To investigate the anesthetic effect and impact on postoperative cognitive function of ciprofol combined with low-dose esketamine in elderly patients undergoing laparoscopic cholecystectomy (LC).

A total of 400 elderly patients scheduled for LC at the 904th Hospital of the Chinese People's Liberation Army Joint Logistics Support Force from January 2023 to June 2025 were selected as study subjects, and randomly assigned to either the low-dose group (observation group) or the medium-dose group (control group), with 200 patients in each group. For anesthetic induction, the low-dose group received intravenous infusion of ciprofol 0.3 mg/kg and esketamine 0.25 mg/kg, while the medium-dose group received ciprofol 0.3 mg/kg and esketamine 0.35 mg/kg, other intraoperative management was identical for both groups. The perioperative conditions and the changes in visual analog scale (VAS) scores at postoperative 2 h, 6 h, 12 h, 24 h, and 48 h were compared between the two groups, the changes in Mini-Mental State Examination (MMSE) scores at preoperative and postoperative 24 h, 48 h and 72 h were compared, as well as the incidence of postoperative cognitive dysfunction (POCD) at 24 h, 48 h, and 72 h after the operation. The changes in serum neuron-specific enolase (NSE) and central nervous system-specific protein (S100β) at preoperative and postoperative 72 h were compared, and the incidence of adverse reactions was also compared.

The total intraoperative dosage of ciprofol was higher in the low-dose group compared to the medium-dose group, while the extubation time, emergence time, and time to recovery of orientation were shorter in the low-dose group (P<0.05); the VAS scores at postoperative 2 h, 6 h were higher in the low-dose group (P<0.05); the MMSE scores at postoperative 24 h, 48 h were higher in the low-dose group, and the incidence of POCD at postoperative 24 h, 48 h was lower (P<0.05); the serum levels of NSE and S-100β at postoperative 72 h were lower in the low-dose group compared to the medium-dose group (P<0.05); there was no statistically significant difference in the total incidence of intraoperative and postoperative adverse reactions between the two groups (P>0.05).

Ciprofol combined with a low dose of 0.25 mg/kg esketamine has a good application effect in elderly patients with LC. It can promote postoperative recovery of patients, reduce the incidence of POCD, and has satisfactory safety,.