Zhen Chen,1 Ying-Ying Liu,1 Qian Hu,1 Jia-Sheng Wang,1 Rui-Yang Cao,1 Su-Ting Yu,2 Feng Lu,3,4 Mao-Lin Zhong,3,4 Wei-Dong Liang,3,4 Lifeng Wang3,4 

1The First Clinical Medical College of Gannan Medical University, Ganzhou, Jiangxi, People’s Republic of China; 2Guangdong Provincial People’s Hospital Ganzhou Hospital, Ganzhou, Jiangxi, People’s Republic of China; 3Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, People’s Republic of China; 4Ganzhou Key Laboratory of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, People’s Republic of China

Correspondence: Lifeng Wang, Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, 128 Jinling Road, Golden Development Zone, Ganzhou City, Jiangxi Province, 341000, People’s Republic of China, Email wwwanglifeng@126.com

Purpose: As a novel intravenous anaesthetic, ciprofol is widely used in clinical practice. However, its potential association with postoperative delirium (POD) is unclear. Silent information regulator factor 3(SIRT3) could regulate mitochondrial function, initiate mitochondrial autophagy, and has played an important role in maintaining normal neuronal cell function. This trial aimed to explore the effect of ciprofol on the pathogenesis of POD and whether SIRT3 had a correlation with the pathogenesis of POD.
Patients and methods: One hundred fourteen elderly patients scheduled for elective hip joint surgery were included in this randomized controlled, double blind study. The patients were randomly assigned at a 1:1 ratio to either the ciprofol group (Group C, induction of anaesthesia with 0.3 mg/kg ciprofol) or the propofol group (Group P, induction of anaesthesia with 1.5 mg/kg propofol). On postoperative days 1 and 3, the 3D-CAM scale was used to assess whether POD occurred in both groups of patients.
Results: No statistically significant difference was observed in the general condition of the patients in the two groups. Within the first 3 days after surgery, the incidence of POD was lower in Group C than in Group P (5.5% vs 20%; P = 0.022). At 1 min of administration, ciprofol had less circulatory effects and a lower incidence of injection pain, but a higher incidence of muscle twitching than propofol. On postoperative day 1, SIRT3 expression was greater in Group C than in Group P (P = 0.028). Additionally, SIRT3 expression was found to be correlated with POD. The serum SIRT3 level on postoperative day 1 had an area under the receiver operating characteristic (ROC) curve of 0.8540 (P < 0.001), with a detection threshold of 1.565 ng/mL, yielding a sensitivity of 0.820 and a specificity of 0.900.
Conclusion: In this study, we found that ciprofol was associated with a lower incidence of POD and had a minimal impact on circulatory function. SIRT3 expression and POD were correlated. A serum SIRT3 level less than 1.565 ng/mL on postoperative day 1 may indicate a likelihood of POD, highlighting its potential diagnostic value.

Keywords: postoperative delirium, ciprofol, total hip arthroplasty, silent information regulator factor 3