Differential impacts of propofol and etomidate on hemodynamic stability and postoperative cognition in elderly surgical patients - A retrospective observational analysis

Q: What was the study design and patient population?

A retrospective observational study enrolled 150 patients aged 65 and above who underwent elective surgery under general anesthesia from January 2023 to January 2025.

Q: What primary outcomes were compared between propofol and etomidate?

Outcomes included adverse reactions during induction, intraoperative hemodynamic variability, emergence time, incidence of postoperative nausea and vomiting, and cognitive changes assessed by MMSE on the first postoperative day.

Q: How did propofol and etomidate differ in key clinical effects?

Propofol was associated with a higher rate of induction hypotension and quicker emergence, but with greater postoperative cognitive decline. Etomidate showed less MAP fluctuation and better cognitive preservation, while producing more myoclonus.

Sep 30, 2026

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Tailoring anesthetic strategies for elderly surgical patients supports safer induction and improved recovery of cognitive function. This retrospective observational analysis compared propofol versus etomidate in 150 patients aged 65+ undergoing elective general anesthesia from Jan 2023 to Jan 2025. Primary measures included induction adverse reactions, intraoperative hemodynamic variability, emergence time, postoperative nausea and vomiting, and first-day cognitive change by MMSE. Propofol increased induction hypotension (36.4% vs 15.1%) and showed faster emergence, while etomidate improved MAP stability and cognitive preservation, but raised myoclonus risk.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Introduction

Study background and clinical challenges

Rationale for comparing propofol and etomidate

® Observational Study Differential impacts of propofol and etomidate on hemodynamic stability and postoperative cognition in elderly surgical patients A retrospective observational analysis Yujiao Chen, MMa , Yan He, MMa , Jing Zhang, MMa , Yulong Zhang, MMa ,* | Abstract
As the aging population continues to expand, tailoring anesthetic strategies to improve safety and recovery outcomes in elderly patients has become increasingly important. Propofol and etomidate are 2 widely used agents for intravenous induction in general anesthesia, each with distinct pharmacologic properties. This study explores the comparative safety profiles and perioperative outcomes of these agents in an elderly surgical cohort. A retrospective observational study was conducted on 150 patients aged 65 and above who underwent elective surgery under general anesthesia from January 2023 to January 2025. Participants were grouped according to the induction drug received: propofol (n = 77) or etomidate (n = 73) . Primary outcomes included adverse reactions during induction (e.g. , hypotension, myoclonus), intraoperative hemodynamic variability, emergence time, incidence of postoperative nausea and vomiting, and cognitive changes assessed via mini-mental state examination on the first postoperative day. Baseline characteristics were comparable between groups. Propofol was linked to a significantly higher rate of hypotension during induction (36 .4% vs 15. 1%, P = .002), whereas etomidate induced more myoclonus (26 .0% vs 3.9%, P < .001) . Mean arterial pressure fluctuated less in the etomidate group during maintenance (8 .6 ± 2.3 mm Hg vs 12.0 ± 3.5 mm Hg, P < .001) . Although propofol yielded quicker emergence (9 .7 ± 2.9 minutes vs 12.5 ± 3.8 minutes, P = .001), it was associated with greater postoperative cognitive decline (P = .011) . Postoperative nausea and vomiting incidence was higher with etomidate but did not reach statistical significance (P = .065) . Propofol offers rapid recovery advantages but increases the risk of hypotension and cognitive impairment in elderly patients. Etomidate provides superior hemodynamic stability and better cognitive preservation postoperatively, albeit with a higher risk of myoclonus. Anesthetic choice in geriatric populations should be guided by individual risk profiles and perioperative goals. | | --- | | Abbreviations: ASA = American Society of Anesthesiologists, BMI = body mass index, MAP = mean arterial pressure, MMSE = mini-mental state examination, PONV = postoperative nausea and vomiting. | | Keywords: blood pressure stability, cognitive function, emergence time, etomidate, geriatric anesthesia, PONV, propofol | 1. Introduction With the ongoing acceleration of population aging, the proportion of elderly patients undergoing surgical procedures continues to rise annually.[1] Due to diminished physiological reserve, a higher burden of comorbidities, and increased sensitivity to anesthetic agents, anesthetic management in this population presents significant clinical challenges. [2,3] Anesthetic drugs not only affect intraoperative hemodynamic stability but are also closely associated with the quality of postoperative emergence and recovery of cognitive function. [4] Inappropriate anesthetic induction or maintenance regimens may lead to complications such as hypotension, arrhythmias, postoperative delirium, and even long-term cognitive impairment. [5–7] Therefore, selecting appropriate anesthetic agents is critical to improving surgical safety and reducing perioperative complications. Propofol is a widely used intravenous anesthetic agent in clinical practice, favored for its rapid onset, short duration of action, and fast recovery, making it suitable for short or ambulatory surgical procedures. [8–10] However, propofol exhibits a dose-dependent inhibitory effect on the cardiovascular system, frequently leading to hypotension and bradycardia, which may be more pronounced in elderly patients. [1

FAQs

What was the study design and patient population?

A retrospective observational study enrolled 150 patients aged 65 and above who underwent elective surgery under general anesthesia from January 2023 to January 2025.

What primary outcomes were compared between propofol and etomidate?

Outcomes included adverse reactions during induction, intraoperative hemodynamic variability, emergence time, incidence of postoperative nausea and vomiting, and cognitive changes assessed by MMSE on the first postoperative day.

How did propofol and etomidate differ in key clinical effects?

Propofol was associated with a higher rate of induction hypotension and quicker emergence, but with greater postoperative cognitive decline. Etomidate showed less MAP fluctuation and better cognitive preservation, while producing more myoclonus.

Sep 30, 2026

Uploaded by awa