Comparative effects of ciprofol and propofol on perioperative outcomes: a systematic review and meta-analysis of randomized controlled trials

Background: The ideal anesthetic agents for sedation, considering their respiratory and cardiovascular benefits and other perioperative or postoperative outcomes, are still unclear. This systematic review and meta-analysis aimed to evaluate whether ciprofol has advantages over propofol for sedation, particularly concerning respiratory and cardiovascular outcomes and other relevant perioperative measures.

Methods: We conducted a comprehensive search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and two Chinese databases for randomized controlled trials comparing intravenous ciprofol and propofol for sedation. The primary outcome was the incidence of adverse respiratory events. Secondary outcomes included incidences of injection pain, hypotension, hypertension, bradycardia during surgery, perioperative nausea and vomiting, and postoperative awakening time. A random-effects model was used for more than four studies; otherwise, we employed the random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment.

Results: Intravenous ciprofol resulted in fewer adverse respiratory events than propofol (Risk Ratio [RR = 0.44]; 95% Confidence Interval [95% CI 0.35-0.55], p < 0.001, I² = 45%, low quality). It also showed a lower incidence of injection pain (RR = 0.12; 95% CI 0.08‒0.17, p < 0.001, I² = 36%, low quality), intraoperative hypotension (RR = 0.64; 95% CI 0.52-0.77, p < 0.001, I² = 58%, low quality), and nausea and vomiting than propofol (RR = 0.67; 95% CI 0.49-0.92; p = 0.01, I² = 0%, moderate quality). However, no significant differences were observed for hypertension, bradycardia, and awakening time.

Conclusions: Ciprofol may be more effective than propofol in minimizing perioperative respiratory adverse events and maintaining hemodynamic stability during sedation without prolonging recovery time.