Effects of preoperative anxiety on anesthetic responsiveness to propofol and ciprofol during pregnancy termination: a prospective observational cohort study

Preoperative anxiety has been associated with increased propofol requirements. Whether anxiety similarly affects ciprofol anesthesia remains unclear. This study investigated the associations between preoperative anxiety and anesthetic requirements during propofol and ciprofol anesthesia. This prospective observational cohort study enrolled women undergoing pregnancy termination under general anesthesia. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and patients were stratified into high- and low- anxiety groups. The primary outcome was the weight-normalized induction dose required to achieve a Patient State Index (PSI) of 50. Secondary outcomes included total anesthetic consumption, EEG parameters, perioperative hemodynamics, induction and recovery times, and intraoperative body movements. A total of 213 patients were analyzed. A significant interaction between APAIS anxiety scores and anesthetic type was observed for induction dose (B = − 0.03, P < 0.01). Higher APAIS scores were correlated with greater propofol induction dose (ρ = 0.22, P = 0.02), but not with ciprofol requirements (ρ = 0.004, P = 0.97). Patients with high anxiety required higher propofol induction doses than those with low anxiety ( P = 0.01), whereas ciprofol requirements were comparable between anxiety groups ( P = 0.08). Similar interaction patterns were observed for total intraoperative anesthetic consumption (B = − 0.10, P = 0.02), although APAIS anxiety scores were not significantly correlated with total anesthetic consumption within either anesthetic group. Processed EEG measures and hemodynamic parameters showed similar overall trends among the four groups, with no significant differences between high- and low-anxiety subgroups within either anesthetic group. The association between preoperative anxiety and anesthetic induction dose requirements differed between propofol and ciprofol among women undergoing pregnancy termination. Higher anxiety scores were associated with increased propofol induction doses, whereas no statistically detectable association was observed for ciprofol. The study protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2500100973).