To analyze the effects of ciprofol versus propofol on hemodynamics during anesthesia induction and maintenance and on postoperative recovery in video-assisted thoracoscopic surgery (VATS) lobectomy.

A total of 173 patients who underwent VATS segmentectomy or lobectomy in our hospital from January 2024 to December 2025 were selected. 95 patients were assigned to the propofol group and 78 to the ciprofol group. In the propofol group, anesthesia was induced with target-controlled infusion (TCI) of propofol 1.5~2.5 mg/kg and maintained with 4~12 mg/(kg·h) under bispectral index (BIS) monitoring. In the ciprofol group, anesthesia was induced with TCI of ciprofol 0.4~0.5 mg/kg and maintained with 0.4~2.4 mg/(kg·h). Intraoperative vital signs, postoperative recovery, and safety were evaluated.

The success rate of anesthesia induction was 100% in both groups. At T₃-T₄ during induction, BIS values reached their nadir in both groups; during the maintenance phase, BIS in the ciprofol group was lower than that in the propofol group at T₇-T₁₀ (P<0.05). The proportion of time with bispectral index (BIS) ranging from 40 to 60 was 44.21% vs 24.36% (P=0.007), and the relative time proportion was (79.67±24.81)% vs (72.62±23.59)% (P=0.059); no statistically significant difference was observed between the two groups. Compared with the propofol group, the reductions in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were milder in the ciprofol group (P=0.028, 0.044, <0.001). The QoR-15 score was higher in the ciprofol group than in the propofol group [137.00 (134.00, 140.00) vs 135.00 (132.75, 137.00), Z=-2.359, P=0.040]. There were no significant differences between the two groups in postoperative RASS score [4.00(3.00, 4.00) vs 4.00(3.00, 4.00), P=0.981], T_ROC [(5.60±1.87) min vs (6.07±2.01) min, t=1.579, P=0.116], extubation time [(4.15±2.05)d vs (4.67±2.16)d, t=1.620, P=0.107], Numerical Rating Scale (NRS) score [2.41(1.81, 2.24) vs 2.93(1.87, 2.70), P=0.601], and incidence of postoperative nausea and vomiting (14.00% vs 18.00%, P=0.585). The incidence of grade 2-3 injection site pain was lower in the ciprofol group (11.54% vs 33.68%, χ²=11.621, P=0.001), as was the incidence of drug-related hypotension during anesthesia maintenance (7.69% vs 24.21%, χ²=8.376, P=0.004). No significant between-group differences were found in the incidences of bradycardia (10.26% vs 13.68%), tachycardia (6.41% vs 13.68%), hypertension (7.69% vs 11.58%) and intubation response (2.56% vs 6.32%) (P>0.05).

Ciprofol can be used for anesthesia induction and maintenance in VATS, with efficacy and safety non-inferior to propofol. It provides more stable hemodynamics and is associated with lower incidences of grade 2~3 injection site pain and hypotension.