Induction of General Anesthesia with Fospropofol in Elderly Patients Undergoing Hip Surgery: An Efficacy and Safety Analysis

Purpose: To compare fospropofol with etomidate for the induction of anesthesia in elderly patients undergoing hip surgery, with a focus on safety and efficacy. Patients and Methods: A prospective, single-blind, randomized, controlled study that enrolled 120 elderly patients, who were randomly assigned to a fospropofol group (10 mg/kg, group P, n = 60) or an etomidate group (0.3 mg/kg, group E, n = 60). The main outcome was the time to loss of consciousness (LOC). The secondary endpoints were the success rate of anesthesia induction, hemodynamic parameters, adverse reactions, dosage of anesthetic maintenance drugs and postoperative recovery conditions. Results: The study was completed by all enrolled patients in both groups. The success rate for induction of general anesthesia in both groups was 100% ( P =1.000). The LOC time was greater in group P compared to group E (98.50 vs. 40.00 s, P < 0.001). Compared to group E, group P had better control of systolic blood pressure (SBP) and heart rate at intubation ( P < 0.001) and required less remifentanil (6.7% vs. 20.0%, P =0.032). In the 10 min post-intubation, group P showed smaller increases in SBP and lower heart rates at most time points ( P < 0.001), along with lower propofol consumption (3.40 [2.50, 4.25] vs. 4.18 [3.83, 4.62] mg/min, P < 0.001). The incidence of myoclonus was less in group P (1.7% vs. 31.7%, P < 0.001), but paresthesia (primarily pruritus) was more frequently observed in group P (15.0% vs. 0.0%, P =0.002). The incidence of postoperative nausea and vomiting (PONV) at 0– 24 h was lower in group P (11.67% vs. 26.67%, P=0.038), while no significant difference was observed at 24– 48 h (5.0% vs. 1.67%, P=0.355) or during recovery (11.67% vs. 21.67%, P=0.149). The incidence of other adverse events was similar between the two groups. Conclusion: Fospropofol provides better suppression of the stress response during tracheal intubation and positioning. It also significantly reduces the incidence of myoclonus and demonstrates favorable hemodynamic stability though its slower onset and higher incidence of pruritus require clinical consideration. Clinical Trial Registration: Registered at: https://www.isrctn.com/, ISRCTN12170320, registration date: 24/06/2025. Keywords: fospropofol disodium, etomidate, elderly patients, hip surgery, anesthesia