Emerging Evidence Suggests Ciprofol May Offer stability in Intraoperative Neurophysiological Monitoring Compared to Propofol
Recent research is spotlighting potential advantages of the anesthetic agent Ciprofol (fospropofol disodium) over Propofol in maintaining stable intraoperative neurophysiological monitoring (IONM) signals during spinal surgery. While Propofol remains a widely used anesthetic, its known effects on motor evoked potentials (MEPs) and sensory evoked potentials (SEPs) – collectively termed “anesthetic fade” – can complicate interpretation of IONM data, potentially delaying critical interventions. This growing body of evidence is prompting neurophysiologists and anesthesiologists to re-evaluate anesthetic protocols to optimize signal fidelity and patient safety.
Spinal surgeries rely heavily on IONM to detect neurological compromise during procedures. Though, anesthetics can significantly influence these signals, creating false positives or obscuring genuine neurological changes. This uncertainty can lead to needless surgical adjustments or, conversely, a failure to recognize a true neurological deficit in a timely manner. The stakes are high: accurate IONM interpretation directly impacts the potential for post-operative neurological complications and long-term patient outcomes. Understanding the differential effects of anesthetics like Ciprofol and Propofol is therefore crucial for refining surgical workflows and improving patient care.
several studies have investigated the impact of anesthetic agents on IONM. Banoub, Tetzlaff, and Schubert (2003) detailed the pharmacologic and physiologic influences affecting SEPs, highlighting implications for perioperative monitoring. Sloan (1998) further elaborated on anesthetic effects on electrophysiologic recordings.more recently,research has focused on mitigating the “anesthetic fade” phenomenon observed with Propofol. Ushirozako et al. (2019) characterized false-positive alerts during scoliosis and spinal deformity surgery, attributing them to this Propofol-induced signal degradation. Tanaka et al. (2021) investigated the relationship between compound muscle action potential normalization and anesthetic fade of intraoperative transcranial MEPs, while Ushirozako et al. (2019) specifically examined the impact of total Propofol dose on transcranial MEPs.
These findings suggest a link between Propofol dosage and signal instability. Sahinovic et al.(2021) provided a current overview of anesthesia and IONM spinal cord monitoring, while dulfer et al. (2021) initiated a prospective observational study to assess the influence of anesthesia depth and blood pressure on muscle-recorded MEPs. Fehlings, Tator, and Linden (1989) established foundational relationships between spinal cord injury severity, evoked potentials, and spinal cord blood flow, underscoring the importance of reliable evoked potential monitoring. The potential for Ciprofol to offer a more stable platform for IONM stems from its metabolic pathway; it is indeed a prodrug of Propofol, resulting in slower and more predictable drug delivery. This may translate to reduced fluctuations in MEP and SEP signals, allowing for more confident interpretation. Further research is needed to definitively establish Ciprofol’s superiority and to develop optimized anesthetic protocols for spinal surgery incorporating its unique pharmacokinetic properties.
