Fospropofol Disodium

The objective of this study is to ascertain the 95% effective dose (ED95) of fospropofol disodium for injection (fospropofol_FD) combined with sufentanil for the attenuation of cardiovascular reactions to endotracheal intubation, to determine the optimal dosage of fospropofol disodium for clinical safe medication use in different populations.

This study employed a biased coin design (BCD)-based up-and-down sequential allocation trial method.

Eighty surgical patients who received fospropofol disodium combined with sufentanil for general anesthesia induction at the First Affiliated Hospital of Nanchang University between March and September 2023 were enrolled. Participants were stratified into two cohorts: middle-aged group (18 to 59 years, n=40, Group A) and elderly group (60 to 89 years, n=40, Group O). The fospropofol disodium dosage was titrated according to the preceding patient's cardiovascular response, with dose increments set at 0.5 mg/kg. Positive cardiovascular response was defined as heart rate or blood pressure fluctuations exceeding 20% from baseline. Furthermore, isotonic regression analysis was implemented to calculate the 95% effective dose (ED95).

The ED95 of fospropofol_FD combined with 0.4 mcg/kg sufentanil for anesthesia induction to mitigate cardiovascular responses was determined to be 13.8 mg/kg (95% CI: 13.57 to 14.1 mg/kg) for Group A and 9.89 mg/kg (95% CI: 9.84 to 9.90 mg/kg) for Group O, with no overlap in confidence intervals between the two groups, indicating a significant difference (p<0.01).

The ED95 differed between patients aged 18 to 59 years and those aged 60 to 89 years, yielding values of 13.8 mg/kg and 9.89 mg/kg, respectively, with the older group demonstrating heightened sensitivity to fospropofol_FD. Pruritus and paresthesia were the primary adverse reactions observed in the study.

Fospropofol is a water-soluble prodrug of propofol that has gained increasing attention in the field of anesthesia due to its gentle modulation of cerebral blood flow and metabolism. This review summarizes the pharmacological mechanisms by which fospropofol regulates cerebral hemodynamics, including direct effects on vascular smooth muscle and indirect modulation via suppression of neural metabolic activity. The article also discusses its ability to reduce cerebral metabolic rate, inhibit neuronal excitability, and modulate energy balance, all of which contribute to its potential neuroprotective properties, particularly in ischemia-reperfusion injury. Preclinical and clinical studies suggest that fospropofol exerts antioxidant and anti-inflammatory effects that may further support neural preservation. Clinically, fospropofol has shown value in various scenarios requiring precise neuromanagement, including neurosurgery, anesthesia in elderly patients, intensive care sedation, and perioperative neuroprotection. Despite promising results, further high-quality, large-scale studies are needed to clarify its neuroprotective efficacy across diverse patient populations and surgical contexts. With its favorable pharmacokinetics, controllable depth of sedation, and multitargeted neural effects, fospropofol is poised to become an important tool in individualized neuroanesthesia and brain-protective strategies.