Comparison of anesthesia induction with ciprofol, propofol, and etomidate in elderly patients undergoing gastrointestinal endoscopy: a single center, prospective, double blind randomized controlled trial.

BACKGROUND: We compared benefits and adverse effects of anesthesia induction with ciprofol, propofol, and etomidate in elderly patients undergoing gastrointestinal endoscopy anesthesia. METHODS: A total of 391 patients who underwent painless gastrointestinal endoscopy; age ≥ 60 years; ASA I-III were involved between April 30 and 30 December 2025. The primary outcome was hypoxemia or apnea during anesthesia. Secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), respiratory rate (RR), SpO2 during surgery, and adverse reactions such as coughing dizziness and agitation. RESULTS: No differences were found in hypoxemia and apnea. Except for RR, other hemodynamic and respiratory parameters were significantly different among the groups (p < 0.05), and the degree of blood pressure decline in group E was smaller than groups C and P. Group E patients had lower intraoperative hypotension (p = 0.007) and lower demand for vasoactive drugs (p = 0.006). The injection pain scores in groups C and E were lower, but patients in group E had a higher incidence of myoclonus, and the proportion of coughing and hiccups during endoscopy was higher in group E. The incidence of dizziness was lower in Group C. CONCLUSION: No significant differences were observed in the incidence of hypoxemia and apnea among three groups. Etomidate has the advantage of stable hemodynamics; however, the incidence of myoclonus, bucking, and hiccups is high. Injection pain occurred less frequently with ciprofol and etomidate, while ciprofol was associated with a low incidence of postoperative dizziness. CLINICAL TRAIL REGISTRATION: https://www.chictr.org.cn/showproj.html?proj=269837, identifier ChiCTR2500101280.