deng 1 , Bin Wu 2 , Yin Zhang 1 , Lu Tian 1 , Yanqing Zhang 1 , Lin Bai 3 1 Department of Anaesthesiology, University-Town Hospital of Chongqing Medical University, Chongqing, China. 2 Department of Anaesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 3 Department of Anesthesiology, Children’s Hospital of Chongqing Medical University, Chongqing, China. Correspondence Y anqing Zhang, University-Town Hospital of Chongqing Medical University, No. 55, Middle Daxuecheng Road, Shapingba District, Chongqing, 401331, China. Email: [email protected] Lin Bai, Children’s Hospital of Chongqing Medical University, No. 20, Jin Yu Road, Liangjiang New Area, Chongqing, 401122, China. Email: [email protected] Keywords: Ciprofol, Pharmacodynamics, Anaesthesia, Blood Pressure, Carotid Endarterectomy Word count:3370; Table count:5; Figure count:2 The authors confirm that the PI for this paper is Xinxin Zheng and that she had direct clinical responsibility for patients. What is already known about this subject • The sedative effect and safety of ciprofol are not inferior to those of propofol. • The level of MAP management during carotid endarterectomy is closely related to perioperative neurological risks and postoperative complications. What this study adds • Ciprofol’s high potency and low accumulation optimally meet CEA haemodynamic demands, rapidly stabilizing blood pressure during cross-clamping and reducing the risk of eCD. • Compared with propofol, ciprofol for anaesthesia induction effectively reduced intraoperative noradrenaline requirements during CEA. Abstract Aim: To compare the effects of ciprofol and propofol on mean arterial pressure (MAP) management, vasoactive drug usage, and postoperative complications during carotid endarterectomy. Methods: A total of 103 patients were included in either the ciprofol (n=50) or propofol (n=53) group. The MAP was recorded at nine perioperative timepoints from before anaesthesia (T0) to extubation (T8). We focused on the achievement rate of the target MAP during carotid cross-clamping at T4-T6. We also examined vasopressor use (noradrenaline, urapidil) and postoperative complications. Results: In terms of primary outcomes, the ciprofol group exhibited a higher MAP at T3 (before the skin incision; P=0.006) and achieved the target MAP faster at T4-T5 (during carotid cross-clamping and 5 minutes after cross-clamping; P<0.001) than did the propofol group. There were no statistically significant differences between groups at T6 (10 minutes after cross-clamping; P=0.360). Haemodynamic stability during extubation was superior with ciprofol (P<0.001). Regarding the secondary outcomes, the ciprofol group was administered a lower dosage of noradrenaline (P<0.001) and had fewer cases of early cognitive dysfunction (eCD) (P=0.024). Conclusion: These findings suggest that ciprofol offers advantages over propofol during carotid endarterectomy by optimising MAP control, minimising vasopressor use, and mitigating postoperative complications. Ciprofol may be the preferable anaesthetic agent in carotid artery-related procedures. Introduction The prevalence of carotid stenosis is increasing each year worldwide 1 . CEA is the primary treatment for carotid stenosis and indicated for patients with more than 70% stenosis, resulting in a 50% reduced risk of stroke 2,3 . During the carotid cross-clamping phase of CEA, the mean arterial pressure (MAP) should be more than 20% higher than the baseline value following the administration of vasopressors 4,5 . This helps maintain the cerebral perfusion pressure and reduces the risks of early cognitive dysfunction (eCD), cerebral ischaemia, and perioperative complications 6 . To achieve the target MAP, vasopressor intervention is often needed 7 , with noradrenaline being the most commonly used vasoactive drug. However, studies have revealed that after carotid artery reperfusion, a MAP more than 40% above the baseline value or reaching 125 mmHg may increase the risk of cerebral hyperperfusion syndrome (CHS) , leading to headaches 8 . Propofol is a widely used anaesthetic agent. However, propofol can cause myocardial depression and peripheral vasodilation. This often results in a decreased MAP 9 . Ciprofol (2,6-disubstituted phenol analogue), an improved version of propofol, retains the advantages of propofol, such as rapid onset, short half-life, and quick recovery, while also featuring minimal respiratory depression and slight injection-site pain. Numerous studies on sedation for gastrointestinal endoscopy, fiberoptic bronchoscopy, general anaesthesia induction, and critical care medicine have revealed the safety and efficacy of ciprofol 10-12 . However, research on the haemodynamic stability of special populations (such as neurosurgical and cardiothoracic surgical patients) receiving ciprofol remains limited, particularly concerning MAP management during carotid endarterectomy (CEA). Inadequate MAP control is a key risk factor for stroke and perioperative mortality in CEA patients 13,14 . Therefore, selecting appropriate anaesthetic agents and using an appropriate amount of vasopressors are highly important for perioperative MAP management during CEA. 2 Materials and methods 2.1 Patient population This study was approved by the Ethics Committee of University-Town Hospital of Chongqing Medical University (IIT-LL-2025067). Clinical data from 103 patients who underwent carotid endarterectomy between 1 January 2023 and 31 December 2024 were collected. The inclusion criteria included an American Society of Anaesthesiologists (ASA) physical status classification of II–III, a body mass index (BMI) between 18 and 30, and a preoperative MAP below 107 mmHg (140/90 mmHg). The exclusion criteria included incomplete perioperative data records or missing postoperative follow-up data; long-term use of sedatives or analgesics before surgery; occurrence of severe anaphylactic shock, pulmonary embolism, or other adverse events unrelated to the study drugs during anaesthesia; placement of a vascular shunt during carotid cross-clamping; and bispectral index (BIS) values outside the range of 40–60 during surgery. On the basis of these criteria, 50 patients were included in the ciprofol group, and 53 patients were included in the propofol group. 2.2 Study procedure This was a single-centre retrospective cohort study. A standardized protocol for anaesthesia induction, maintenance, and extubation was used for all the patients included in the study. Upon entering the operating room, the medical team performs invasive radial artery blood pressure monitoring for each patient, records the BIS every 15 minutes and continuously monitors regional cerebral oxygen saturation (rSO2). The standardized induction protocol used in the department was as follows: patients were preoxygenated with 100% high-flow oxygen, and then administered intravenous midazolam (2–4 mg kg -1 ), sufentanil (0.5 μg kg -1 ), and either ciprofol (50 mg 20 ml, H20200013, Liaoning Haisco Pharmaceutical Co., Ltd.) at 0.2–0.4 mg kg -1 (ciprofol group) or propofol (200 mg 10 ml, H20030115, Xi’an Libang Pharmaceutical Co., Ltd.) at 1–2 mg kg -1 (propofol group). After the BIS value dropped below 60, cisatracurium besylate (0.15 mg kg -1 ) was administered intravenously as a neuromuscular blocking agent for tracheal intubation. Anaesthesia was maintained with intravenous infusions of remifentanil (10–15 μg kg -1 h -1 ) and cisatracurium besylate (0.05 mg kg -1 h -1 ). For sedation maintenance, ciprofol was infused at 1–2 mg kg - 1 h -1 in the ciprofol group, and propofol was infused at 4–8 mg kg -1 in the propofol group. By excluding patients with BIS values outside the 40–60 range, we can minimize the confounding effects of sedation depth on MAP and vasoactive drug usage. When cerebral oxygen saturation dropped below 50%, the surgeon placed a vascular shunt. 2.3 Data collection Data regarding the anaesthetic agents and intraoperative events were continuously recorded using the MEDICALSYSTEM(Suzhou Medical System Technology Co., Ltd. ). Data were extracted at the following time points for both groups: T0 (before anaesthesia induction), T1 (after anaesthesia induction), T2 (during endotracheal intubation), T3 (before skin incision), T4 (during cross-clamping of the carotid artery), T5 (5 minutes after cross-clamping), T6 (10 minutes after cross-clamping), T7 (5 minutes after carotid artery reperfusion), and T8 (during endotracheal extubation). The primary outcomes included the MAP at T1–T8 and the rate at which the target MAP was reached during cross-clamping (T0 was the baseline MAP, and the target MAP was defined as an MAP more than 20% higher than the baseline MAP. The secondary outcomes included the use of vasoactive drugs (noradrenaline and urapidil) and postoperative complications. Data on eCD and headache within 24 hours postoperatively were obtained from anaesthesia postoperative follow-up records during hospitalization. Postoperative complications (stroke, myocardial infarction, death) within 30 days were recorded through telephone follow-up. Additionally, anaesthesia time, surgical time, carotid cross-clamping time, net fluid intake and the use of midazolam, sufentanil, remifentanil, and cisatracurium besylate throughout the anaesthesia period were also recorded. 2.4 Statistical analysis Statistical analyses were conducted using R (4.3.2). Continuous variables are presented as means (standard deviations, SDs) or medians (interquartile ranges, IQRs), depending on the distribution of the data. Categorical variables are described as frequencies and percentages (n%). To compare continuous variables between two independent groups, the Wilcoxon rank sum test was used for nonnormally distributed data. For categorical variables, Pearson’s chi-square test was applied when the expected count in each cell was five or more. In cases where the expected count was less than five, Fisher’s exact test was used instead. Multivariable analysis was performed using a linear regression model to assess the association between the dependent variable and multiple independent variables, adjusting for potential confounders. The level of significance was set at a P value < 0.05 for all tests. 3 Results A total of 117 patients were assessed for eligibility; however, 4 patients were excluded because of missing intraoperative monitoring data, and 10 were excluded because of our inability to obtain postoperative complication information during the telephone follow-up. One hundred three patients were ultimately eligible and grouped on the basis of the anaesthetic agents used during the procedure. Fifty patients were assigned to the ciprofol group, and 53 patients were assigned to the propofol group (Figure 1). The basic demographic characteristics of the patients were similar between the two groups (Table 1). 3.1 MAP Management Parameters In terms of the primary outcomes, the ciprofol group had a slightly higher MAP at T3 (86.5 ± 6.1 mmHg vs. 83.2 ± 6.5 mmHg, P = 0.006). During the early period of cross-clamping, the differences between the two groups were significant at T4 (106.5 ± 5.6 mmHg vs. 98.1 ± 10.8 mmHg, P < 0.001) and T5 (114.4 ± 7.3 mmHg vs. 101.3 ± 10.8 mmHg, P < 0.001). However, at T8, the MAP in the ciprofol group was lower than that in the propofol group (94.6 11.2 mmHg vs. 106.4 ± 17.3 mmHg, P < 0.001). This difference may be attributed to 2 cases (4%) in the ciprofol group and 8 cases (15%) in the propofol group, where the MAP increased to more than 40% above the baseline value during tracheal extubation. (Figure 2) 3.2 Rate of Target MAP Achievement During Cross-Clamping During cross-clamping of the carotid artery (T4), the MAP was 17% higher than the baseline in the ciprofol group and 7% higher in the propofol group (P < 0.001) (Table 2). Despite a statistically significant difference in the target MAP achievement rates (38.0% vs. 17.0%, P = 0.017), the target MAP was reached in fewer than 50% of patients in both groups. Five minutes after cross-clamping (T0), the MAP was 26% higher than the baseline in the ciprofol group and 10% higher in the propofol group (P < 0.001). The rate of target MAP achievement, defined as a MAP at least 20% higher than the baseline MAP, significantly differed between the groups (76.0% vs. 20.8%, P < 0.001) . Ten minutes after cross-clamping, the target MAP achievement rate was similar between the groups (80.0% vs. 64.2%, P = 0.074), indicating that in the early stage of carotid cross-clamping, the target MAP was reached faster in the ciprofol group than in the propofol group. 3.3 Medication Dosage and Timing and Net Fluid Intake The ciprofol group had higher MAPs and compliance rates during cross-clamping of the carotid artery but received less noradrenaline (403.5 mg vs. 610.0 mg, P < 0.001) (Table 3). At the time of tracheal extubation, data on the use of urapidil were recorded as ”missing”. Future studies with larger sample sizes are needed to clarify whether there is an association between the use of ciprofol and propofol and the dosage of urapidil. There were no significant differences between the two groups regarding other drug dosages, surgical or anaesthesia times, cross-clamping times, or net fluid intake. 3.4 Postoperative Complications Four patients (8.0%) in the ciprofol group and 13 patients (24.5%) in the propofol group experienced eCD (p = 0.024) (Table 4). With respect to the incidence of other complications, including headache, no clear significant differences were observed. Within 30 days, one patient in the ciprofol group experienced a stroke, and one patient died; however, in the propofol group, one patient experienced a stroke, and another experienced a myocardial infarction. However, there is currently no evidence to suggest that these events are related to the intraoperative medications administered. 3.5 Confounding Factors Results of the multivariable analysis for Noradrenaline using a linear regression model. Linear Regression Model: Noradrenaline=Age+BMI+ASA+Hypertension+CHD+Group Number in dataframe = 103, Number in model = 103, Missing = 0, Log likelihood = -666.31, AIC = 1348.6, R-squared = 0.38, Adjusted R-squared = 0.35 After adjusting for the other variables in the model, Group and BMI were significant. The amount of noradrenaline administered to the patients in the ciprofol group was 226.97 µg (95% CI -291.74 to -162.21) less than that administered to the patients in the propofol group. When the BMI increased by 1, the noradrenaline dosage decreased by 15.52 µg (95% CI -29.27 to -1.77). 4 Discussion Ciprofol and propofol are both γ-aminobutyric acid (GABA) receptor agonists and have dose-dependent effects. However, subtle structural differences between these compounds determine their pharmacological properties and clinical manifestations. Specifically, the chemical structure of ciprofol is (R)-2-(1-cyclopropylethyl)-6-isopropylphenol. The addition of a cyclopropyl group to the isopropyl side chain of propofol forms the R-enantiomer. This modification enhances the spatial effect of ciprofol, significantly increasing its affinity for the GABAA receptor. As a result, ciprofol is 4 to 5 times more potent than propofol is 15 . The higher lipophilicity of ciprofol enables it to enter cell membranes quickly, which lowers the concentration of free molecules in the emulsion. This reduces drug side effects and their impact on the circulatory system. This high lipophilicity also promotes rapid onset and metabolism, leading to a shorter half-life and a higher pharmacokinetic clearance rate 16 . The rapid activation and metabolism of the anaesthetics can compensate for rapid changes in the MAP during surgery, meeting the specific circulatory requirements during CEA. Many studies have revealed that intravenous ciprofol (0.4 mg kg -1 ) has similar sedative effects but lower risks of anaesthesia-related adverse reactions than propofol (2.0 mg kg -1 ) does 15,17 . Another meta-analysis of 12 randomized controlled trials involving nonpaediatric and nonelderly patients aged 34-58 years revealed that ciprofol significantly reduced the incidences of injection pain and hypotension 18 . However, considering that studies on the efficacy and safety of ciprofol are based on relatively healthy adult patients, there is currently no clear evidence of its advantages in CEA. Patients with carotid stenosis, due to narrowing of the major cerebral blood-supplying arteries, experience dilation of collateral microarteries and capillaries. Over time, this leads to impaired smooth muscle contraction function and reduced vascular resistance, causing cerebral blood flow (CBF) to fluctuate dramatically beyond the normal range in response to changes in the MAP. The baroreceptor sensitivity of the carotid sinus is further impaired due to the compressive behaviour of plaques and injury during surgery at the site of stenosis 19 . Patients with impaired cerebral vasoregulation cannot withstand rapid changes in MAP, and dramatic fluctuations in CBF are directly associated with increased risks of postoperative complications and mortality. Intraoperative hypotension is associated with eCD, stroke, and cardiovascular events, whereas hypertension may lead to complications such as cerebral hyperperfusion syndrome (CHS) and stroke 8,20 . Therefore, CEA requires very strict intraoperative circulatory management 21 . Some researchers believe that prospective studies in which significant fluctuations in the MAP are artificially induced in CEA patients is unethical, as differences in strategies to manage MAP may lead to irreversible consequences 4 . In our retrospective study, we excluded patients who did not undergo standardized anaesthesia induction or surgical protocols at our research centre. By doing so, we aimed to show that ciprofol is superior to propofol for managing MAP during CEA. In the final comparative analysis, the ciprofol group demonstrated a more stable circulatory state early in the surgery. The target MAP was reached quickly during carotid artery cross-clamping, which reduced the duration of cerebral ischaemia, effectively lowered the incidence of eCD, and required fewer vasopressors overall. We believe that this result is due to the greater potency of ciprofol, which leads to less drug accumulation and faster metabolism at the same effective concentration, resulting in fewer, easy-to-manage decreases in MAP. Further exploration of the accumulation and pharmacokinetic properties of ciprofol in CEA patients is needed in the future. Interestingly, we found that while the propofol group had a slower target MAP achievement rate during carotid artery cross-clamping, they had a significantly higher rate of hypertension during tracheal extubation. Notably, 8 (15%) patients had a MAP more than 40% higher than the baseline, a factor that may contribute to postoperative headaches 22 . Further exploration and confirmation of the correlation between intraoperative MAP variability and headache caused by CHS are needed in future studies. The mechanism underlying the higher incidence of hypertension in the propofol group during tracheal extubation remains uncertain. We speculate that this may be related to the following factors: noradrenaline, an adrenergic receptor agonist, primarily activates α receptors (nonselective for α1 and α2) and weakly activates β1 receptors. Through the cAMP/PKA and ERK pathways, it synergistically activates eNOS (endothelial nitric oxide synthase) under acute conditions, leading to endothelial dysfunction and affecting vascular elasticity and stiffness. The duration of these effects is related to specific pathological conditions, oxidative stress levels, and intraoperative ischemia-reperfusion injury 23 . Decreased vascular compliance and increased resistance during the perioperative period increase the MAP, especially in patients with impaired cerebral vascular autoregulation, who are more sensitive to changes in MAP 24,25 . Additionally, we found that the dosage of noradrenaline decreased with increasing BMI. Several studies have confirmed this 26 . Although the distribution of baseline BMI was well balanced between the ciprofol and propofol groups [24.5 (22.3, 26.0) vs. 25.0 (23.0, 26.0), p=0.479], indicating that there was no significant difference in BMI between the two groups, further analysis revealed that BMI was an independent factor influencing noradrenaline dosage in both groups. This suggests that while BMI did not confound the primary outcome between the groups, it still played a role in determining the individual noradrenaline requirements within each group. Therefore, the balanced distribution of BMI across groups ensured that this factor did not bias the overall comparison of noradrenaline demand between patients administered ciprofol and those administered propofol, but its independent effect on dosage was still accounted for in the regression model. The administration of noradrenaline should be improved in the future to reduce the risk of postoperative adverse events, and better anaesthesia management strategies are needed for patients undergoing CEA under ciprofol anaesthesia. Conclusion This study examined the efficacy of ciprofol and propofol for MAP management in patients undergoing CEA. The target MAP was reached more quickly and fewer vasopressors were administered to patients who underwent CEA under ciprofol anaesthesia, provided that specific haemodynamic conditions were met. These findings indicate that ciprofol anaesthesia is also better for managing the MAP during CEA. It induces fewer stress responses, reduces the risk of postoperative complications, enhances blood pressure management, and improves the overall safety of CEA. Limitations The study was a retrospective, single-center analysis of a small sample of patients. Future research should involve large-scale, multicentre prospective clinical studies that focus on safe blood pressure thresholds in CEA patients. These studies should include more detailed long-term data on postoperative complications. These findings will contribute to investigations of the pharmacological mechanisms and clinical effects of ciprofol, thereby optimizing anaesthetic management strategies. Author contributions Yanqing Zhang conceived the study; Xinxin Zheng was responsible for writing the manuscript; Shiyun Deng and Bin Wu conducted the statistical analysis; Yin Zhang and Lu Tian helped collect the data; Lin Bai reviewed and revised the paper. Acknowledgements We express our gratitude to all the patients who participated in this study and to the researchers who contributed to the clinical observations, data organization, and manuscript writing. Conflict of interest statement All the authors declare that they have no conflicts of interest directly related to the content of this article. Funding information Sponsored by the Natural Science Foundation of Chongqing, China (#CSTB2022NSCQ-MSX1528) Data availability statement The data from this study have not been shared with any institution. ORCID Xinxin Zheng https://orcid.org/0009-0009-2970-8196 Yanqing Zhang https://orcid.org/ 0000-0002-0456-2110 Lin Bai https://orcid.org/ 0009-0003-6995-7636 References 1. Song P, Fang Z, Wang H, et al. Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling study. Lancet Glob Health. May 2020;8(5):e721-e729. doi:10.1016/S2214-109X(20)30117-0 2. Halliday A, Harrison M, Hayter E, et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet. 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Demographics and baseline characteristics Age 71.0 (66.0, 75.0) 70.0 (65.0, 74.0) 71.0 (67.0, 76.0) 0.350 Sex 0.973 Female 29 (28.2%) 14 (28.0%) 15 (28.3%) Male 74 (71.8%) 36 (72.0%) 38 (71.7%) BMI 25.0 (23.0, 26.0) 24.5 (22.3, 26.0) 25.0 (23.0, 26.0) 0.479 ASA 0.402 II 31 (30.1%) 17 (34.0%) 14 (26.4%) III 72 (69.9%) 33 (66.0%) 39 (73.6%) Smoke 0.443 Yes 41 (39.8%) 18 (36.0%) 23 (43.4%) No 62 (60.2%) 32 (64.0%) 30 (56.6%) Hypertension 0.211 Yes 60 (58.3%) 26 (52.0%) 34 (64.2%) No 43 (41.7%) 24 (48.0%) 19 (35.8%) DM 0.616 Yes 50 (48.5%) 23 (46.0%) 27 (50.9%) No 53 (51.5%) 27 (54.0%) 26 (49.1%) CHD 0.142 Yes 34 (33.0%) 13 (26.0%) 21 (39.6%) No 69 (67.0%) 37 (74.0%) 32 (60.4%) CVA history 0.983 Yes 31 (30.1%) 15 (30.0%) 16 (30.2%) No 72 (69.9%) 35 (70.0%) 37 (69.8%) a Median (IQR); n (%) b Wilcoxon rank sum test; Pearson’s Chi-squared test Abbreviation: BMI , body mass index ; ASA , American Society of Anaesthesiologist ; DM , Diabetes Mellitus ; CHD, Coronary Heart Disease; CVA history, history of cerebrovascular accident Table 2. MAP increase percentage and target achievement rate at different time points (T4, T5, and T6) during cross-clamping T4_T0 0.12(0.12) 0.17(0.08) 0.07(0.13) <0.001 T4_T0_YN 0.017 Yes 28 (27.2%) 19 (38.0%) 9 (17.0%) No 75 (72.8%) 31 (62.0%) 44 (83.0%) T5_T0 0.18(0.14) 0.26(0.10) 0.10(0.12) <0.001 T5_T0_YN <0.001 Yes 49 (47.6%) 38 (76.0%) 11 (20.8%) No 54 (52.4%) 12 (24.0%) 42 (79.2%) T6_T0 0.25(0.10) 0.27(0.08) 0.23(0.11) 0.173 T6_T0_YN 0.074 Yes 74 (71.8%) 40 (80.0%) 34 (64.2%) No 29 (28.2%) 10 (20.0%) 19 (35.8%) a Mean(SD); n (%) b Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test T0 (before anaesthesia induction); T4 (during cross-clamping of the carotid artery); T5 (5 minutes after cross-clamping); T6 (10 minutes after cross-clamping) Table 3. Comparison of drug dosages, surgical and anaesthesia times, cross-clamping times, and net fluid intake Noradrenaline µg 524.0 (383.0, 663.5) 403.5 (331.3, 453.0) 610.0 (551.0, 757.0) <0.001 Urapidil mg 12.5 (12.5, 12.5) 12.5 (12.5, 12.5) 12.5 (12.5, 15.6) 0.574 Missing 93 48 45 Midazolam mg 3.0 (3.0, 4.0) 3.0 (2.0, 4.0) 3.0 (3.0, 4.0) 0.704 Sufentanil µg 35.0 (30.0, 35.0) 35.0 (30.0, 35.0) 35.0 (30.0, 35.0) 0.423 Remifentanil mg 1.5 (1.3, 1.8) 1.5 (1.3, 1.7) 1.5 (1.4, 1.9) 0.434 Cisatracurium mg 16.0 (15.5, 18.0) 16.0 (16.0, 18.0) 16.0 (15.0, 17.0) 0.478 Anaesthesia-time min 169.0 (148.5, 185.5) 171.0 (149.5, 184.0) 166.0 (149.0, 186.0) 0.496 Surgery-time min 110.0 (98.0, 121.0) 112.0 (99.3, 121.8) 104.0 (98.0, 121.0) 0.301 Carotid cross clamping - time min 31.0 (27.0, 35.0) 31.0 (27.0, 34.0) 32.0 (27.0, 40.0) 0.163 Net fluid intake ml 640.0(455.0,820.0) 675.0(515.0,825.0) 635.0(415.0,910.0) 0.402 a Median (IQR) b Wilcoxon rank sum test Table 4. Comparison of postoperative complications between the Ciprofol and Propofol groups eCD 0.024 Yes 17 (16.5%) 4 (8.0%) 13 (24.5%) No 86 (83.5%) 46 (92.0%) 40 (75.5%) Headache 0.061 Yes 8 (7.8%) 1 (2.0%) 7 (13.2%) No 95 (92.2%) 49 (98.0%) 46 (86.8%) Stroke >0.999 Yes 2 (1.9%) 1 (2.0%) 1 (1.9%) No 101 (98.1%) 49 (98.0%) 52 (98.1%) MI >0.999 Yes 1 (1.0%) 0 (0.0%) 1 (1.9%) No 102 (99.0%) 50 (100.0%) 52 (98.1%) Death 0.485 Yes 1 (1.0%) 1 (2.0%) 0 (0.0%) No 102 (99.0%) 49 (98.0%) 53 (100.0%) a n (%) b Pearson’s Chi-squared test; Fisher’s exact test Abbreviation: eCD , early cognitive dysfunction; MI , myocardial Infarction Table 5. Results of multivariable analysis of results for noradrenaline using a linear regression model Age [52.0,89.0] Mean(SD) 530.9 (199.7) 1.94 (-2.72 to 6.59, p=0.410) BMI [19.0,30.0] Mean(SD) 530.9 (199.7) -15.52 (-29.27 to -1.77, p=0.027) ASA II Mean(SD) 496.8 (180.4) - III Mean(SD) 545.6 (207.0) 35.35 (-41.31 to 112.00, p=0.362) Hypertension No Mean(SD) 506.0 (193.6) - Yes Mean(SD) 548.8 (203.7) 4.52 (-61.16 to 70.20, p=0.892) CHD No Mean(SD) 509.0 (184.5) - Yes Mean(SD) 575.4 (223.8) 29.17 (-44.29 to 102.62, p=0.433) Group Propofol Mean(SD) 643.8 (191.0) - Ciprofol Mean(SD) 411.3 (126.4) -226.97 (-291.74 to -162.21, p<0.001) Abbreviation: BMI , body mass index ; ASA , American Society of Anaesthesiologist ; CHD, Coronary Heart Disease; After adjusting for the other variables in the model, Group and BMI were significant. Supplementary Material File (changes in map.tif) Download 5.62 MB File (strobe flow diagram of the study.tif) Download 15.32 MB Information & Authors Information Version history V1 Version 1 04 June 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords anaesthesia blood pressure critical care neurology pharmacodynamics pharmacokinetic-pharmacodynamic physiology stroke Authors Affiliations Xinxin Zheng 0009-0009-2970-8196 University-Town Hospital of Chongqing Medical University View all articles by this author Shiyun Deng University-Town Hospital of Chongqing Medical University View all articles by this author Bin Wu The First Affiliated Hospital of Chongqing Medical University View all articles by this author Yin Zhang University-Town Hospital of Chongqing Medical University View all articles by this author Lu Tian University-Town Hospital of Chongqing Medical University View all articles by this author Yanqing Zhang [email protected] University-Town Hospital of Chongqing Medical University View all articles by this author Lin Bai Chongqing Medical University Affiliated Children's Hospital View all articles by this author Metrics & Citations Metrics Article Usage 238 views 146 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Xinxin Zheng, Shiyun Deng, Bin Wu, et al. 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