omparison of the Effects of Fospropofol Disodium and Etomidate for Induction of General Anesthesia in Older Patients with Frailty

Corresponding author: LI yuan-hai, liyuanhai-1@163.com

DOI: 10.12201/bmr.202610.00029

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  Abstract: Objective To compare the efficacy and safety of fospropofol disodium combined with sufentanil versus etomidate for induction of general anesthesia in older patients with frailty. Methods Eighty-eight older patients with frailty who were scheduled for elective surgery under tracheal intubation general anesthesia at the Fourth Affiliated Hospital of Anhui Medical University from January to June 2026 were enrolled. Using a random number table, patients were assigned to a fospropofol disodium group (group F) or an etomidate group (group E). Both groups received sufentanil 0.4 μg/kg and midazolam 0.03 mg/kg before the study drug. Group F received intravenous fospropofol disodium 7.5 mg/kg, whereas group E received etomidate 0.3 mg/kg. Results The induction success rate was 100% in both groups. The time to loss of eyelash reflex and the time to the first Modified Observer''s Assessment of Alertness/Sedation score ≤1 were longer in group F than in group E (both P<0.001). The incidence of hypotension was 43.2% in group F and 40.9% in group E (P=0.828), with a risk difference of 2.3% (95% CI, -17.7% to 22.0%). Because the upper limit of the 95% CI exceeded the prespecified non-inferiority margin of 12%, non-inferiority of fospropofol disodium to etomidate for the primary endpoint was not demonstrated. Propofol consumption per unit time was lower in group F (P<0.001), whereas recovery time did not differ between groups. MAP was lower in group F at T2-T4, and heart rate was lower in group F at T2 and T3. Myoclonus occurred less frequently in group F than in group E (0 vs 15.9%, P=0.012), whereas paresthesia occurred more frequently in group F (18.2% vs 0, P=0.006). Conclusion Fospropofol disodium provides satisfactory sedation for induction of general anesthesia in older patients with frailty but has a slower onset than etomidate. Non-inferiority for induction-related hypotension was not established. Fospropofol disodium may attenuate the immediate hemodynamic response to tracheal intubation and reduce myoclonus and subsequent propofol requirements, but paresthesia is more common. Individualized selection should consider circulatory reserve and the risk of adverse reactions.

  Key words: Fospropofol disodium; Etomidate; Frailty; Aged; General anesthesia induction

  Submit time: 13 October 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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