Cipepofol combined with esketamine for anesthetic management of patients with extensive severe burns: a retrospective case series

Background Patients with extensive severe burns are prone to both hypermetabolic tachycardia and anesthesia-induced hypotension, and their pain is often inadequately controlled with opioids alone. Cipepofol, a novel intravenous hypnotic structurally related to propofol, has shown greater hemodynamic stability than propofol, whereas esketamine provides analgesia and has indirect sympathomimetic activity. We evaluated the feasibility of a cipepofol–esketamine total intravenous anesthesia regimen in this high-risk population. Methods This single-center retrospective case series included consecutive adults with extensive severe burns (total body surface area ≥50% or full-thickness burn ≥20%) undergoing debridement, escharectomy, or skin grafting. Patient characteristics, postoperative complications, and the Day 28/pre-discharge global analgesic assessment were summarized for seven patients. Hemodynamics, bispectral index values, and rescue analgesic use were summarized across 16 procedures, while paired cortisol concentrations were analyzed for 12 procedures. Acute pain data were limited to event-triggered numerical rating scale scores recorded at rescue. Results Seven male patients (mean age, 45.0 ± 11.1 years; mean total body surface area burned, 73.4 ± 17.2%) underwent 16 procedures. Heart rate (HR) was lower after incision. At 90 min, among 10 contributing procedures, the mean within-procedure HR change was −22.8 beats/min (95% CI, −30.4 to −15.1), while the mean arterial pressure (MAP) change was −11.1 mmHg (95% CI, −23.0 to 0.9). Variable sample sizes and wide blood-pressure confidence intervals limited interpretation. Bispectral index values were between 40 and 60 for 65.3 ± 21.0% of valid maintenance time. Rescue analgesia was required after 6/16 procedures, with event-triggered pain scores of 4–6. The late global analgesic rating was excellent or good in all seven patients. Conclusions Cipepofol–esketamine-based multimodal total intravenous anesthesia was feasible in this small series. Prespecified hypotension was common and was managed with intermittent norepinephrine boluses without continuous infusion. The observed arterial pressure profile reflects both the anesthetic regimen and active vasopressor management. With four agents co-administered and no comparator, the contribution of individual agents cannot be isolated. These descriptive findings establish neither comparative safety nor acute analgesic efficacy and require prospective controlled evaluation.