Effects of Fospropofol on intraoperative hemodynamics in patients undergoing Supratentorial tumor resection: A randomized controlled trial

BACKGROUND AND OBJECTIVE: We evaluated the efficacy and safety of fospropofol in maintaining intraoperative hemodynamics and perioperative outcomes in patients receiving supratentorial tumor resection and compared its performance against that of propofol. METHODS: A multicenter randomized controlled trial was carried out between August 2023 and December 2024, in which patients scheduled for elective supratentorial tumor resection were assigned to receive either fospropofol or propofol for anesthesia induction and maintenance. The primary outcome was the area under the threshold (AUT) for a mean arterial pressure < 65 mmHg. Secondary outcomes included the patients' vital signs, medication use, the incidence of hypotension, hypertension, bradycardia, and tachycardia, and various intra- and postoperative measurements. RESULTS: In total, 217 patients were included in the study analysis, with 108 and 109 patients under fospropofol and propofol treatment, respectively. The fospropofol group had more males and a higher smoking rate than the propofol group. The AUT was significantly lower for the fospropofol group than for the propofol group (65.7 vs. 353.0 mmHg·min, P < 0.05). The fospropofol group also exhibited a lower incidence of intraoperative hypotension (49.1% vs. 70.6%, P < 0.05) and required less ephedrine (P < 0.05). The incidences of emergence and postoperative delirium were comparable between the two groups (P > 0.05). However, the fospropofol group had a longer time to recovery (35 vs. 25 min, P = 0.002) and a higher delayed recovery incidence (60.5% vs. 38.3%, P = 0.005). CONCLUSIONS: Fospropofol provided more stable intraoperative hemodynamics than propofol in patients undergoing supratentorial tumor resection without increasing the delirium risk. This indicates that fospropofol is a safe and effective option for neurosurgical anesthesia, albeit with a slower recovery profile than propofol.